National Demographic and Health Survey, 2022:
Health care far from universal as 30-50% of Filipinos unaware of PhilHealth coverage and costs of health care increase 117% – Medical Action Group

The Medical Action Group (MAG), a health and human rights organization, says the Philippine health system is literally in the ICU as a PSA survey shows health costs increased to P46,640 for each average inpatient care episode in 2022 from P21,400 in 2017, an increase of 117%. The survey also showed that 30% of the population is unaware of PhilHealth, a slight decrease from 34% in 2017, even as the UHC Law was passed in 2019.

MAG raised these urgent concerns regarding the state of population and health in the Philippines as President Ferdinand Marcos Jr. is due to deliver his second State of the Nation Address this month.

Just three weeks ago the Philippine Statistics Authority revealed the Final Report on the 2022 National Demographic and Health Survey (NDHS 2022) which included the above information. The report covers the entire period of the Duterte administration and the first three years of implementation of the UHC law passed in 2019.

“The Duterte administration failed to sustain the improvements under the Aquino administration which had raised PHIC membership by 6% from 60 to 66% in 2017 (NDHS 2017), while another survey (National Health Expenditure Survey of 2021) showed that 1 in 2 Filipinos were unaware of PhilHealth benefits. Under the Aquino administration PhilHealth was covering 45% of the average cost (P9,658 out of P21,400 average cost), but this declined to 37% under the Duterte administration (P17,507 out of P46,640 average cost), “ Dr Juan A. Perez III, Co Chair of the Medical Action Group explained.

According to a UN report (World Population Prospects 2022) issued last year, the Philippines was predicted to be one of eight countries that would contribute to 50% of population growth by 2050. However, the total fertility rate (TFR) has plummeted from 3 children per woman in 2013 to 1.9 in 2022, a decline of at least 33%. This decrease is especially notable among younger age groups, particularly those aged 15 to 29. Fertility remains high in the 25-29 age group and is increasing in the 10-14 age group. Maternal mortality is at the highest since 1952 with 2,478 deaths in 2021, increasing the country’s maternal mortality ratio to 189 per 100,000 births (SDG target is 90).

The Covid-19 pandemic has also had a profound impact on the population and the health system, resulting in excess mortality and an increase in maternal deaths. The number of deaths in 2021 reached 879,429, representing a 30% increase compared to the previous year. Although Covid-19 accounted for only 40% of these excess deaths, the majority of excess deaths were attributed to cardiovascular diseases, hypertension, and diabetes.

Furthermore, the number of senior citizens has risen, with 8.5% of the household population in 2020 being senior citizens, up from 7.5% in 2015. Notably, there is a higher proportion of females than males among the senior citizen population, and while seniors make up less than 10% of the population they consume 22% of health care costs (PSA study on vulnerable populations, 2018). Another study by UPPopulation Institute shows that many senior citizens face financial constraints, and29% lackthe financial capacity to see doctors(UPPI study).

The affordability of healthcare in the Philippines remains a major concern, particularly for the poorest quintile. The share paid by PhilHealth even in public hospitals has declined form 71% in 2017 to 62% in 2022 as shown in the NDHS.

“The bottom 20% of the population has seen its health costs increase by 12% from 2014 to 2020 while the richest quintile has seen a decline in its contribution to health costs decrease by 13%,” Dr Perez asserted, citing data from the latest Philippine National Health Accounts (PNHA) and published by DOH in its Health Care Financing Strategy, 2021.

Addressing these challenges necessitates a comprehensive approach that focuses on social determinants of health (SDH) not just the actions of DOH and the PhilHealth alone.

“Improving the health of the poorest Filipinos requires not just direct action of the health sector but also other sectors such as the population and development sector. Both health and population sectors should focus on the areas of the country that have fallen behind in social and health development, and converges health and population development measures in these areas,” Dr Perez suggested.

“This is an opportunity for the new Health Secretary to show his mettle in shaping health and health care financing policies and programs in the areas of the country and population segments in greatest need,” Dr. Perez asserted.

Dr. Juan Antonio A. Perez III, Co-Chair of the Medical Action Group and Vice President of the Forum for Family Planning and Development emphasizes the need for targeted interventions and collaborative efforts. “We cannot underestimate the impact of social determinants of health. By adopting a comprehensive approach that addresses poverty, health inequity, and social determinants of health, we can create supportive and inclusive communities, enhance social support networks, and reduce health disparities,” said Dr. Perez.

MAG firmly believes that through these comprehensive reforms and the adoption of a social support ratio approach, the Philippines can make significant strides toward achieving universal healthcare. By ensuring equitable access to quality healthcare services, addressing social determinants of health, and fostering collaborations, the country can improve health outcomes and reduce health disparities.

MAG strongly urges all stakeholders, including policymakers, healthcare providers, and the public, to unite in supporting these reforms and work together towards a healthier future for all Filipinos.

Press Contact:
Ms. Edeliza P. Hernandez, RN
Executive Director
Medical Action Group
Email: ehernandez@magph.org
Mobile: +639498833814

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