Problem Solving the Philippines: What the Universal Health Care Act Promises, and Who Has to Deliver It
By Giancarlo Angulo
In August 2024 I wrote about the DOF’s move to take “idle” money from PhilHealth, and I said I’d save the deeper discussion of the Universal Health Care (UHC) law for a later post. This is that post, two years late. Before arguing about PhilHealth’s money, I think we should know what the law actually says. This first part covers what Republic Act 11223 promises and who has to deliver it. This is part 1 of 4 in The UHC Series.
TLDR
- RA 11223, signed in February 2019, says every Filipino is automatically a member of the National Health Insurance Program (NHIP), with no co-payment in basic or ward accommodation.
- It splits health care in two: population-based services (free, paid by the national government) and individual-based services (paid mainly through insurance).
- Much of the structure is written as “shall endeavor”. In my reading, that makes it depend on agencies and local governments choosing to build it.
What the law promises
- Everyone is in. “Every Filipino citizen shall be automatically included into the NHIP” (Section 5). A PhilHealth identification card “shall not be required in the availment of any health service” (Section 9). For direct contributors, “failure to pay premiums shall not prevent the enjoyment of any Program benefits”, though missed contributions must still be paid with interest (Section 9).
- A wide range of services. Preventive, promotive, curative, rehabilitative and palliative care, including dental, mental and emergency services (Section 6). What exactly is covered is to be decided through a Health Technology Assessment process (Section 34).
- No co-payment in basic or ward accommodation (Section 9), and “the current PhilHealth package for members shall not be reduced.”
- A primary care provider for everyone. The DOH and local governments “shall endeavor” to give every Filipino a primary care provider who acts as “navigator, coordinator, and initial and continuing point of contact.” Every Filipino “shall register” with one, and, except in emergencies, access to higher levels of care is to be coordinated by that provider (Section 6).
- An outpatient benefit within two years of the law taking effect, including outpatient drugs and emergency medical services (Section 6(b)). PhilHealth’s primary care benefit started as Konsulta and has since grown into YAKAP, which adds a new clinic registration process. I look at how Konsulta, YAKAP and GAMOT measure up against that promise in part 4 of this series.
Two kinds of health services
The law separates who pays for what (Section 7):
| Population-based | Individual-based | |
|---|---|---|
| Examples | Disease surveillance, health promotion, public health campaigns | Hospital stays, consultations, medicines |
| Paid by | The national government, through the DOH | Mainly insurance: PhilHealth, private insurance and HMOs |
| Cost to the patient | Free at the point of service | Covered by premiums and benefit packages |
Who has to deliver it
- PhilHealth pays for individual-based care. The law tells it to “shift to paying providers using performance-driven, close-end, prospective payments” based on diagnosis-related groupings (Section 18(b)), instead of paying per item.
- The DOH is to contract province-wide and city-wide health systems for population-based services (Section 17).
- Local governments are to merge municipal and city health systems into province-wide and city-wide systems overseen by Provincial and City Health Boards (Section 19). These pool money in a “special health fund” (Section 20). The law promises technical and financial support for six years to selected local governments that commit to integration, “subject to further review after the lapse of six (6) years” (Section 41(d)).
- Congress gets a Joint Congressional Oversight Committee that must commission “an independent study to evaluate the implementation of this Act” (Section 39). I could not find that study. I say more about that in part 2 of this series.
A reading of mine: in Sections 6, 17, 18 and 19, the verbs for DOH, PhilHealth and local governments are mostly “shall endeavor”. That is not an obligation to finish, only to try. When a national promise is built on “endeavor” and on hundreds of separate local governments, it gets delivered unevenly. This is an observation about the wording, not a claim about anyone’s intent. Karl Garcia made a related point in January in When Doctors Leave, Quacks Arrive: the central failure is delivery capacity, not financing, because UHC “promises entitlement” but not presence.
What I’m still unsure about
- A law’s text shows what was promised, not what was built. I haven’t audited the DOH, PhilHealth or any local government.
- I’m not a lawyer or a health economist, and I wrote this from the statute text and public reports. If I got a section or number wrong, please comment. Corrections welcome, especially from people who work in health care.
Sources
- Republic Act No. 11223 (Sections 5 to 9, 17 to 20, 34, 37, 39, 41)
- My earlier post: Policy Making is Hard (PhilHealth Edition)
- Karl Garcia: When Doctors Leave, Quacks Arrive (January 17, 2026)
The UHC Series
Problem Solving the Philippines: The UHC Series.
- Part 1: What the Universal Health Care Act promises, and who has to deliver it (this post)
- Part 2: The study I can’t find, and the rules under the Act
- Part 3: Whose money? The PhilHealth reserve rule, the Supreme Court and the numbers
- Part 4: The outpatient benefit the Act promised within two years
Lovingly made with Claude.
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Endeavour is not a proper goal, I agree. It is an excuse not to succeed (gadzooks, I’m starting to write like AI, inevitable, I suppose).
Thanks for the brief, one of four parts. Covid was a scramble, for sure, tinged with corruption, a human’s greatest evil, stealing from the sick. Individual health care at private hospitals is good. I’ve migrated through two serious health problems without insurance. Care here is capable of saving lives, for sure.
That said, I’m reminded of the case in Mindanao when I was there, in which the patient, diagnosed with malaria in the province, died of a ruptured appendix during the two hour drive to the hospital in the city.
We have excellent healthcare for those who can pay and have the basic instinct on how to navigate complex regulated domains. Everyone else sadly would not get the best care.
I always have to stay my mind when I think if they had a capable AI assistant this would not be an issue. The accurate expression of the problem is probably the biggest issue with less capable people on making great use of AI. Excited with the future discussions as most of my posts are personal in nature but masquerading as informative.
“We have excellent healthcare for those who can pay…” Giancarlo
I am a “guest” in an e-mail discussion group composed of Filipino doctors. It includes doctors in the US and in the Philippines.
Many of them say otherwise, i.e. that the quality of health care in the Philippines, even for those who can afford it, is suspect. Many highly recommend getting second and third opinions. Of course availability is always a problem….they advice that older folks get a complete physical check up before going to places like Boracay because if you have a serious incident like a heart attack, there is no quick access to health care no matter how much money you have. They also don’t advice you have an emergency on a Sunday as most doctors are out on a golf course on that day. They say that the very wealthy back home go to Singapore for their medical needs if it is not an emergency.
They are also very critical of many of the Philippines’ medical schools and they claim that they do not provide quality education and thus quality graduates.
I have personal stories that attest to their claims.
Just saying.
advice – advise. Sorry…
I think, that is just mean! doctors maybe playing golf as they are certainly allowed to have leave and days off, but they have pagers! some are on call and will leave everything upon being called. so dont believe when they say not to have emergency on sundays for there are always medical staff available 24/7. they work different shifts. where one staff is absent, another takes over. emergency dept of hospitals are always open even on public holidays and there are always doctors available.
The smartest most competent doctor I’ve ever met works the emergency room at Chong Hua Hospital Mandaue. Records every detail in her handheld device, pulls history up next visit, knows every symptom in every body part. Knows every doctor. Incredible. Mid 30s in age, and good looking, lol.
doctors are notorious if not fastidious record keepers, for that may well be the only thing that will save them if taken to court for malpractice. medical records can be subpoena’ed and can stand up to scrutiny in the courts of law. and sometimes, doctors relay on those medical records for teaching purposes (sans identity of patients) when teaching student doctors. if your details are to be included in the teaching process, you will be notified and your permission is needed. only your medical condition is discussed, not your identity.
Ah, thanks. Matches what I’ve seen.
Secondhand and thirdhand accounts when unable to be correlated are not reliable.
Top-tier private hospitals are University of California or Stanford hospital level, with modern equipment and with the added bonus of concierge service. It is “cheap” for an average American. Every metro area has a bunch of these hospitals.
Government hospitals are competent, but congested since they are mandated to serve everyone, even the indigent. Equipment is adequate.
The worst are small private “hospitals” with the name of the doctor (e.g. Dr. X Hospital) that it seems any doctor can open. These are the most numerous. Bad equipment, doctor who come in whenever they feel like it, imperious nurses, rude staff, and so on. These are the hospitals known for holding patients “hostage” which is now illegal, so they hold IDs or valuables hostage, also illegal. Or they demand upfront payment, likewise not permitted. Filipinos usually go to these because the culture teaches them to think “private = good, public = bad.” But in actuality government hospitals have better health outcomes.
Elderly tourists who are going to somewhat remote places is not really advisable when they have medical conditions. Someone with those conditions who still go, well that’s on their bad judgement.
The Philippines is still developing. Could things improve? Sure. But to compare the Philippines to what is expected in HDI countries is quite unfair. That’s what makes Filipinos feel shitty about themselves and leads them to think improvement is impossible. Fair comparisons are comparisons to peers and near-peers.
Also, I would add that a lot of these elderly diaspora Philippine-trained doctors are major assholes who hate their own home country and won’t waste a chance to talk down on the Philippines. I know them quite well — they looked down on my high school friend’s father since he chose to serve poor patients and earn a modest living rather than act rich and mighty. A lot of those pre-1990 Philippine-trained doctors wouldn’t be able to practice if they entered the practice today. They are grandfathered on the pre-USMLE requirement transition where foreign trained doctors were able to practice in the US without retraining. My friend’s parents are both UP-trained doctors. His father had to pass the USMLE as they immigrated in the late 1990s, while his mother failed and became a nurse/senior home owner.
doctors in govt hospitals in philippines are not just trained here but they go for overseas studies too. all doctors use universal language and can communicate with doctors overseas, and have open lines and all have access to peer reviewed journals. they knew all about trends and
continuation of the above before I got cut off for accidentally hitting send!
.. . . our doctors new all about new trends and latest discoveries. and sometimes they teleconference with other doctors and specialists overseas as regard current emergence of dangerous disease like the one currently doing the round in russia that has already killed a lab worker. apparently the disease escaped its containment.
though doctors are known to bully other doctors and even harassed female doctors and sexually assault them too. there are cases.
anyhow, I have got to mention a very recent medical case here that baffles me, with our dilg sec jonvic remulla asking vice mayor respecio to undergo drug test for the vice mayor’s undue behavior. respecio submitted a negative test result to remulla, the test being done by a private hospital, st luke’s. and that’s when my hackles went up a notch! really, the specimen submitted by respecio ought to have been tested by two independent labs, one private the other preferably a public govt lab. if the two labs come up with the same results, no problem, but if the two labs come up with two different results, one being false negative as the specimen submitted might have been contaminated. that could be a problem. but remulla is not to know for he settled early and did not seem to know how our system work.
as well, disgraced congressman romualdez cousin of the president na sangkot sa flood scam was deemed sick and not fit to be transferred for detention. but on examination of govt doctors, it was found out that romualdez may be sick but his sickness do not warrant hospital arrest that will make him stay in hospital indefinitely, he can be safely monitored out of hospital, thus contradicting the finding of the private hospital. and so, romualdez was transferred and now serving detention and awaiting his day in court.
Yeah most Filipino doctors are competent at the family doctor (general practitioner) level. The bad apples seem to me to be those who failed at being a family doctor and decided to open their own small hospital. Those are the “hospitals” that are dirty, non-sterilized tools, rusty surgical trays, imperious staff. Sadly many Filipinos prefer to go to these run-down private hospitals as they are led to believe government hospitals are bad and private is better. These small private hospitals are basically family medicine practices that just happen to offer the semblance of critical care.
I have many acquaintances who obtain medical services at government hospitals and while there is sometimes a long wait depending on the severity of the patient’s condition, the medical service the patient gets in the government hospitals is always geared towards the best outcomes.
The main problems in Philippine healthcare are:
1.) Access to competent, affordable medical services
2.) Long waiting times in government hospitals for non-urgent care
I think we need to stress that government hospital workers are public servants, even the doctors and nurses there. They have chosen to serve the public for a lot less salary than they could’ve earned in a private hospital or private practice. I find them to be much more empathetic and diligent than the small private hospitals. Of course expensive private hospitals are on a different level because they have access to huge budgets. I think government hospital workers should be commended for their selflessness and the government should build more and allocate more resources to government hospitals.
true, there is triage in public hospitals, those deemed with dire conditions are given priority like if you are having heart attack and cannot breathe, you’ll get treated 1st. if you present with stab wounds or bullet wounds, you will get priority too, else you bleed to death! all others can wait.
That is why there is a qualifier that there is a basic instinct of navigating complex systems.
The problem with medicine anywhere is that quality is hard to ascertain or come by. This is quality requires reps and a different kind of deliberate practice that we cannot see, we cannot judge. A lot of the best doctors here have trained at the best institutions abroad. But there is a sense of omerta or something similar. The worst offenders or worse people of the profession is protected by other people of the profession. Expound on that and you get a hard to quantify quality rating for any service here.
The nature of not having a strong primary care practice locally also deprives the patient of what is in other countries the primary health manager. These are the doctors who you have known your whole life and thus you are bound by that human instinct when someone becomes family. It becomes personal and the professional omerta becomes. I will direct this patient to the best surgeon for this case that I know or know of. I will direct this patient to the best xxxx I know of.
Losing the main health manager also kneecaps the team. Each specialist is concerned with their specialty. Who is concerned with getting the best QOL for the patient ? Specialist have a tendency to have the hammer syndrome or reverse hammer syndrome. This impedes care.
Another problem is keeping abreast with the latest stuff . Their training that pushes everything drills it into their mind crossed with how inflexible people become as they age is not a good mix.
okay, 1st thing 1st, your own local doctor whom you see regularly takes care of you. if your sickness is beyond the kakayahan of your local doctor, your local doctor will send you to a specialist, your medical hx (history) will be emailed to the specialist as well. all you have to do is call the specialist and ask for appointment and maybe ask for quote of how much the specialist will cost you. they are quite upfront about their fees. if you have pte insurance, it will take care of your med expenses.
and maybe even before the specialist can see you, you will be asked to undergo further tests as the specialist wants to see what really is going on inside your body before seeing you in person. all test results will be emailed to the specialist and the results will be there when you front up for consultation. your local doctor will then be informed of the specialist’s findings and then your local doctor will take over your care from there on. you will not be left hanging on a lurch as there is a team looking after you. miss kris aquino is example. there is a medical team looking after her.
pls be inform that these days, medical AI may will be analysing your test results as AI apparently have accuracy of 95% compared to doctor’s 87% last I heard. if you dont want 95% accuracy and prefers doctor’s 87% accuracy, that can be accommodated too.
if you think you have short changed by your doctor, you can sue the pants off them!
private hospital dont readily share data, you may will have hard time accessing records of your treatment there, but govt hospitals being public allow the public to access medical records but only if asked. the courts though can subpoena pte hospitals to submit your medical records for perusal.
My private hospital puts lab tests and other reports on line for easy patient access and so doctors can easily get briefed up on a patient’s health history. Also billings.
that is good practice for continuity of patient care, putting medical records and reports online so other doctors are informed and can carry on treatment, if the treating doctor is absent or on leave.
“My private hospital puts lab tests and other reports on line for easy patient access…” – JoeAm
“that is good practice for continuity of patient care, putting medical records and reports online so other doctors are informed and can carry on treatment, if the treating doctor is absent or on leave.” – Kasambahay
That sounds like a well-organized system. But the experience of D–E patients deserves equal attention. Joey N.’s perspective would be useful here.
Kasambahay earlier described a process in which your regular local doctor refers you to a specialist, emails your medical history, and leaves you to arrange an appointment and ask about the cost. That description assumes access to a regular doctor, an available specialist, and the means to pay. We should not take those conditions for granted when discussing poorer patients.
I’m not questioning the value of online records. My concern is how widely that continuity of care is available.
we are actively working on that in Quezon City Government. We started with Brgy Health Centers, now we are doing the QC LGU Hospitals.
I fear we would not reach the non QC LGU hospitals before Mayor Joy’s term ends but that is the target.
One patient one record everywhere.
“One patient one record everywhere.” – Giancarlo
Yup…slow and steady wins the race. When I learned what Estonia did with its X-Road program, I got excited and thought it would be great for the Philippines to help in its fight against graft and corruption. The government did somewhat embrace it with its eGovDX program. Not surprisingly, it is moving at a turtle’s pace. But at least it is moving, I think.
poor patients in back towns and villages pay their doctors with maybe a sack of corn, prized pigs or plum chickens and other equally deserving farm produce like langka or durian. poor patients also have continuity of care, they just have to wait a bit for it, for the next time visiting medical officers arrived in the barrios. hindi sila pinapabayaan, we have universal health care now that even the poorest of the poor have access to heath care as there are provincial clinics staffed by nurses everywhere now complete with hand me down medical facilities like x-rays and computers. and our govt pays their medical expenses, medications included. the poor just have to authenticate that services have been given to them and sign forms to that effect. the poor have been told not to wait for their condition to get worse that it becomes dire and outcomes may not good.
in the meantime, the poor just have to take their medication as per instruction, and not to stop taking their medication thinking they are already better. worse, if they keep their medication for others to use. or sell them.
p.s. medical services in the provinces are not to be underestimated, provincial doctors are just as organized and knew how to use the phone too, and often confer with fellow doctors as regard diseases that seem incurable but curable. they are not that isolated too, as they often received medical delegations from big cities coming in for look see of how govt’s health resources are best put to good use.
Average life expectancy in the Philippines is 71 years, 5 to 10 years less than developed countries but on par with other poor Asian countries. Health care in the provinces, and for D/E, is poor. Poverty is a bitch, truly. That is no reason to slander doctors who work within the Philippine social system. Some leave. Others stay, and universities teach new aspirants. i’ve been tended to by perhaps 30 doctors during my almost 20 years here. About 15 are high-skill, 10 are functional, and 5 have weak personal or medical skills. The provinces have pill doctors and people hate going to outlying hospitals because so many don’t come out alive. To think that it should somehow be “better”, as if doctors were responsible for poverty, is really poor critical thinking.
Thanks, JoeAm. Let me try to apply some thinking—and perhaps even some critical thinking to this topic.
“Average life expectancy in the Philippines is 71 years, 5 to 10 years less than developed countries but on par with other poor Asian countries.” – JoeAm
“Other poor Asian countries” is not the right comparison. The World Bank now classifies the Philippines as an upper-middle-income country.
I asked The Machine to compare life expectancy among Asian countries with similar income per person—not simply countries sharing the broad “middle-income” label. Using a range within 25 percent of Philippine income, it placed the Philippines last among eight countries. Jordan ranked first at about 78 years, Vietnam fourth at about 75, and Iraq seventh at about 72.
Philippines ranked last.
That comparison does not explain the causes, much less establish that doctors are to blame. But it does suggest that poverty alone is not a sufficient explanation for our position. The question is what Filipinos can do to improve their country’s health outcomes.
“Health care in the provinces, and for D/E, is poor. Poverty is a bitch, truly.” – JoeAm
Kasambahay gives a more reassuring account:
“poor patients also have continuity of care, they just have to wait a bit for it, for the next time visiting medical officers arrived in the barrios. hindi sila pinapabayaan, we have universal health care now that even the poorest of the poor have access to health care as there are provincial clinics staffed by nurses everywhere now complete with hand me down medical facilities like x-rays and computers. and our gov’t pays their medical expenses, medications included. the poor just have to authenticate that services have been given to them and sign forms to that effect.”
Those accounts may reflect different places and experiences. Still, there is a substantial difference between the picture you describe and the one Kasambahay presents. That seems worth examining rather than resolving through generalizations.
“That is no reason to slander doctors who work within the Philippine social system… To think that it should somehow be ‘better’ as if doctors were responsible for poverty is really poor critical thinking.” – JoeAm
I think you may be attributing an argument to me that I did not make. Giancarlo’s claim was that if you have the money, you can expect to get excellent health care in the Philippines.
As I recall, I told Giancarlo that doctors in the Philippines and in the diaspora had warned me that even someone with money could fall through the cracks and fail to receive the excellent care available here.
That is a concern about the reliability of the system, not a blanket condemnation of Filipino doctors. The quality of individual doctors is only one factor. Your own account acknowledges variation: you describe some as highly skilled, others as functional, and some as having weak personal or medical skills. You also mention “pill doctors,” which I take to be a criticism, not a compliment.
“Some leave. Others stay, and universities teach new aspirants.” – JoeAm
Certainly. But the fact that universities produce new doctors does not settle the question of how well they prepare them. There are also local criticisms of medical-school standards.
In his March 2026 column “Doctor shortage,” Boo Chanco wrote:
“The quality of graduates varies widely; some medical colleges report impressive licensure passing rates (ranging from 80 to 100 percent) compared to national averages that historically hover between 50 and 77 percent.”
That does not establish that most medical schools are poor. It does show that questions about uneven standards are not merely criticisms coming from outsiders like myself or even Fil-Am doctors who may have superiority complexes. J
My point is reliability: excellent care may be available without being consistently accessible, even to those who can afford it. We can recognize the dedication and competence of many Filipino doctors while still examining weaknesses in education, access, and the system itself.
Finally, I neither said nor implied that doctors were responsible for poverty. You must be thinking of someone else.
I’m reminded of a pin ball machine with the ball careening off lighted bumpers. I’m not sure where the discussion is headed. The idea that doctors are golfing on Sundays, mentioned in your prior comment, and your US doctor friends criticizing Philippine medical care, seems to me to miss the context of a medical arena struggling for funding, from patients and from government, but waging the battle with thousands of competent doctors doing their best, within a system that does not set appointments because people don’t show up costing doctors money, where hospitals hold patients until they pay, and that demands patients provide watchers in hospitals to alleviate nursing expenses. If poverty is not the problem, what is?
“If poverty is not the problem, what is?”- JoeAm
JoeAm, I agree that poverty makes health care harder. But I do not think poverty alone explains the problem.
The Philippines is now classified by the World Bank as an upper-middle-income country. That does not mean everyone is well off, but it does mean the country has more resources than a genuinely poor country would have.
The bigger issue, in my view, is how those resources are used. Corruption, poor planning, weak PhilHealth administration, and uneven services waste money and make good care unreliable—especially in the provinces and for poorer patients.
PhilHealth is a good example. In 2024, the government identified P89.9 billion in supposedly unused PhilHealth funds and transferred P60 billion to the National Treasury. Later, the Supreme Court ruled the transfer unconstitutional, and the P60 billion was returned to PhilHealth.
Yet while PhilHealth was said to have billions in unused funds, patients still faced high out-of-pocket costs, limited benefits, and hospitals complained about delayed reimbursements. If that is “excess,” then the problem is not simply that the Philippines is poor. It is that health money is not being converted reliably into accessible care.
There are at least thousands of other examples of misuse of the abundant money that the government has.
Corruption also does more than keep many Filipinos poor. It helps keep the government poor. When I lived in the Philippines from the 1950s to the 1970s, “lack of funds” was already a favorite excuse. I believe it still is. Yet a government that allows billions to be stolen, wasted, or diverted every year is not as poor as it claims to be.
That is why I cannot accept “throw more money at health care” as the main solution. There may be money to throw, but too much of it is being thrown at the kleptomaniacs in government first. Reduce corruption, recover stolen and wasted funds, and spend public money honestly and efficiently. Then there will be more money left in government coffers for health care, schools, infrastructure, and the other needs of ordinary Filipinos.
Doctors should not be blamed for poverty. But a health system cannot be fixed by adding money to a leaking bucket. First, stop the leak.
One case of Government going for a money grab does not signify a corrupt industry. PhilHealth not covering hospital covid costs, and stiffing patients on coverage does. But these are agencies, not doctors. I’ve not heard of corruption from doctors as you read about corrupt police, or customs, LTO, and immigration officials. So, yes, the Philippines is corrupt in spades. Not doctors. Not hospitals in the main.
The middle income designation is new and if you come to the Philippines and drive around, you will see poverty with your own eyes, and understand why health care struggles and life spans are short. Statistics are clean neat representations that have nothing to do with the struggles of D/E citizens, a full 90% of the population base.
You persistently want the Philippines to be better as if seeing the empty part of the glass were science rather than, what? Bias? Ignorance? Self justification at having left?
Giancarlo doesn’t need to be corrected. His series on health has come from his living and thinking about Philippine health care. Maybe listen, read, and appreciate. He is doing what you refuse to do. Put skin in the game. Golf course, my ass.
I wonder if 1950s-1970s Philippines education taught PhD-level fallacious argumentation as a core subject. Hard to believe that Ateneo taught in this manner, then or now.
I’m also reminded on effective change by Bayard Rustin’s (Martin Luther King Jr.’s lieutenant) 1965 essay in Commentary magazine, From Protest to Politics, paraphrased:
https://www.commentary.org/articles/bayard-rustin-2/from-protest-to-politics-the-future-of-the-civil-rights-movement/
“I wonder if 1950s–1970s Philippines education taught PhD-level fallacious argumentation as a core subject.” – Joey N.
Well, you have seen my argument. Let us see yours.
The challenge from JoeAm was simple: “If poverty is not the problem, what is?”
My answer was not that poverty does not matter. It is that poverty is not the whole explanation. The Philippines is now an upper-middle-income country, yet corruption, waste, and weak administration keep public money from reaching patients, hospitals, and communities that need it.
The PhilHealth case illustrates the point. Billions in supposedly unused funds were identified and transferred to the National Treasury, only for the Supreme Court to rule the transfer unconstitutional and order P60 billion returned. Meanwhile, patients continued to face high out-of-pocket costs and hospitals complained about delayed reimbursements.
So my argument is straightforward: reduce corruption and improve the use of public funds, and the government will have more resources for health care. Poverty is real, but it is not an excuse for a system that loses or misuses the money it already has.
If you believe poverty alone is the explanation, please explain why a government with billions in PhilHealth funds, and with so much public money lost to corruption and waste, still cannot deliver dependable care.
You seem to have a consistent problem with conflation, which is also a type of logical fallacy.
The PhilHealth reprogrammed funds (which I am against) is one thing (a question of applicability with regards to the relevant law). Whether that reprogramming constituted corruption and graft is another thing (one no one seems to be able to prove).
Extraordinary claims require extraordinary evidence.
Absent evidence, extraordinary claims can quickly become a quasi-religious belief, also known as a conspiracy theory.
I will have you know that the main problem with corruption in the Philippines is not with a Philippine President, but at the LGU level. Most of the corruption has to do with kickbacks and fund diversion to allied contractors of official funds such as NTA and special funds like flood control disbursements. Corrupt dynasties are not unsophisticated operators skimming off the top like they did in your day. They set up shell corporations under relatives and allies, buy out the national overseers assigned to look after them, and so on. All of which, by the way, the Philippine law requires to be overseen and managed by the LGU executive, not the President. Fixes need to be done at the LGU level, either by incrementalism to demonstrate the greater benefits of better behavior or by dictatorship. The Philippines has tried dictatorship once under Marcos Sr., how did that work out?
I increasingly find what you have to say to be irrelevant. It is stuck in 1980. It is unwilling to update or consider the realities of TODAY.
Even on the most expensive months a round-trip ticket from SFO or LAX to MNL costs $1,400. It is about $700-800 on slow months before the ber months and after Christmas. You may have your reasons, but it is highly odd that you haven’t bothered to visit since you left in 1980. I wasn’t even born yet that time. My suggestion is to take a look for yourself by visiting. Do not rely on the accounts of resentful, boastful diaspora old men who post their fantasies in online groups.
The challenge: “If poverty is not the problem, what is?”
“I will have you know that the main problem with corruption in the Philippines is not with a Philippine President, but at the LGU level.” – Joey N.
I think you are acknowledging that poverty is not the root problem, but corruption. That is precisely my argument. It looks like you are agreeing with me. Thank you!
Corrections to my interpretation of your words welcome. I say that because you earlier criticized my logic, and then seem to agree with it.
Dude. I was educating you on where the actual corruption exists. It is you who conflated it with poverty because that suited your narrative bias. There are plenty of corrupt countries which have had reductions, sometimes massive, in poverty. China for example. Poverty exists due to LACK OF OPPORTUNITY. Two different issues that sometimes intersect.
“Dude. I was educating you on where the actual corruption exists. It is you who conflated it with poverty because that suited your narrative bias.” – Joey N.
I was somewhat afraid of that. So your response to JoeAm’s challenge—“If poverty is not the problem, what is?”—is to educate me on where the actual corruption exists. Interesting.
In truth, it does not matter where the corruption in government exists, and I did not claim it was in Malacañang. I claimed it was in government.
What matters is its size and whether it makes the country poorer—so much poorer that it contributes to the lack of services to the taong bayan. I believe that is JoeAm’s point: our health-care sector cannot deliver enough because of a “lack of funds” from government.
“There are plenty of corrupt countries which have had reductions, sometimes massive, in poverty. China for example. Poverty exists due to LACK OF OPPORTUNITY. Two different issues that sometimes intersect.” – Joey N.
Yes, you can bring up China and other countries. But then there is the Philippines. JoeAm points out that more money would help our health-care situation. If less money were lost to corruption, I submit that more money could be directed to health care, giving people like JoeAm less reason to blame poverty. The Ombudsman in the Philippines in 2019 estimated that the Philippine government loses about 700 billion pesos annually to corruption.
If I robbed a homeless person here in the United States of $100,000, I could hardly conclude that the person was not poor—only homeless. Likewise, the Philippines is not poor in the formal World Bank sense; it is now upper-middle-income. But that classification does not erase the poverty and inadequate services many Filipinos experience. If the Philippine government hypothetically cut the 700 billion peso loss to corruption in half, and hypothetically poured that savings (350 billion pesos a year) additionally into just the health care situation, I believe it would that help those especially in the D/E class with their poverty and health care situation…possibly even with their lack of opportunity situation. It is just common sense.
I again remind you of JoeAm’s challenge: “If poverty is not the problem, what is?” Back in 1987, the Philippines was classified as lower-middle-income, not poor—although it was financially strapped and had to restructure its foreign loans. So while Filipinos may experience poverty, it is not a valid excuse for the Philippine government to use to defend the neglect of the health care situation in the country.
Reading what you wrote gave me a headache. A bunch of stuff that has no clear through-line to connect each piece nor realistic ideas rooted in pragmatism to solve it. Each reply moves further away from the original topic at hand.
If you care about the Philippines that much, which I still hope you do, go yourself and help out. Even in a single barangay. Even to change the mindset and habits of a handful of Filipinos by your own good example towards a more positive direction. If you’re not willing to do that, it might be best to simply offer your good prayers for the Philippines and leave it at that.
It wasn’t an argumentative challenge, as a debate to be won or lost. But a challenge for you to find better clarity on what makes the Philippines tick. You persist in trying to win debates, which you can’t, because you refuse to put down your hackles and strive for understanding, and the natural respect for Filipinos that would arrive with it.
I have taken the liberty of deleting CV’s last comment.
CV, it would be highly appreciated if you not just reflect on what you are being told, but also to respect the author of these 4 excellent posts on Philippine Healthcare, especially the work he did since 2024 to create these articles, by not incessantly haranguing other commenters.
It makes the threads, which were very useful and readable when kasambahay, Joe and Joey were conversing with giancarlo, not really easy to follow and discourages silent readers, of whom we have many as the topic seems to have struck a nerve among some.
I BTW have refrained from commenting as I know nearly nothing about the Philippine health system.
If giancarlo is a system analyst who checked the system in much detail and with very respectable effort, and Joey is someone who knows the system well too, Joe, kasambahay and Karl are at least users of the system which we both, CV, are NOT.
bigyan kita ng beer diyan, doon ka sa likod uminom at huwag ka nang maingay ha..
P.S. honorable or not, I am now applying “restraint” to you, the rest after that is up to Joe.
P.P.S. nothing wrong with your (indirect) contribution, but please don’t just argue in order to argue.
Thank you Irineo.
@ibrsalazar I am curious about the lived experience of Healthcare in Germany. Primarily primary healthcare access and specialist access. Care to share any stories?
It sometimes seems that way. But to be honest, I’ve often slipped into arguments that would fail formal tests of logic, so some latitude is necessary. But as you and I both tire from, and avoid, foreigners ganging up on the Philippines, I find relentless mischaracterizations, and the subsequent defense of them, to be insufferable.
Actually a comment analysis I did a while back but decided not to post suggested that you very seldomly fail to apply formal logic, mostly due to occasional use of personal anecdotes (the analysis said the same of me).
Ah, good to know, thanks.
This is the optimal setup.
even those going overseas for treatment, overseas doctors still need to see the previous medical history of patients held here in philippines, hence there will be close communication and exchange of medical records between our local doctors and foreign doctors. it is good manners for someone like loren legarda who is currently overseas for apparent treatment to inform their local doctor 1st hand before embarking on overseas medical sojourn.
there many venues for aging medical health workers like doctors and nurses. if they can no longer practice, they can teach in colleges and universities and sometimes do admin stuff or become hospital administrators and liaise between hospitals and the public like in public health promotion like doing the rounds of educating people how to prevent AIDS and hiv. where they dont have to consult with patients and map out each patient’s individual health care.
if they do teach, they are subject to timely peer review to ensure what they are teaching is in accordance to prescribed curriculum.
pls be informed that I think, we all get the best care, maybe not the best outcome. sometimes our doctors and nurses are so overworked that they cannot entertain patients whiles and whim, and daings too. patients have to fit in with the system like they have to shower in the morning and not in the evening or they miss doctor’s ward round where they’ll have a change to question doctor and ask for clarification of their medical condition. so dont be shy and ask questions no matter how silly you think your questions are. god knows doctors sometimes can do with a bit of joke! fit in with the system, if visiting times are over, dont ask your visitors to stay longer or you’ll end up missing your medication when nurses do their round. calling nurses later to administer your medications means calling nurses away from task at hand and if they are assisting an emergency, then you will just have to wait, grumble all you like but that wont change a thing, an emergency is emergency.
so, I think, we get from good to best care under the circumstances.
This is spot on. The doctors know the doctors in other specialities and develop a system of referrals and paybacks. Ad hoc teams form to handle life-threatening cases.
I think, all doctors also contribute to database and form part of epidiomological studies, where all trends in sicknesses and diseases are noted and tabled. doctors knew which region in philippines has the highest count of HIV infected individuals and can therefore send resources to those places that need them the most.
The fact is Philippine medical facilities are chock full of patients, thousands in Cebu hospitals every day, being treated professionally by smart, competent doctors with access to modern equipment. I’ve been given two extra lives thanks to the care I’ve received here. So if we are weighing anecdotes, put my experiences on the plus side of the T chart.
I would add that my primary physician gives me direct cell phone access anytime, and has taken my texts on weekends and evenings. Unbilled.
your physician is commendable.
I beg to differ.
I have a doctor friend who complaons about her doctor siblings in the US, they sort of have superiority complex. Maybe the Community you are in are all in the US, perhaps?
Imperious doctors in the US probably would get a ton of complaints from patients to their state Board of Medicine. Too many complaints would trigger an investigation which might risk their medical license. So it’s rare to have imperious doctors here. Medicine in the US is generally empathetic though very direct (like a level of directness which might seem unkind to those not used to American culture). Even the most lax state Board of Medicine in the US is very strict and a doctor who is willing to risk their license is probably insane to begin with.
Though I have seen Philippine-trained, US-based doctors act imperiously to their Filipino-American patients, scolding in Tagalog in a nasty and unnecessary way, then switch to talking empathetically in English to non-Filipino patients. Then I asked the name of the doctor and sent a complaint to the Board of Medicine.
it is also good if you have a recording done via cell phone of the mistreatment of patients. you have more leg to stand on especially if the recording is timed and date stamped. then medical board will be hard pressed to act, or you can contact the doctor concerned so he/she can apologize to the patient. but if you post the recording on line, be prepared for there might be backlash.
Yes, money opens competent doors. I use Gemini a lot to understand various health issues and get exercise routines for well-used bodies. I hope it evolves to the point they can get rid of all the disclaimers and the patient is free to choose AI’s advice over an incompetent provincial doctor’s guess. Lab reports issued electronically and submitted to “the machine”. I’m an expert in Philippine medical care, LOL, so I read your reports with personal interest.
ultimately, doctors are responsible for your care, AI is not. doctors ought not to 2nd guess themselves just because AI is more accurate, never gets tired, has no personal or marital problems, and can work non stop without pay.
and AI is learning and getting better all the time!
That sin tax funding measure still has that requirement of burning out your lungs and liver.
good! if people continue on to smoke out their lungs, and burn their liver with over consumption of alcohol, they have been warned about limits and overindulgence that can both shorten their lives dramatically. as well, being in hospital and sick with preventable diseases is punishment as oppose to being healthy and enjoying life.