Moving Beyond COVID-19: The Path Towards Universal Health Care in the ASEAN Region

04 October 2021

Written by Pura Angela Wee-Co (Country Manager, ThinkWell), Ileana Vilcu (Program Manager, ThinkWell), and Marissa Maggio (Communications Specialist, ThinkWell)

The COVID-19 pandemic has stifled nations across the globe in their pursuit for Universal Health Care (UHC)—and the countries that make up the Association of Southeast Asian Nations (ASEAN) are no exception. For many, the pandemic has introduced additional barriers to high-quality health care at a low cost. To highlight how ASEAN nations are rising to new challenges, the Center for Strategic and International Studies (CSIS) held a webinar in August 2021 to discuss a path towards sustainable health care financing in the region. Joined by other experts, Dr. Marife C. Yap, Senior Technical Advisor at ThinkWell Philippines, discussed how the country has responded to COVID-19 challenges and several strategies that national health systems can employ to make UHC a reality.

Following the passage of the Universal Health Care Act in 2019, the Philippine Health Insurance Corporation (PhilHealth) was tasked with putting the law into practice and launched KonSulTa, a primary care benefits package that provides access to comprehensive outpatient services under one affordable, fixed rate. However, with multiple lockdowns, widespread mobility restrictions, and a reduced budget, PhilHealth has faced several challenges in ensuring equal access to care. For instance, PhilHealth experienced hurdles in quickly and sufficiently reimbursing coverage payments—such as those for COVID-19 testing—to hospitals, which limited the delivery of essential health services.

Faced with these new obstacles, what can the Philippines do to improve UHC? Dr. Yap touched on several key approaches, including:

1. Integrate across the health system. The key to making the UHC rollout successful, Dr. Yap says, is three types of integration—managerial, clinical, and financial; managerial to ensure capable province-wide health systems, clinical to provide a comprehensive set of health services from preventative to curative, and financial to lessen the fragmentation of fund pools. By ensuring integration across the health system, PhilHealth can establish a smooth delivery of health services under province-wide networks.
2. Simplify membership. Prior to the 2019 UHC law, there were five categories of PhilHealth membership, which led to confusion and limited enrollment. Now, membership has been simplified to just two categories, direct and indirect contributors, which is envisioned to help increase enrollment and access to a universal primary care benefits scheme.
3. Increase and consolidate health funding. Despite increased health budgets during the COVID-19 pandemic, the Philippine Department of Health (DOH) has only disbursed 141 billion pesos out of the 205 billion allocated to tackle diverse health needs. To achieve UHC, the DOH needs to remain accountable for the proper allocation of funds and continuously demonstrate the value of maintaining a substantial health budget. This will help the DOH and PhilHealth to improve health service delivery to all Filipinos.
4. Promote utilization. Some health packages offered in the Philippines have experienced low utilization due to a lack of awareness or trust in government agencies. For instance, PhilHealth has offered the ‘Z benefits package’ since 2014, which aims to support health programs that require costly treatments—such as cancer care—and may be delivered through outpatient services. However, despite the support available, a 2020 study shows that the Z benefits package was not widely used, suggesting that awareness must be raised to improve program utilization.
5. Close gaps in coverage. There are several policy gaps that need to be addressed in order to achieve UHC. Foremost among these is the need to change people’s perspective on accessing PhilHealth benefit packages. Because PhilHealth provided mostly inpatient services—or when people are admitted to a hospital—prior to the 2019 UHC law, many are still not aware that more outpatient services are available to them, particularly KonSulTa’s comprehensive outpatient benefit package. This further exacerbates gaps in coverage. In addition, PhilHealth can improve the capacity of health care purchasers to finance both COVID-19 and non-COVID-19 services. Not all hospitals are accredited by PhilHealth, leaving many patients that seek care to pay out-of-pocket for health services. And while there has been a slight decrease in paid claims in 2020, down from those received in 2019, there are still many unpaid claims that must be settled. To provide a comprehensive set of services under UHC, strategic health care financing can close these gaps and ensure costs are covered.

Looking to the rest of the ASEAN region, other panelists touched on several core ideas to improve the sustainability of health care financing during and beyond the COVID-19 pandemic, including:

1. Build awareness. COVID-19 has introduced a unique opportunity to promote awareness of the need for UHC. Although UHC is meant to ongoingly provide essential health services, this pandemic has shown that people need affordable, effective health coverage most in times of crisis. Therefore, this is the best time to hold ASEAN governments accountable to bolster UHC programs and prepare for future emergencies. Moreover, the pandemic response has also lent many lessons that can inform new processes and innovations across health systems. For example, community health workers (CHWs) in the Philippines are not considered part of the official health system. However, the COVID-19 response has revealed the monumental role that CHWs play in managing local, frontline emergency response teams, clearing a permanent space for them in the Philippine health sector.
2. Encourage better health behavior. In addition to addressing pandemic and disease-related challenges, ASEAN governments should seek to promote better health behavior, all the way from health prevention and screening to rehabilitation. For instance, governments can encourage healthy behavior—such as routine immunization—and discourage high-risk behavior—such as high tobacco or alcohol consumption—to keep health costs low and balance the availability of funding across the entire health system.
3. Invest in better treatment. As COVID-19 becomes endemic, or a routine disease found globally at a reduced rate, ASEAN nations must continue to invest in better health solutions that will last beyond the current pandemic. Governments must work towards UHC while accepting that the COVID-19 disease will remain, in some capacity, and continue to innovate better health technologies to improve quality of life for all.

If you want to learn more about ThinkWell’s work in the Philippines, you can read about it here. You may also watch the full webinar recording below.