Author: Hans Jesper F. Del Mundo
The gross inequality in people’s health status, particularly between developed and developing countries as well as within them, is politically, socially and economically unacceptable (Alma Ata Declaration, 1978). However, this is still a common concern in many countries, especially in my country, the Philippines.
The Philippine Health Agenda under the Duterte administration currently aspires to create a health system providing financial protection and better health outcomes and responsiveness. In line with financial protection, Filipinos—especially the poor, marginalized and vulnerable—should be protected from high health care costs, but this is still far from reality for most Filipinos. Life expectancy, infant mortality rates and maternal mortality rates differ across geographic and economic regions in the Philippines. In other words, grave inequities persist in the health status of Filipinos. This is despite recurrent efforts by all past administrations to address the unfair and unjust inequalities in access to health by the majority of poor people. Individuals who live in prosperous regions and communities generally live longer than those in isolated and poorly developed parts of the country.
The Philippine healthcare system is two-tiered and consists of public or state-run system and a private system, but with a wide gap between them. Health human resource development is still not based on need, primary level care is underdeveloped, medicine prices remain high and quality healthcare remains inaccessible and impoverishing. Poor-quality and undignified care is attributed to public clinics and hospitals due to long waiting times; limited autonomy to choose providers; less-than-hygienic restrooms; a lack of amenities, privacy and confidentiality; poor record-keeping; and overcrowding. Additionally, the Philippines is still not fulfilling the WHO’s recommendation to spend at least 5% of its national budget on health, unlike neighboring countries such as Thailand and Vietnam, which now have much reduced health inequalities. The?Philippine Health Insurance Corporation?(PhilHealth) was created to implement?universal health coverage?in the?Philippines, with a goal to ensure a sustainable?national health insurance?program for all. Even so, if all of PhilHealth’s funds are used, it will only account for about 7.2% of health needs, with out-of-pocket expenditures still reaching up to 60% of all health expenses.
Large health inequalities also persist even within rich countries such as the USA and Australia, with life expectancy still varying across the population by over 20 years. Extreme shortages of health workers exist in 57 countries, with 36 of these found in Africa. Many Americans are also denied treatment by their health care insurance companies, which differs from the universal, free health care systems in Canada, France, Great Britain, and Cuba.
To serve as examples, in the United Kingdom, the National Health Service does not require payment at the point of service, and essential medicines are state subsidized.?Health personnel are salaried personnel who are not under the private sector and do not charge fees for service. They have strong state subsidies, funding through taxes and a good?referral system. Finland, on the other hand, has strong state support, with?general practitioners as first-line doctors and a stronger focus on service delivery than just triage. Medical and health sciences education are also state subsidized. Out-of-pocket expenses are affordable (<10%), and private-sector involvement is regulated. In Cuba, primary health centers serve as the first level of care, and one exists in every ten blocks. The focus is on primary health care, which also includes community involvement for disaster preparedness. Specialty training is based on the needs of specific provinces, with Cuba also exporting doctors to developing countries. Thailand has social health insurance along with functioning primary-level health centers. Strong importance is given to health, with its Ministry of Health continuing despite changes in politics. Thailand also has tax-based social health insurance, and doctors are required to serve as primary care physicians for two years.
In conclusion, no country can be particularly exempted from having health inequity, high income or not, as even a developed country like the USA cannot provide quality care for all of its citizens, especially those with low socioeconomic status or no health insurance, despite spending more on healthcare than European countries and Canada, which have better healthcare systems. Relatively lower-income countries like Thailand and Cuba, on the other hand, have successfully reduced inequities by focusing on primary health care and the specific needs of their countries along with higher budget allocations to health. They certainly set great examples for many countries still experiencing vast inequity—including my country—and give hope that someday, there will be universal free healthcare for all, which will ultimately lead to better health outcomes as inequity will finally be extinguished.