Universal healthcare: Public guarantee, private hands

My mother asked me recently: “Why do we always think universal healthcare means government hospitals? Can’t private hospitals and doctors do it?”

It’s a fair question. In the Philippines, “healthcare for all” usually conjures images of state-run hospitals, barangay health stations and public doctors. Yet in countries like Germany, Switzerland and the Netherlands, most care is delivered by private providers. People are still universally covered — not because the government owns the hospitals, but because the government guarantees the rules, the coverage and the payments.

That is our “aha” moment: universal healthcare (UHC) is less about ownership and more about governance. It is about writing good contracts, enforcing them and making every peso traceable.

The problem at home

Healthcare still impoverishes Filipinos. In 2023, households paid 44 percent of total health costs out of pocket. That means half a million families fall into poverty each year just because someone got sick.

At the same time, two-thirds of our hospitals are private. Any attempt to build a massive public provider network from scratch will take decades and drain the treasury. The UHC Act (RA 11223) already gave us the framework: automatic enrollment into PhilHealth, province- and city-wide health systems and pooled Special Health Funds. But implementation has been patchy. Patients still get “balance-billed.” Local governments still guard their own turf. PhilHealth still struggles with late payments.

I think of a young father with kidney failure who skipped two dialysis sessions because he could not afford the “extras” outside PhilHealth’s package. He was not just a statistic. He became a funeral notice pinned outside a chapel, a reminder that sickness here is still a death sentence for the poor.

Instead of dreaming about a hospital empire, why not make the system we already have work better?

Where we should aim

Imagine a Philippines where:

●Everyone is enrolled. No more gaps, no more paperwork to prove you belong.

●Every Filipino has a primary care provider. That doctor or clinic is your front door into the health system.

●No balance-billing on a standard package. Covered services are truly covered, whether you walk into a public ward or a private hospital.

●Providers are paid on time. Claims are processed electronically; 70 percent released within days, the rest within 30.

●Quality is rewarded. Dialysis units with fewer infections, hospitals with fewer readmissions, maternity centers with safer outcomes - these get bonus payments on top.

●Every peso is traceable. Ghost dialysis and ghost deliveries cannot hide in a tamper-proof system.

That is not fantasy. In fact, reforms are already underway.

The playbook

●Primary care as the front door. Everyone registered with a general practitioner (GP) or clinic, paid through Konsulta — now expanded to include labs, cancer screenings, maintenance medicines and outpatient drug allowances.

●Hospitals paid for value, not volume. DRG-style case rates, outlier protection for complex patients and higher reimbursement rates for 2026.

●Quality over quantity. Facilities earn bonuses for fewer infections, safer deliveries, better chronic care.

●Money should be honest. Ghost claims and deliveries have haunted PhilHealth for years. What is needed is a national receipt book — a permanent log where every treatment and every peso paid is stamped, visible to patients, auditors and the public. It will not solve every problem, but it closes the door on fraud at its root.

●Fair drug prices. Centralized negotiations, published references, aligned reimbursement.

Simple rules. Honest rails.

What is fair for providers

Here is the part often left unsaid: are Filipino health workers fairly paid?

The average physician earns about P1.3 to 1.5 million per year. It may sound like a comfortable sum, but after 10 to 15 years of training, the weight of life-and-death responsibility and the cost of raising a family, it falls short.

A dignified, balanced life — housing, education for children and some savings — typically costs about P3.5 to P4.5 million a year in National Capital Region, more if you include premium schools or extended-family support.

Some specialists in large cities do better, but most doctors — especially those just starting out, those in government hospitals, or those serving in the provinces — do not. Nurses fare even worse, many earning only P20,000 to 30,000 a month, while abroad, they can earn five or six times more. Midwives, aides and medical technologists often take home barely above minimum wage.

Doctors who should be spending weekends with their families are often forced to take extra shifts or multiple jobs just to make ends meet. The very people entrusted with preserving our health are sacrificing their own balance and well-being in the process.

We cannot call it universal healthcare if it still drives families into universal debt — and that includes the families of health workers themselves.

Fairness is not just about how much you earn. It is about getting paid on time, having safe staffing ratios and being allowed a life outside the hospital without guilt or exhaustion.

Signs of progress

Yes, there have been gains. Dialysis is now free all year. Konsulta covers more medicines and screenings. Cardiac and transplant packages have expanded. And after a year of zero subsidy, government finally restored funding for 2026.

These are welcome steps - but they are still not enough.

Closing reflection

Universal healthcare is not about who owns the hospital. It is about who guarantees the rules.

We already have the law. We already spent nearly six percent of Gross Domestic Product (GDP) on health. We already rely on private hospitals. What we need is discipline in purchasing, fairness in payment and honesty in execution.

Health should not be bought at the cashier’s counter but guaranteed by the country’s conscience.

My mother was right. The government does not need to own every hospital. It only needs to guarantee that care is universal, payments are honest and no Filipino ever again has to choose between sickness and poverty.

That, more than any new building or ribbon-cutting, is what universal healthcare should mean.