WHILE most would agree that there is a long way to go before the Philippines truly achieves universal health care (UHC), it is fair to say that over the past several years, a great deal of progress has been made. More Filipinos than ever before are able to access subsidized treatment for illness and injuries, reduced-cost and, in some cases, free medications and treatments to manage longer-term health problems and health screening to prevent problems before they start. The system is not perfect by any means, and high out-of-pocket expenses are still a burden on many families, but the overall situation has improved, and there are more options available to manage health emergencies.
There is, however, a gaping hole in the UHC aspiration for the country, and that is the almost total absence of any attention to the need for home health care. It is a real and distressing issue for many Filipino families, and one that is only going to grow as the population ages.
Many in our own Manila Times family could provide examples of this problem, and we are certainly not a unique subset of the population in this regard. It is quite likely that your own family, or someone you know, has faced the same challenge of caring for a family member with a chronic or extended debilitating condition. Here are two examples that we are familiar with that illustrate the problem.
In the first, a family consisting of working parents, both with good incomes that would be considered on the upper end of the middle-class spectrum, two young children and an elderly grandmother who served as the caretaker of the children, experienced a personal calamity when the grandmother was stricken by two strokes in a short period. While the insurance coverage provided by the Philippine Health Insurance Corp. (PhilHealth) did cover good hospital treatment and follow-up visits to the doctor for the grandmother — with the remaining expenses not covered being easily managed by the working parents’ own resources — she was left disabled, and in need of proper physical therapy to recover some of her mobility and ability to function normally, such as using the bathroom or bathing on her own. Finding that visits from properly trained and licensed home nursing or physical therapy providers were prohibitively expensive and not covered by the PhilHealth insurance available to them, the parents resorted to the services of a recommended neighborhood hilot, whose care, while helpful, was inadequate; the grandmother passed away within a couple of months.
In the second example, a family consisting of two elderly parents, both collecting SSS pensions and covered by PhilHealth, and three adult children whose combined incomes put the family into upper-class status by Philippine standards, found themselves financially challenged by the elderly father’s diagnosis of Parkinson’s disease, a debilitating and incurable condition. He was, within a relatively short period, rendered completely disabled and requiring constant assistance for basic living functions, but with the parents’ PhilHealth and the children’s own PhilHealth or private health insurance not offering home health care coverage, the family took up the task of caring for him on their own. As Parkinson’s is a progressive disease, this eventually became too difficult despite their yeoman-like efforts, and the elderly father sadly passed away.
PH aging more quickly
We have no doubt that these examples are familiar to thousands, perhaps tens of thousands, of Filipino families, and it is a potential public health crisis that must be addressed. Despite the self-congratulatory pretense adopted by the government in the past couple of years about the “demographic dividend” the Philippines’ young population provides, the reality is the population is aging more quickly than anyone imagined. The birth rate has fallen to 1.57, well below the 2.1 rate needed to keep the population steady, which means that Filipinos are getting older and moving into retirement age — when health problems requiring long-term care are more prevalent — faster than they are being replaced by young people.
Long-term care is understandably a difficult thing to manage, from the perspective of PhilHealth or insurance providers, or other support structures such as the Malasakit program or the assistance provided by the Philippine Charity Sweepstakes Office, because long-term or home health care tends to be open-ended. However, that does not make the need go away. To truly have “universal health care,” it is a need that the government needs to find some way to address.
