The Philippines: rapidly moving towards universal healthcare coverage
The inclusion of healthcare as a priority on the presidential agenda has led to knock-on consequences that are being felt across the healthcare value chain in the Philippines. Universal healthcare coverage (UHC) has been cemented, which has led to a shift from branded medicines to generics, leading many players to a strategic repositioning. The most successful players have been those that focused on a strategy that was inclusive of all stakeholders and aligned with the presidential agenda of affordable and accessible healthcare.
“When the new administration took over in 2010, our mantra was to include the previously overlooked poorest segment of the population,” says Enrique Ona, Secretary of Health of the Philippines. “Through our Department of Social Welfare, we had identified 5.2 million households -which could include four to five family members- as part of the poor layer of society. In terms of people, that number comes down to roughly 25 million, or a quarter of the country’s population,” said Ona. Now, the challenge of the Department of Health (DOH) is to address the next layer of society, the so-called ‘near poor’ that are not yet enrolled in the PhilHealth scheme. “The projected number of families from this layer is 14.7 million, essentially 58.8 million Filipinos, that should be enrolled by the end of 2014,” Ona explains.
The enrolment rate means that these are people that have come under the health insurance program at one point or another. Whether they can avail of benefits is what our coverage rate focuses on.”
Since 2010, the Aquino administration has reached a number of major achievements on the healthcare front. The amendment to the National Health Insurance Act, officially called Republic Act 10606, was essential in the sense that it made it mandatory for all Filipinos to be covered through the national insurance body PhilHealth. Officially, PhilHealth now has enrolled 83 percent of the population. “The enrolment rate means that these are people that have come under the health insurance program at one point or another. Whether they can avail of benefits is what our coverage rate focuses on. Our covered rate is really around 73 to 74 percent,” explains Alexander Padilla, president and CEO of PhilHealth. “Our key priorities remain membership and benefits. In line with the President’s desire, we will have each and every Filipino registered as part of PhilHealth. When it comes to health, the political will is certainly there”.
To make healthcare affordable, in 2008, the government implemented the Universally Accessible Cheaper and Quality Medicines Act, which included the Maximum Drug Retail Price (MDRP) scheme. The MDRP called for a 50 percent price reduction on 21 molecules, and introduced some systematization to drug pricing in the country. It led many multinational corporations (MNCs) into a period of negative growth, but those with the right portfolios continued to grow.
The requirement for the industry to deliver relevant products is a question of alignment with the needs of the patients, the government and the country at large. “We have observed a shift with many of the industry’s stakeholders, including several NGOs, now taking a more holistic view beyond drug prices. The sector is now taking a joint approach to define a sustainable future for the healthcare system as a whole,” says Reiner Gloor, advisor to the Pharmaceutical and Healthcare Association of the Philippines (PHAP), an industry association largely composed of MNCs. “Now, we have reached a point where we have gained the trust of groups that were traditionally opposed to ‘big pharma’,” explains PHAP’s executive director Teodoro ‘Ted’ Padilla. “Apart from the NGOs, this includes institutions such as the Department of Health, the local FDA and PhilHealth.”
President Aquino has pledged to improve healthcare in the country and the Department of Health now has one of the largest budgets in the government.”
UHC turned the government from a mere stakeholder into an increasingly important customer, which was particularly beneficial to local manufacturers. “We also have the feeling that the industry has changed,” explains Thelma Tobias-Go, president of the Philippine Chamber of the Pharmaceutical Industry (PCPI), the leading industry association for Filipino-owned, mostly generic, manufacturers. “President Aquino has pledged to improve healthcare in the country and the Department of Health now has one of the largest budgets in the government. The local industry has faith in President Aquino and wants to try to work with the government as a new customer.”
UHC was a particular attempt to reduce out-of-pocket expenditures in the Philippines, which accounted for 54 percent of total healthcare spending in 2010, according to a World Bank report published in 2012.