PR 19 NOV 2018

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SWP to UHC Bicam: UHC is good to go, except these two provisions [updated] | SWP Press Statement 19 Nov 2018
SOCIALWATCH PHILS·SUNDAY, NOVEMBER 18, 2018

SWP to UHC Bicam: UHC is good to go, except these two provisions

On Monday, November 19, the House of Representatives and the Senate are convening for the official Bicameral Conference Committee (Bicam) meeting on the #UniversalHealthCare (UHC) bill, a proposed legislation certified as urgent by President #Duterte.
Social Watch Philippines (SWP) supports the approved UHC Bill at the Senate (Senate Bill 1896) and some of its laudable provisions. Advocates believe that key components needed for a good UHC Law are already in the bill.

There are, however, two important issues on health financing that have yet to be resolved, and which will determine just how equitable and sustainable the UHC law will be.
The first issue is raising resources for UHC from premium payments through the UHC Bill, as proposed by Senator Sen. Ralph Recto, by setting a premium contribution monthly salary ceiling of P40,000. The second issue is legislating a two-tiered social health insurance scheme in order to encourage high-income earners from the informal sector to pay premiums.

On the first issue, setting a premium contribution salary ceiling of P40,000 is tantamount to stating that those who earn, say, P1,000,000 or P100,000 per month will have to pay the same premium contribution as those who earn P40,000. This is regressive as it clearly places the burden on middle-income individuals who currently contribute the most in terms of premium payments. The most sustainable, equitable, and progressive proposal is to remove the salary ceiling and impose payment of premium based on a salary percentage across all income levels. This way, those who earn more will have to contribute more.
In addition, SB 1896 proposes that those who are directly contributing premiums will be provided additional benefits. SWP opposes this provision as it worsens inequity, unequal treatment, and discrimination in health service provision.

Social Health Insurance, or the PhilHealth, should exercise the principles of social solidarity and the promotion of equity, consistent with public health principles expressed through “relatively healthy individuals” paying higher prices for health insurance so that the well-off subsidizes the poor and the healthy subsidizes the sickly. Internationally, there is now growing recognition that a two-tier scheme has not effectively solved health care problems, and has even reinforced inequity in health services utilization between groups. It is also contrary to the spirit of the UHC and the Sustainable Development Goal (SDG) No. 10. The #SDG10 posits that to reduce inequality, policies should be universal in principle, paying attention to the needs of disadvantaged populations. Two-tiered benefits often equate to differential treatment, where directly contributing members in social health insurance will enjoy better benefits, will be treated differently and with greater advantage in health facilities while ‘services for the poor end up as poor services’, to repeat a famous observation by Amartya Sen.

Indeed, health financing cannot rely solely on social insurance premium payments, given that the majority of PhilHealth’s direct members are either low-wage earners or are part of the informal economy. Rather, funding for health care should come primarily from taxes, through the General Appropriations Act (GAA). This means that funding for PhilHealth will increasingly come from the GAA, as is the current trend, especially to support indigent and low-income Filipinos who also have right to quality healthcare.

Furthermore, governance and administrative reforms in Philippine Health Insurance Corporation, including strengthening its outreach programs and coordination with agencies such as the Social Security System, Home Development Mutual Fund, Bureau of Internal Revenue, Professional Regulation Commission, etc., should be undertaken to encourage high-income earners belonging to the informal sector to pay.

Ultimately, despite the President’s support of and the public’s high hopes on the UHC, the crux of the matter remains to be its long-term financing. According to the Department of Health (Philippines), UHC approximately needs a budget of P257 billion on the first year of implementation alone, with a current funding gap of P164 billion and which should increase thereafter.

There should be no equivocation on the part of government to demonstrate its commitment to ensuring the well-being of its people by adequately financing the UHC from the GAA. To further strengthen the country’s fiscal capacity, SWP, alongside other health advocates, is pushing for the passage of SB 1605 which seeks to increase tax on tobacco to P90/pack with 9% annual increase, set to be tackled by the end of November at the Senate Committee on Ways and Means chaired by Senator Sonny Angara. This legislation, if passed in this Congress will not only finance the funding requirements of the much-awaited UHC Bill, but as importantly, prevent the ascendance of a new generation of smokers, and will improve the people’s health. These two landmark pieces of legislation, both championed by Sen. JV Ejercito, along with other legislators and also strongly pushed by former Representative and Presidential Spokesman Harry Roque, will truly be this Congress’ and Administration’s gift to the Filipinos.

Finally, Social Watch Philippines also calls for a transparent Bicam process, so Filipinos may know in the day of reckoning of the bicam meeting who among the legislators truly promoted their interests, and who had other interests in mind.
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Social Watch Philippines (SWP) is a network of over a hundred civil society organizations and individuals engaged in research and lobby efforts in holding the government accountable for the fulfillment of national, regional and international commitments to eradicate poverty and carry out social, economic, and gender justice. SWP promotes people-centered sustainable development by proactively monitoring the progress and delivery of social commitments forged by the government and influencing the outcomes of policy decisions through citizen's participation in public finance.

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