A shorter life

In 2000, a person born in the Philippines could expect to live to about 70 years old. By 2021, that expectation had fallen to 66.4 years, according to the World Health Organization (WHO). That was a startling reversal at a time when medicine and public health were making significant strides, with new vaccines and treatments, better diagnostics, major advances in the management of chronic illnesses, and wider access to technologies unimaginable to earlier generations. Across the Western Pacific, such gains have translated into longer lives. Life expectancy in the region rose from 72 years in 2000 to 77.4 years in 2021, based on WHO data. The Philippines, remarkably, went the other way. For sure, COVID-19 played a part in the 2021 figures, but the pandemic affected every country, rich or poor. It cannot explain why Filipinos are living shorter lives than their neighbors. What helps explain it is a health-care system that remains underfunded, paralyzed by bureaucracy and burdened by corruption. Now, the proposed 2027 national budget threatens to hurt more than heal a failing health sector. From last week's House budget hearings, the public learned that the Department of Health (DOH) had requested P837 billion for next year. But budget managers slashed that by over half, to P353.8 billion, in the proposed P7.2-trillion National Expenditure Program, also known as the President's budget. Acting Health Secretary Edwin Mercado warned lawmakers that the cut could delay the government's plan to add 15,000 hospital beds by 2028, on top of the existing 30,000. The Health Facilities Enhancement Program (HFEP), which funds the construction of new facilities and improvement of existing ones, has been reduced from P29 billion to P14 billion. The DOH's hospital operations funding is also down by P11 billion. And then there is Philippine Health Insurance Corp. (PhilHealth). The DOH subsidy for the state health insurer has been slashed from P379 billion to P73 billion. PhilHealth president and chief executive officer Beverly Lorraine Ho said the insurer expects at least P244 billion in payouts next year for indirect contributors if utilization and benefit levels remain the same. Mercado warned that PhilHealth may eventually be unable to sustain its benefit packages if the government subsidy falls below what was requested. It's the ultimate irony in health care: saving money today only to pay more tomorrow, when untreated illnesses become emergencies and families are pushed deeper into medical debt. The Alliance of Health Workers has called the proposed cuts a 'direct threat to the delivery of essential health services.' It pointed out that P33.9 billion has been cut from the operations of 72 DOH hospitals, while another P5.4 billion was slashed from the budgets of four specialty hospitals: the Philippine Heart Center, National Kidney and Transplant Institute, Lung Center of the Philippines, and Philippine Children's Medical Center. Public hospitals already face chronic shortages of health workers, overcrowding, aging equipment, and insufficient medical supplies. Cutting their resources further does not eliminate these problems but only transfers the cost and the burden to patients. At present, the country is dealing with surges in leptospirosis, influenza-like illnesses, and dengue. Meanwhile, the leading causes of death in 2021 included ischemic heart disease, stroke, lower respiratory infections, kidney disease, tuberculosis, and diabetes–conditions that require early detection, treatment, and sustained access to health services. That makes the proposed health budget particularly difficult to understand when compared with other budget items. The Department of Public Works and Highways, for instance, is being allocated P644 billion. Infrastructure matters, certainly. Roads, bridges, and flood control projects save lives and support the economy. But hospitals, doctors, nurses, medicines, and health insurance are infrastructure of another kind: one that keeps people alive. The country has learned the hard way that universal health care requires sustained public investment and accountability for every peso spent. It requires confronting the corruption and bureaucratic failures that have too often turned health funds into opportunities for abuse, or allowed badly needed services to languish in administrative limbo. The PhilHealth and Pharmally scandals during the pandemic were recent examples. Of course, throwing more money at a broken system is not the solution, but neither is starving it. Congress should restore the drastic cuts to DOH hospital operations, the HFEP, and the government subsidy for PhilHealth, while strengthening corruption curbs in the implementation of these programs. The government's answer should be to invest in keeping Filipinos alive longer, rather than cutting their lifeline. In a region where people are living longer, there's no reason Filipinos should be dying earlier.