Scalpel, please: dissecting the out-of-pocket scheme of the Philippine healthcare system the case of the poorer segment of Philippine society

Abstract

Health is a right. It is a right that every individual is entitled to. Given this context and fact, there are institutional arrangements that can foster and advance the right to health, and one of which is through public health laws and health law reforms. Governments are guided by this flexible yet abiding standard in order to attain the highest standard of health, which is the ultimate goal of the right to health, either through quality healthcare or public health service. This paper aims to look at the nature of out-of-pocket spending (OOPs) in relation to the overall Philippine Health Insurance System (PhilHealth) scheme. It also analyzes the effect of OOPs on the health-seeking behavior of the Filipino people, particularly the poorer segment of society. The theoretical reference of the study consisted of Kleinman’s Social Suffering which posits that socioeconomic and sociopolitical forces can at times be the root of disease. Additionally, the study also used the World Health Organization’s Social Determinants of Health which posits that there are social determinants of illness that should be addressed such as poverty and impoverishment, inequities, income maldistribution, and the structure of health insurance coverage. This was an instrumental case study involving both qualitative and quantitative methodologies. Key interview was conducted among six experts from theScalpel Please: Dissecting the Out-of-Pocket Scheme of the Philippine Healthcare System health, and urban poor sectors. Using a reliability level of 95% and systematic random sampling, a total of 384 respondents (who sustained an illness/es and hospitalization for the previous and/or current years) was selected and surveyed. Health spending was operationalized as out-of-pocket contribution. Health-seeking behavior was operationalized as point of illness to seek for treatment, immediate action when sick, and follow-up when doctor prescribes. Test statistics, primarily Pearson’s chi-square test, showed an association between OOP contributions, and point of illness to seek for treatment (0.24) and immediate action when sick (0.001). Association was strongest with immediate action when sick at 89.301 (0.001). Results also revealed that health expenditures mainly came from out of pocket contribution at 94.5%, followed by donation from PCSO (79.2%), and then PhilHealth (78.6%) trailing behind along with loans (53.1%), solicitation (21.6%), private insurance (2.1%), and other government agency contributions such as DSWD (1.6%) and DOH (0.3%). Moreover, intervening variables such as household income (0.001), and family size (0.020) showed associations with healthcare service utilization. The qualitative data showed that the Philippine healthcare system is fragmented, and inequitable. A triangulation of both quantitative and qualitative points to the presence of triple burden of disease, expensive healthcare, and high out-of-pocket spending that can lead to impoverishment of a household