Category: My Daily Race

My Vision of a Better PhilHealth

I do believe the changes we are proposing will make PhilHealth more responsive to the health needs of the Filipinos.

1 June 2011

Senate of the Philippines

PhilHealth Amendments


On June 1, 2011, I sponsored Senate Bill No. 2849 which amends the existing PhilHealth law or Republic Act No. 7875.

I had to take time to educate myself and spend a lot of long hours, including ice packs for my headaches and at night, after working, drink chamomile tea to help my brain shut down and rest. My staff worked overtime on this bill too and in a future blog, I should write about how they coped with the long hours.

I apologize in advance because this blog entry is a bit heavy and technical. Whether I am drafting a senate bill, writing a committee report or my blog, I always try to simplify the technical terms used.  Legal phrases and procedures are easier for me to explain because of my legal background. But medical and financial terms are of a different class altogether. So, I am warning you, there is a fair share of medical and health financing terms used here.

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During numerous hearings and technical working group meetings, it was revealed that in the 16 years since PhilHealth has been in effect, it has failed to cover many Filipinos, particularly the poor who are in dire need of health care. Philhealth now provides a wide array of benefits. But without Philhealth membership they have to pay for all their medical expenses.

The other problem is for those who are already members – many are still unable to use their Philhealth benefits because the out-of-pocket expenses they need to shoulder are way too high.

Thus, my bill aims to resolve the current problems as follows:

1. Universal coverage

  • Section 17: all Filipinos shall be enrolled in the PhilHealth program.
    • All Filipino citizens will have to be properly categorized as (i) indigents, as may be identified by a means test to be conducted by the National Government, (ii) members of the informal sector, (iii) practicing professionals and self-earning individuals, and (iv) the formal sector, or those whose PhilHealth premiums are automatically deducted from their salary.
    • The bill further identifies who will pay for the premiums of the different categories:
      • Indigent- national government
      • Lowest income level earners of the informal sector- local government, legislative sponsor or other sponsors; or
      • Able and capable- oneself
  • Section 6: mandates that no Filipino shall be denied access to basic health care services, which are identified in the bill. Further, no woman who is about to give birth shall be denied maternal and newborn care.

2. Lower out-of-pocket expenses

  • The poorest of the poor are not able to avail of health care services because they need to shoulder more than half of the total expense which is considered out-of-pocket expenses, thus, a shift to case-based payment from the current fee-for-service arrangement is proposed in this bill. And this is where I spent many hours understanding how these payment systems work. I also tried to simplify the definition of the terms.
  • Section 2:
    • Fee for service payment which is defined in as a fee pre-determined by PhilHealth for every single test conducted, every drugs and medicines given, and in addition, for the professional fee and hospital bill.
    • Case-based payment scheme which is where the treatment of a certain disease, from diagnosis to cure is charged a one fixed package cost.
  • Section 6: PhilHealth and DOH shall annually study the services being offered to determine its financial sustainability and relevance to health innovations with the end in view of reduced out-of-pocket expenditure, among others.
  • Section 15 further directs that the excess reserve funds will be used to meet the principles of the bill, one of which is to reduce out-of-pocket expenses.

3. More efficient allocation of funds

  • To reinforce the focus on preventive and primary health care, the bill provides for community-based services in the form of Essential Health Care Packages and per capita payment- based services.
  • Section 2:
    • Essential Health Packages refers to a variety of health care packages consisting of promotive, preventive, diagnostic, curative and rehabilitative services that respond to the needs of the community.
    • Per capita payment refers to a pre-determined fixed rate paid to a health care provider to provide a defined set of services in the community for a fixed period of time for each enrolled individual.
  • Capitation. Capitation is the amount paid by PhilHealth to an LGU for every indigent that an LGU enrolls. Section 22: directs the LGUs to invest this capitation fund solely on health infrastructures or equipment, professional fees, drugs and supplies or information technology and database.

4. Other Features of the Bill

a. Reserves

  • Under the existing law, Philhealth is allowed to save two years worth of its projected expenditures as “allowable reserve fund.” This has been highly criticized because Philhealth is suppose to spending the funds on health care services instead of saving it as if it were a bank. Thus, under this bill, Philhealth is limited to save for its reserve fund an amount equivalent to projected expenditures for only one year. Any excess in the actual reserves will be used to meet the principles stated in the bill, which is to expand the health care benefits of the people.

b. Information technology

  • The bill mandates that PhilHealth should invest in the acceleration of its information technology systems.
  • It should maintain and secure a database of all its enrollees to ensure universal coverage.
  • The bill obligates the PhilHealth to diligently educate its users of health benefits, and of their rights and privileges under the law.

I am ready to defend this bill on the floor. I do believe the changes we are proposing in this measure will make PhilHealth more responsive to the health needs of the Filipinos. But the filing of this committee report is just part of the process and the bill will now be scrutinized by my colleagues. I am looking forward to their inputs during the periods of interpellation and amendments so we can make this an even better bill.

Full text of Sponsorship Speech of SB No. 2849

Read More

Behind the Scenes

Do not be fooled. That is not a girls’ lunch out or is it a summer weekend tea party. It is just a regular summer working day for me and my staff.

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During the senate summer recess and even after session resumed, we continue to work either at the office, in my house or out of town. 

This is just one of the regular workdays we had in my house.

Now that we are working on the final drafts of both the PhilHealth and Reproductive Health bills, we have been spending even more late nights and weekends working from my house. That is Atty. Joei and me and the Reproductive Health bill.

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Bill drafting, reviewing and proof reading take a lot of patience and practice. That is why I think a conducive work environment is crucial.

After years of not having much of a living room, everything finally fell into place. The right sala set, big enough to accommodate a large group but still cozy enough for just my kids and I to laze around in at night. The right round table, perfect for breakfast or group meetings like that shown in the pic. Actually that table and chair set belong to my parents. We kind of borrowed it when I celebrated my birthday two months ago, and have been enjoying it ever since.

I like to think of my home as an alternative work environment for my staff where they can be more relaxed while still getting the work done. As you can see, professional work clothes are not required. (Sidenote on that: My Chief Of Style…Oops! Chief-Of-Staff, DG, wore a brown mid-knee  romper for work the day before. Inspired by her summer-friendly attire, I decided to wear a summer outfit the next day. So on the next day, I wore a denim romper only to find out that DG outshone me when she showed up in a bright colored romper with splashes of yellow, orange and pink. But that is fine, I am more than happy that she can freely express herself.) They are also free to raid my kitchen and my stash of chocolate (Although, I do hide that well). They are also free to swim in my little backyard pool, although so far, the only ones who have used the pool are the kids of my Chief-Of-Staff, who take their swim lessons there with my triathlon coach.

Working from my house necessarily includes an invitation to do a sunset trail bike run or swim. See that floral arrangement on the table? When I asked who would like to go for a run later, Mich, my researcher, actually tried to hide behind it! As if I didn’t know she was there! Oh well, there is always Che, my ever-reliable executive assistant/political-international relations officer. She won’t back down on any invitation to run whether it be under the sun or in freezing weather.

But like I said, do not be fooled by the homey atmosphere and the floral prints. My legislative team is lean and mean. The bills we have been toiling over will be out soon. Then we go to the next stage, which is defending them on the senate floor. Meanwhile, I would like to think that I provide an employee-friendly, women-friendly, child-friendly working environment for my staff.

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Murder At Sea

Today, I woke up to a very disturbing headline in the Philippine Daily Inquirer, entitled “Coral Reefs Twice Size of Manila Destroyed”. Last Tuesday, officials from the Bureau of Customs reported that a “reef complex” off the coast of Cotabato Province was obliterated, destroying coral reefs and killing other marine life. In the opening paragraph of the article, “the crime was described as the ‘rape of the ocean’.”

Photo Credits: Philippine Daily Inquirer
Photo Credits: Philippine Daily Inquirer

What are the applicable laws?

  • Section 27(a) of Republic Act No. 9147 entitled “Wildlife Resources Conservation and Protection Act” penalizes illegal acts such as “(a) killing and destroying wildlife species…” Section 28 of the same law states that any person found guilty of such illegal act shall be imposed with “(b) imprisonment of four (4) and one (1) day to six (6) years and/or a fine of Fifty thousand pesos (P50,000.00) to Five hundred thousand pesos (P500,000.00) if inflicted or undertaken against endangered species.”
  • Section 91 of Republic Act 8550 or the “Fisheries Code of 1998”, outlaws “any person or corporation to gather, possess, sell or export ordinary, precious and semi-precious corals whether in raw or in processed form.” Any person found guilty of such act is penalized with six months to two years imprisonment and a fine from P2,000 to P20,000 or both at the discretion of the court.
  • The Convention on International Trade in Endangered Species of Wild Fauna and Flora prohibits the the collection and harvesting of endangered species such as coral reefs and sea turtles. We are a party to the Convention, and are bound by the same.

My work in the Senate

On numerous occasions on the Senate floor, including budget deliberations/hearings, I have continuously called for the increase in budget allocation to protect our resources. I know that the Department of Environment and Natural Resources has actively sought for the same, reverberating the call for more budget for the environment.  Unfortunately, this was a low priority of the previous administration. Perhaps this would serve as a wake up for the current administration.

On my part as a legislator, I have filed and sponsored on the floor a number of bills declaring various areas in the Philippines as protected areas. To name a few, these are the protected area bills which have been enacted into laws:

  • Republic Act No. 9847 
“Mounts Banahaw-San Cristobal Protected Landscape (MBSCPL) Act of 2009”
  • Republic Act No. 10067 “Tubbataha Reefs Natural Park (TRNP) Act of 2009”
  • Republic Act No. 9486 or “Central Cebu Protected Landscape Act of 2007”
  • Republic Act No. 9494 or “Mimbilisan Protected Landscape Act of 2007”

Aside from these, I have proposed budget amendments for the protection of areas covered by the aforementioned laws and certain protected areas found in the provinces of Occidental and Oriental Mindoro, Bukidnon, and Davao.

One effective model for the protection of both marine resources and forests is to empower the locals thru education and  awareness  programs to protect their own environment. I have been supporting and pushing for more eco-tourism projects as well. This has proven to be successful in pilot projects across the country.

But despite the existence of these laws and international convention, for as long as the demand on our precious marine life remains, these crimes will continue. As a people, we must unite and declare war against these poachers and murders of our marine life. Government authorities must act with haste. It is important that we show our determination in prosecuting these heinous offenses. These criminals must be put behind bars and made to pay for their crimes.

Smoking Kills

The statistics…

Tobacco use kills more than five million people per year. It is responsible for 1 in 10 adult deaths.

Every eight seconds, someone dies because of smoking-related diseases like chronic obstructive pulmonary diseases and heart diseases.[1]

Among the five greatest risk factors for mortality, it is the single most preventable cause of death. But, if the current patterns continue, tobacco use will kill more than 8 million people per year by 2030. Up to half of the world’s more than 1 billion smokers will die prematurely of a tobacco-related disease.[2]

In the Philippines, 34.8% of our population is engaged in tobacco smoking. What is more disturbing is that children as early as nine years old smoke.[3]

For every cigarette stick smoked, a smoker loses at least five minutes of his precious life and also endangers the lives of innocent people around him whose only fault is that they did not forget to breathe.

As Chairperson of the Senate Committee on Health and Demography in the 14th Congress, I heard and then sponsored the bill mandating picture-based warnings on tobacco products (SB 2377).

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We need the bill to deter new smokers, especially among the youth, try to lessen the urge of existing smokers, as well as implement our commitment under the Framework Convention on Tobacco Control (FCTC), which is an international treaty initiated by the World Health Assembly. It is the first global public health agreement devoted entirely to tobacco control to which the Philippines is a signatory and which was participated in by 192 countries.

The Philippines acceded to the FCTC in 2005 obliging us to comply with certain standards, such as tobacco price and tax increases, tobacco advertising and sponsorship, illicit trade and second-hand smoke. More importantly, the FCTC recommends implementing effective measures on packaging and labeling of tobacco products, such as the adoption of a picture-based health warning on tobacco packages.

I defended this bill on the floor and was hoping it would pass, but there was strong resistance from some senators. It was very disappointing.

Meanwhile, a similar bill filed in the House of Representatives was not prospering either, also due to the resistance of some lawmakers.

Soon after, then Secretary of Health Esperanza Cabral came out with DOH Administrative Order 2010-0013 which mandated that graphic health warnings be placed in tobacco packages in accordance with our obligation under the FCTC.

This was a move I fully supported and was happy to see implemented.

Unfortunately, the tobacco companies filed a petition questioning the legality of DOH AO 2010-0013 and seeking to prevent the DOH from implementing the same. An injunction order restraining the DOH from implementing the AO was granted by a Regional Trial Court of Malolos, Bulacan. Thus, the DOH filed a petition with the Supreme Court to question the decision of the lower court.

Former Health Secretaries Francisco Duque III, Jaime Galvez-Tan, Alberto Romualdez, Alfredo Bengzon and Esperanza Cabral, then filed a Motion to Intervene in the Supreme Court case citing that as former health secretaries, “it is our moral responsibility to continue to protect public health interest from an industry that fosters disease and death in its regular course of business.” They also said that “the meddling of the tobacco industry is preventing the DOH from carrying out its mandate to protect and preserve the health and lives of Filipinos.”[4]

In April 2011, the Supreme Court granted said Motion to Intervene.

The mandate for tobacco products to bear graphic health warnings should no longer be a subject of great debate. Studies show that graphic health warnings are effective.

tobacco]

In Brazil, two thirds of smokers (67%) said the warnings made them want to quit.[5]

In Canada, nearly half of smokers (44%) said the warnings had increased their motivation to quit.[6] More than one quarter of smokers (27%) also smoked less inside their home as a result of warnings.[7]

In Singapore, more than one quarter of smokers (28%) said they consumed fewer cigarettes as a result of the warnings[8]and one out of six (14%) of smokers said they avoided smoking in front of children as a result of warnings.[9]

In Thailand, nearly half (44%) of smokers said the pictorial warnings made them “a lot” more likely to quit over the next month.[10]

Now in the 15th Congress, I have re-filed the Senate Bill No. 2340 or the “Picture-Based Health Warning Law”. As Chair of the Committee on Health, I intend to hold a hearing soon. I know the tobacco lobby is strong but policy makers and legislators should not hesitate to support policies and legislation that will promote the health of Filipinos. This is mandated in Sec. 15 of the Philippine Constitution which says that “the State shall protect and promote the right to health of the people and instill health consciousness among them.”

Tobacco products have been proven to be hazardous to people’s health. The tobacco companies are not being prevented from conducting business. But since they are selling a hazardous product, they should be responsible corporate citizens and comply with policies that are pro-health.

My Thai Princess

6 to 9 January 2011

Bangkok, Thailand

I have visited Thailand for various reasons. In 2007, I was there to cheer for our national team during the Southeast Asian Games. I have joined a number of triathlons there, including last year’s 70.3 Ironman Asia Pacific Champs in Phuket. I have also been there to study their land registration system in connection with a bill I filed in the Senate to streamline our land registration and prevent double titling.

My last trip was with my daughter Max who turned 16 years old this year. My little baby girl. My first born. She is now just a few inches shorter than me. She is growing up so fast. I wanted to spend time with her.  I decided to take her on a trip. We chose Thailand.

When I travel with my kids, I always try to include a tour that will expose them and help them learn more about the city or country’s history and culture. For this trip, we went on a river boat cruise. We had a lively guide who filled us with details of Thai history and customs.  As we moved along the Chao Phya River and klongs (canals), she pointed out different structures and explained their significance.

When we got to the Wat Arun or the Temple of Dawn, we got off the boat and roamed around. It was a beautiful temple made of broken ceramic. I dream of building something like that here! We  climbed the temple. The steps were very very steep.

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Max wanted to explore on her own, so I let her.

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According to the website of the Tourism Authority of Thailand:

“The temple was built during the Ayutthaya period and was originally called Wat Makok after the name of the local village Tambol Bangmakok. It means “Village of Olives”. Wat Arun gets its name from Aruna, the Indian god of the dawn, hence its common name The Temple of Dawn. The location of the temple is in the area that used to be occupied by the palace of King Taksin who re-established the Siamese Kingdom after the fall of Ayuttaya more than two hundred years ago. The main Buddha image is believed to have been designed by King Rama II. Wat Arun, often called The Temple of Dawn, is one of the most remarkable visual identities of Bangkok. The imposing Khmer-style prang or tower is 67 metres tall and decorated with bits of porcelain that was used as ballast by boats coming from China. It is surrounded by four smaller prangs. Construction of the prangs were started by King Rama II and completed by King Rama II.”

ceramic tile

When we got down, she wanted to try on the costumes. So she did. Whoa! Suddenly, my Filipina daughter was transformed into a Thai princess.

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I am not Thai. We have no Thai blood as far as I know. But look at this child of mine, does she not look like a Thai Princess?

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After that fun picture taking session, we went back on our boat, learned a bit more about Thai culture and finished our cruise.

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