The Philippine Alliance of Patients’ Organizations (PAPO) is a small but growing movement to strengthen the voice of patients. PAPO is the umbrella organization of patient groups in the Philippines and a member of the International Alliance of Patient Organizations (IAPO), a unique global alliance of national, regional and international groups representing patients.
Our mission is to help build patient-centred healthcare in the country so that the healthcare system is designed and delivered so that it can answer the needs of patients. In the Philippines, we are currently advocating changes in 3 areas:
- Respect for patient rights
- Universal health coverage
- Patient participation in health policy-making.
Thank you for the opportunity to comment on Republic Act 9502 or the Universally Accessible Cheaper and Quality Medicines Act of 2008. The Cheaper Medicines Law was meant to increase competition in the supply and demand of drugs and medicines by amending intellectual property laws, promoting the use of generics and included as a reserve instrument, the power to impose price control upon recommendation of the Secretary of Health and the approval by the President of the Philippines. The law is clear in its intent is to broaden access thru full competition and price control as a tool of last resort. Other cost-containment measures contained in Chapter 4, Rule 21 of the IRR stated that the DOH shall have the power to implement any other measures that the government may avail of to effectively reduce the cost of drugs and medicines, such as, but not limited to, competitive bidding, price volume negotiations, and other appropriate mechanisms that influence supply, demand and expenditures on drugs and medicines.
We asked PAPO members on their views on the Cheaper Medicines Law and to our surprise, there seems to be little or vague awareness of this measure. Many patients continue to rely on their doctors for information about medicines and thus, healthcare providers are still the most effective conduit to influence behavior. Many patients have been informed by their doctors of cheaper or more affordable options and they know how to source these. Thus, at the patient level, Generika and The Generics Pharmacy have certainly made inroads in positioning their drugstores as providing these options. Rite-med thru constant TV advertising has also delivered the message of providing affordable alternatives to the extent of even asking patients to ask for their brand. Not to be outdone, Rhea generics has partnered with other companies to provide a viable competition for the high volume, low margin generics business. The work that remains to be done is at the Food & Drug Administration (FDA) level where a more rigorous process needs to be in place to assure patients of high quality generic medicines. Punishment for erring manufacturers, importers and drugstores must be swift and painful specially when patients’ lives are at stake. PAPO is willing to work with FDA to address the scourge of fake medicines.
The DOH, thru the National Center for Pharmaceutical Access & Management (NCPAM) has been relentless in promoting generics and ensuring there is compliance to the Generics Law. They have also implemented the Drug Price Monitoring System and most importantly have institutionalized a multi-stakeholder body to improve Access to Medicines. The Advisory Council on Access to Medicines, where PAPO sits as one of the members meets quarterly to discuss policy issues relating to health and medicines in particular. We have co-developed and participated in various fora and consultations on important AOs relating to patient safety, ethical promotions and others.
While the Cheaper Medicines Law has cushioned to some extent the cost of healthcare, there is still much to be done for patients.
There is a need to increase the support value of government and our Social Health Insurance thru Philhealth for our healthcare spending. Currently, on average, according to data from our National Health Accounts, about 57% is still paid out of pocket (OOP). For other diseases such as cancer, the OOP expenses are even higher. Currently, maintenance medicines available as Commpacks are only available to the indigents and free Tsek-up is not yet available to all Philhealth member types. There is a need and clamor for preventive health since Philhealth funds continue to be drained by expensive downstream treatments such as kidney dialysis, heart diseases and cancer.
PAPO therefore asks the QAMC Oversight Committee to look at addressing not just medicines but other sources of the OOP expenses such as laboratory and diagnostics services, medical supplies such as blood and blood products as well as professional fees of doctors. Please allow us to make the ff. recommendations:
- Provide Outpatient Health Services for all Filipinos
Encourage prevention among Filipinos and reward health-seeking behavior by offering incentives to those who live a healthy lifestyle. Assign Filipino families to a family doctor and encourage them to seek consultation at the primary level and help the manage their disease condition at an early stage by providing free maintenance medicines to prevent costly complications. Government should help encourage family medicine practitioners, allied health professionals such as nurses, pharmacists and others to work as teams to improve health outcomes of entire barangays and communities and not just individual patients.
- Increase the government budget for Universal Health Coverage
Government must endeavor to be a major player to really drive change in the health system. If UHC will cost 350 -600B, government should look at ways in funding this and at the same time ensuring healthcare providers are closely monitored and evaluated for their performance. This is where PAPO can help government – by providing a feedback mechanism and holding these institutions accountable. We are also committed thru our partnership with Philhealth to help educate and inform our patients about both our entitlements and responsibilities.
- Impose a MAXIMUM CO-PAY for All-Case Rates in Hospitals and strictly enforce the No Balance Billing (NBB) in government hospitals
In our dialogues with Philhealth, we are advocating a Maximum Co-payment for the other member types such as the those belonging to the formal economy, the OFWs, the informal economy and Seniors. Currently, the Indigents and Sponsored members are entitled to No Balance Billing (NBB) which is only being enforced in a dismal 60-70% of government facilities. Under our proposal for a Maximum Co-Pay, there will be some kind of predictability for patients for hospital confinement. Since Philhealth pays using Case Rates or fixed amounts for all conditions, there can be a system to enforce a maximum Co-pay for these except for those staying in suites.
In closing, allowing patient groups to be part of the policy-making process helps to ensure that policies reflect patient and caregiver needs, preferences and capabilities, making it a culturally-appropriate and cost-effective way to address the health needs of Filipinos.
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