DESPITE rapid economic growth in recent quarters, the Philippines has been doing a poor job in providing adequate health care, and inequality in access to health services is in fact high, according to a health economist.
Oscar F. Picazo, senior health research consultant at state think tank Philippine Institute for Development Studies (PIDS), presented data on worsening health conditions in the country as he laid the case for crafting a policy that will make health care more “inclusive” in the press conference last Sept. 4 for the 11th Development Policy Research Month at the NEDA sa Makati Building.
Maternal health alone—which serves as a good indicator of the health system as it covers the entire spectrum of the referral scheme—is not improving as shown by a spike in the maternal mortality ratio to 221 maternal deaths per 1,000 live births in 2011. Before that, the ratio had declined steadily to 161 in 2006 from 209 in 1990, based on government statistics. The infant mortality ratio, meanwhile, is decreasing but not as fast as neighbors in the region, Picazo told members of the press.
“Reproductive health has something to do with this,” he said. “There’s still a high number of children per woman … Unwanted pregnancies are high among the poor.”
Picazo also pointed to the high variation of health outcomes across socioeconomic classes and regions. For instance, there is a huge discrepancy in Philippine Health Insurance Corp. coverage between the rich and the poor—52.8 percent of the richest have coverage while only 21 percent of the poorest are covered, he said. “Rich people are being subsidized by PhilHealth,” he added.
There are three sets of underlying causes for large disparities in health, Picazo said. The first is the interplay between poverty, income inequality, and the burgeoning population. Hospitals are unable to accommodate the growing number of clients, and the number of health workers per population is declining. Frequent disasters and environmental risks are also worsening inequality, Picazo said.
The second challenge pertains to the effects of demographic and epidemiological transitions as well as population mobility. The country’s population is starting to age, which will lead to a shift in disease burden to noncommunicable diseases from infectious diseases. PhilHealth is also unable to keep up as more Filipinos seek work overseas, which leaves dependent families without health coverage.
The third set of factors is systemic in nature, Picazo said. Doctors, nurses, and midwives are concentrated in Metro Manila and nearby regions. While the government has a program to upgrade health facilities, equitable distribution remains an issue, and the Department of Health has limited absorptive capacity despite increasing fiscal space for health expenditures.
The Philippines could do well to make use of information technology to improve health outcomes, such as by using laptop computers to connect patients with their doctors. “I don’t understand why we’re the outsourcing capital of the world and we can’t do that,” Picazo said.