A HOUSE to call your own, a good education for your children and spare cash to buy a car and travel. It’s the American dream for many Filipinos.
And for the people managing the country’s economy, it’s a dream that could come into fruition in two decades. These managers call this “AmBisyon 2040,” a long-term vision of seeing Filipinos living a “matatag, maginhawa, at panatag na buhay” or a stable, comfortable and satisfying life.
To attain this dream, the National Economic and Development Authority (Neda) aims to grow Filipinos’ income to as high as $11,000 per capita GNI (Gross National Income) from only $3,000 today. By doing so, the Neda places the country on the high-income growth trajectory.
However, a survey funded by private firm PhilhealthCare Inc. (PhilCare) shows that economic growth and rising incomes are not the only things that will lead to a comfortable life for Filipinos. Health and well-being are also key factors that will allow Filipinos to turn their dreams into reality.
HMO poll
PHILCARE’S 2019 Wellness Index is the second study of its kind in the Philippines. PhilCare commissioned its first study five years ago, which allowed the health maintenance organization firm to develop affordable and responsive medical insurance plans that provided coverage to Filipinos without a risk coverage.
The firm’s pollsters held face-to-face interviews with 1,350 respondents selected from following a multi-stage cluster and regional sampling of the population in Luzon, the Visayas, Mindanao and the National Capital Region.
Results of the Philcare Wellness Index showed that while many Filipinos feel good about their health, they consider medical costs a threat to their well-being.
Respondents rated themselves “somewhat good” in terms of their overall health with a score of 2.84. They also said they felt good about their psychological wellness.
Meanwhile, respondents also rated themselves as “somewhat good” when it came to their physical, lifestyle, nutritional, financial and medical well-being.
However, about 540 people (40 percent) said they are unsure whether they can pay for their medical bills. About 405 (35 percent), meanwhile, expressed doubts they could afford regular medical checkups.
The inability to finance their medical needs was also evident in the findings of the survey, which said that more than 60 percent of respondents (810 respondents) have incurred up to P30,000 in medical bills.
Ease burden
ABOUT 37 percent (nearly 500 people) said they managed to pay their bills using their savings, while 25 percent (337) ended up borrowing from friends and relatives to pay what they owe. Only 15 percent, or 202 people, said they were able to settle their bills using health insurance.
Among the respondents hospitalized in the previous year, the survey also revealed that only 63 percent of them managed to use their PhilHealth benefits to ease the burden of their medical expenses.
“Their health and wellness are linked to their capacity to pay,” lead researcher and University of the Philippines Professor Fernando D. Paragas told the BusinessMirror in an interview.
Based on data from the Philippine Statistics Authority (PSA), the country’s total health expenditures at current prices grew by 8.3 percent in 2018, amounting to P799.1 billion from P737.8 billion in 2017. Spending on health care in 2018 contributed 4.6 percent to the country’s economic activity—measured as gross domestic product or GDP—last year.
More than half of this amount (53.9 percent) came from households. Data showed that households’ out-of-pocket payment (OOP) reached P413 billion in 2018.
And more than half (50.1 percent) of OOP worth P206.7 billion is the amount households spent on pharmacies. Hospitals received the second largest amount of OOP by households at P148.8 billion.
Stress amid progress
MORE notable, however, is the fact that many provinces that are already experiencing higher income levels are also reporting their population is experiencing stress.
Many of these provinces’ populations are deemed generally of sound mind and body because of the higher incomes they now have, compared to previous years when money was difficult.
Nonetheless, stress among them is rising, the survey revealed. Paragas said stress is caused by lack of sleep as well as less time for family, for work-life balance and recreation.
Data showed that respondents in the City of Iloilo and Legazpi City consider themselves “stressed.” These cities were given a score of 2.63 in the Philcare Wellness Index.
Other up and coming cities like San Fernando City in Pampanga were “somewhat stressed” with a score of 3.48; Pili in Camarines Sur, 3.19; San Fernando City in La Union with a score of 3.16; Tagbilaran City, 3.21; and, Bacolod City, 2.63.
Paragas explained the stress levels could be due to the change in the lifestyle they are now experiencing. Rapid economic growth leads to more hours devoted to one’s work.
PSA data showed that regions where these cities belonged exhibited high economic growth. Western Visayas, where Iloilo and Bacolod is located, registered an average GRDP growth rate of 6.92 percent in the past five years.
Lifestyle change
BICOL, where cities like Legazpi and Pili are located, experienced an average GRDP growth of 6.52 percent in the 2014 to 2018 period.
Central Luzon, Ilocos and Central Visayas—where San Fernando City in Pampanga, San Fernando City in La Union are located, respectively—posted average GRDP growth rates of 8.12 percent; 6.52 percent; and 6.8 percent, respectively.
“Your lifestyle will not remain the same with those growth rates. The higher the economic growth rate you have, the higher your stress level [would be],” Paragas said. “It’s the lifestyle change; it’s the adjustment.”
However, cities in Metro Manila were considered “not stressed,” “neither stressed nor not stressed” or “not very stressed,” despite accounting for 60 percent of the country’s GDP.
The data showed respondents living in the cities of Manila, Taguig and Pasig are “not stressed,” while those living in Caloocan, Pasay and Parañaque were considered “not very stressed.”
Those living in Quezon City, Taguig and Pasig were “not stressed,” while those in Marikina City were “somewhat not stressed.”
Paragas said this is because residents in these cities were used to the hustle and bustle of city life. This means getting used to traffic congestion and the long hours spent working.
Transitioning
IN contrast, the up-and-coming cities were more stressed compared to these places because their economies are transitioning to a higher level.
“For them, these places are relatively laid-back urban centers [that] are now experiencing this kind of growth,” Paragas said. [They’re] growing quite fast; so many things are happening, so many changes.”
One of the factors that could explain this further could be the presence of the 24-hour operations of business-process outsourcing (BPO) firms that have relocated in these places.
While this sector and their allied industries offer workers higher disposable incomes, there’s also a factor of low inflation. The combination of low prices and higher salaries is a combined pressure for workers and their families to spend for rest or relaxation.
For this reason, Paragas said, being more conscious of health in these places is important. However, he said, given their newfound purchasing power, people should also invest in activities or measures that will prevent them from getting sick or encountering medical expenses.
“It’s a wake-up call, as we have discussed with mayors and members of the press, that they should be mindful—that while it is fortunate—that they are growing this fast, maybe [they] should also mitigate unintended consequences,” he said.
Health behavior
PHILIPPINE Institute for Development Studies (PIDS) Senior Fellow Michael Ralph M. Abrigo said available studies for determining the effects of economic growth on health in the Philippines are scant.
Nonetheless, Abrigo said economic growth is related to negative health-related behaviors such as increased consumption of sugary, salty and fatty food, among others, which often leads to non-communicable diseases (NCDs) or what are called “lifestyle diseases.”
Incidentally, NCDs are now considered the leading cause of morbidity in the Philippines. Around 579,237 Filipinos died in 2017. This represented, however, a decrease of 0.5 percent than the previous year’s 582,183 deaths.
Based on the PSA’s data, the top 10 leading causes of death led to 407,824 deaths in 2017. This represented 70.41 percent of the total deaths in that year.
The top cause of death was ischemic heart disease, which accounted for 84,120 deaths in 2017. This was followed by neoplasms or cancers with 64,125 deaths, cerebrovascular diseases (59,774 deaths), pneumonia (57,210 deaths) and diabetes mellitus, 30,932, which accounted for 84,120 deaths in 2017.
Hypertensive diseases caused 26,471 deaths in 2017, followed by chronic lower respiratory infections, 24,818 deaths; respiratory tuberculosis, 22,523 deaths; other heart diseases, 22,134 deaths; and diseases of the genitourinary system, 15,717 deaths.
Consumption ways
ACCORDING to Abrigo, “there are indications that economic growth is also related to negative health-related behaviors, including increased consumption of sugary, salty and fatty food and tobacco products and alcoholic beverages, which may increase the incidence of non-communicable diseases in the longer term.”
However, households with higher incomes can also afford better and higher quality health-care services. One example of this is in terms of maternal health.
Citing a study they conducted last year, Abrigo said that mothers who have higher incomes can seek antenatal care from skilled attendants. They also have better access to antenatal care in the first trimester of their pregnancy and have at least eight antenatal care visits in areas with vibrant economies.
The rise in access to better health services when household incomes increase in relation to better economic growth has spillover effects in other cities and municipalities, according to Abrigo.
This now places more pressure on governments to deliver on the needed infrastructure and services that will enable households to get their medical and health needs.
Paragas said this was also observed in the Wellness Index where good medical health was akin to access to checkups and dental care. He said dental care is very important since it can be a predictor of disease.
“If public infrastructure are not sufficiently adequate, then fast economic growth may also impact health through other channels, such as through poor water and sanitation, pollution from traffic congestion, etc.,” Abrigo said.
ASIAN Development Bank (ADB) Health Sector Group Chief Patrick L. Osewe asserted in a recent ADB blog entry that it was time for countries to invest in universal health care.
Osewe said investments in health coverage are investments in economic growth. He said basic health care remains out of reach for millions worldwide. This is a potential threat to meeting the Sustainable Development Goal (SDG) 3 on ensuring healthy lives and promoting well-being for all at all ages.
One of the targets in SDG 3 is achieving universal health coverage, particularly in financial risk protection and access to quality essential health-care services. The targets also include the need to increase access to safe, effective, quality as well as affordable essential medicines and vaccines for all.
SDG 3 also targets that by 2030, countries must reduce premature mortality from NCDs by one-third through prevention and treatment, and promote mental health and well-being.
“Investments in universal health coverage are investments in economic growth. Such investments play a critical role in leveraging opportunities, anticipating challenges, and delivering the knowledge, expertise, and financing countries need to achieve universal health coverage within the region,” Osewe said.
“A growing body of evidence suggests that progress toward universal health coverage can ensure that people have access to the health care they need without suffering financial hardship, and it can also help drive better economic development outcomes,” he added.<
IT is fortunate that the Philippines successfully passed a law institutionalizing universal health care (UHC). However, there are many concerns regarding the implementation of the law.
For one, the Department of Health (DOH) said in September it is not yet ready for the nationwide implementation of a UHC program since the government failed to raise the required P257 billion to fund its implementation.
Of the proposed budget, PhilHealth was supposed to get P153 billion for UHC for 2020. However, PhilHealth Acting Senior Vice President for Actuary Nerisa R. Santiago told the BusinessMirror that it was only given P67 billion, which translates to a shortfall of P85 billion.
Santiago said this was because of a projected low “sin” tax collection, particularly for tobacco products, for 2020.
Both the DOH and PhilHealth are hoping this funding gap will be addressed once the proposed bill raising taxes on alcohol and vape products is passed into law.
Further, Health Secretary Francisco T. Duque III recently said that the “opt out” provision included in the law, which was provided to local government units (LGUs), is the biggest hurdle in achieving true UHC in the Philippines.
Duque said that with this option, local officials can refuse to integrate their health services to hold on to control of the local health system made up of health stations and rural health units.
Ensuring effect
IF local officials such as mayors agree to buy into the UHC, they will have to surrender control over this system to the governor of the province. Through this transfer, a health fund can be created that will make funds available for all.
“Their mayors probably do not want to give up control of their local health system,” Duque said. “It is a very real, on-the-ground hurdle but it needs a lot more educating, a lot more explaining and the DOH will never get tired of convincing those without doubts.”
However, Duque said, the way toward achieving UHC is a whole-of-society approach. He said the DOH is “too small” an agency to implement the UHC law. He said the “buy-in” of major stakeholders, such as LGUs, is crucial in making UHC reach all Filipinos.
For one, Abrigo said the role of LGUs cannot be played down in terms of helping citizens cope with the demands of growth and development. LGUs can ensure the trickle-down effect of progress by providing better roads, better health services, and better public facilities, he said.
These, Abrigo said, can include infrastructure that can promote better health outcomes. He said there must also be more information campaigns on health-related behaviors.
“Having public parks, for example, have been documented in some studies to improve quality of life even in cities that are known to be very congested,” he said.
Not enough
MEANWHILE, given the results of the Philcare Wellness Index, Paragas said a UHC that is designed on “a per-disease” basis is not enough.
He explained that health care should not be reactive but proactive. This means putting more emphasis on preventive care through greater private- and public-sector partnership, which Duque also recognized.
This is especially crucial given the Philippines’s aim to be classified as an upper-middle-income country under the Duterte administration. If the government is successful in increasing Filipinos’s GNI per capita, Paragas said more second-tier cities will become “stressed.”
Paragas said the top cities in the Philcare Wellness Index which showed high stress levels should be closely monitored, along with other possible local areas expected to benefit from high economic growth.
“Expect [that stress levels will increase] because of the absorptive capacity of cities in terms of accommodating greater investments. What now are the mitigating activities that you can implement to help residents?” Paragas asked.
These mitigating activities can include “wellness breaks” that can be introduced in the workplace as well as stress-coping mechanisms for people living in previously laid-back communities which are now experiencing rapid urbanization and growth.
Too fast, too soon?
THE recent economic success of the country, particularly of many provinces and second-tier cities, speaks highly of the kind of macroeconomic policies implemented in the country in the past five years.
While the government intends to continue on this high-growth path, the Philcare Wellness Index showed there are unintended consequences that need to be prevented by institutions.
And investing in people, particularly in their health, is the first step toward the right direction—high growth—and a “matatag, maginhawa, at panatag na buhay.”
