Interview: Enrique Ona

What major issues currently limit the impact and delivery of health care in the Philippines? In which areas does the country stand to improve?

ENRIQUE ONA: A major obstacle to the development of the country’s health sector has been the lack of comprehensive and complete insurance coverage for its citizens. When the Aquino administration assumed power, it was discovered that despite the government’s pledge to provide basic health insurance to all Filipinos by 2010, only 53%of the country’s population had been covered. It was obvious that coverage of the national health insurance programme, PhilHealth, was severely lacking and that many Filipinos did not benefit from it.

This lack of coverage was especially prevalent among the country’s most vulnerable populations. A large majority of the people who make up the poorest 20% of society (comprising around 5.2m Filipino families in 2010) were not insured. The more affluent segments of the market exhibited higher levels of penetration, but these rates were still not in line with the government’s mandate of covering every citizen.

By April 2011 the department was able to enrol all 5.2m of these families in PhilHealth. Coverage rates for the rest of the population have also improved dramatically. However, while it is easy to say citizens have been enrolled with the national insurance programme, many of these individuals are uneducated and largely unaware about what this entails. Thus, the department is currently advocating for programmes to educate the population about the benefits to which they are entitled.

With a viable and comprehensive third-party payer, which in this case would be PhilHealth, the national government and the department’s hospitals will no longer be directly responsible for the costs associated with medical treatment for those who cannot afford to pay. This will bring much needed relief to these institutions and will liberate significant amounts of money, which can then instead be put towards equipment acquisition, the recruitment and training of better-qualified staff and a general improvement in service offerings.

How can private investment be incentivised in the health care industry, and what opportunities exist for public private-partnerships (PPPs) therein?

ONA: Unfortunately, over the years investments in health facilities by the government have not been sufficient to keep up with the growing demands of Filipinos. This is especially true at the local and provincial level, but it also affects the government’s national hospitals, which have in the past been seriously lacking in equipment, medicine and facilities. We see private investment as a valuable tool to reverse this trend.

At the national level, the Department of Health has 72 hospitals throughout the country, of which about 30 are regional medical centres that should be capable of performing all procedures except those that are extremely specialised. To fulfil this mandate, we plan to modernise and rehabilitate these facilities. This is where the PPP model comes into play.

The Philippines has actually been designated by the UN Economic Commission on Europe as the site of its international specialist centre for PPPs in Health. This designation gives the country access to all international best practices in terms of health PPPs and shows the government’s readiness to pursue PPPs in health.

At the same time, the Department of Health has also formed its own PPP office, and we have already identified as many as 30 Philippine hospitals for major rehabilitation and modernisation efforts via a PPP model.

We also see private funding as an important mechanism for the expansion and improvement of health care provision. This will come via the construction of new facilities, as the country has a pressing need for both specialised and general care hospitals.

The health industry is in a period of transition and our department is currently evaluating a number of proposals, from which we anticipate significant progress throughout 2012. Although the current PPP push has been concentrated around the big-ticket national projects as of late, this does not exclude the PPP model from also being used at the local and provincial levels.