The Anatomy of Philippine Health Care: recurring problems, challenges, and solutions

OUR geographical location and growing population are still the top and perennial reasons why developing the Philippine health care system remains a challenge, said the Department of Health (DoH) and several United Kingdom-based pharmaceuticals executives in a recent dialogue.

The World Health Organization recommends that there should be 20 beds in a hospital per 10,000 people. The current population of the Philippines is over 100 million. Beds, among our many needs, are usually insufficient. According to the 2008 DoH report “The Philippine Health System at a Glance” available on its website, almost all regions have insufficient beds relative to population. The sufficiency of beds is one indicator of a good (or a failing) health care system. The Autonomous Region of Muslim Mindanao (ARMM) has the smallest bed-population ratio, said the data.

“The ARMM has the worst health system in the Philippines. It shares the same health care level with Africa,” said GE Healthcare country manager Ivan Arota at the recent dialogue with private pharmaceutical companies held at the British Embassy on Aug. 11.

“We still conduct our operation under the trees,” affirmed an audience member from Mindanao. She pleaded for assistance from PhilHealth central branch manager Arsenia Torres, who said PhilHealth would help but it could not enter if there is no hospital to begin with.

The DoH data available on its website said private hospitals outnumbered government-owned hospitals in all levels. There are four classifications of hospitals. Level one is comparable with infirmaries and has a limited level of access. Level one hospitals are scattered around the country, but level four hospitals -- which have the most advanced technology -- are concentrated in Metro Manila and Region III only.

Despite the challenges, the DoH hopes to welcome new innovative drugs into the country through its plans of reforming the Philippine National Drug Formulary (PNDF), which aims to make drugs available, accessible, and affordable.

“It is a paradigm shift we’re trying to implement,” said DoH Undersecretary Kenneth Hartigan-Go.

The PNDF has over 600 drugs listed and approved by the Food and Drugs Authority.

Mr. Hartigan-Go said the formulary was last updated in 2008. Many drug innovations have happened since then; new drugs need to be listed and entered into the formulary. “There are also a lot of drugs, which are not cost effective, that need to be replaced,” he said.

He added that sometimes, choosing more innovative and yet expensive drugs is more cost-effective than cheap but inefficient drugs.

A panel of expert decides on what drugs should make it to the list based on their cost-effectiveness and safety. Now the number of experts in the panel is down to five members only, said Mr. Hartigan-Go. It makes the evaluation faster.

According to United Kingdom Trade and Industry director Iain Mansfield, health spending in the country has been increasing twice as fast as our gross domestic product.

The market, however, remains self-pay (the public pays for its health needs). From 1997 and 2007 and until today, the majority of our health spending comes from the consumers’ pocket, said the DoH data available on its website. In 2007, the bulk of health expenditure were paid out of pocket (57%), followed by the national government (12%), local government units (11%), and social insurance (9%).

But Mr. Hartigan-Go said the DoH is also increasing its spending.

PhilHealth now covers and shoulders 80% of the population and has included retirees as its latest members.

While Mr. Hartigan-Go said that the DoH and the Department of Science and Technology (DoST) are supportive of homegrown talent, he said only a handful of students apply to the DoST program. The majority leave the country and work for international companies. He said the DoH is working on better incentives for skilled workers to address the problem of brain drain, or the exodus of professionals in pursuit of greener pasture.

Still, the Philippines is the third biggest country in the Association of Southeast Asian Nations region, next to Singapore and Thailand, when it comes to clinical research, said GlaxoSmithKline general manager Francis del Val.

Clinical research ensures the effectiveness and safety of drugs and treatments for human use.

According to Mr. Mansfield, the United Kingdom committed €2 million for scientific research by British and Filipino scientists. Private pharmaceuticals like GE Healthcare meanwhile allocates $6 billion for its research program targeting health care in the country, said its general manager, Mr. Arota.

While private pharmaceutical companies in the country are continuously conducting their private research and innovating on cheap drugs, the Philippines, in particular Metro Manila, isn’t ready yet to be a medical tourist destination, said Mr. del Val. But the country has all the right ingredients to be one. He said we are English proficient, have a good pool of experts, and service-oriented.

But then again, perhaps, we need to address other significant issues first.

source: Business World