Challenges for ‘zero balance billing’
One of the most-applauded parts of President Marcos’ recent State of the Nation Address, aside from the warning about shameless corruption, was that Filipinos need not worry about hospitalization because their bills are already considered paid in government hospitals (“bayad na ang bill ninyo”).
Thus, the “Zero Balance Billing” (ZBB) policy looked very good on paper. But on the ground, a lot of improvement is needed to make the system work for its intended beneficiaries—poor Filipinos who cannot afford health care.
The President himself found this out when he visited several Department of Health (DOH) hospitals last month: Long lines compounded by hospitals’ tedious process of applying for the benefit inconvenienced patients—and their families—already burdened by health issues. This could be addressed by using an electronic medical record system, which the Bataan General Hospital and Medical Center—one of the facilities that the President visited—has implemented.
But the queues and the bureaucratic process are the least of the problems. Health Secretary Teodoro Herbosa acknowledged that insufficient bed capacity and the lack of DOH-run provincial hospitals have made the ZBB privilege inaccessible to many Filipinos.
Significant gap
As of 2024, according to Herbosa, the country’s bed-to-population ratio was 1.005 beds per 1,000 population—lower than the ideal ratio of 1.5 per 1,000. On the other hand, the Philippine Health Facility Development Plan targets 2.5 beds per 1,000 population. The difference between the actual ratio and the target highlights a significant gap in health care infrastructure and exposes the risk that hospitals face in cases of public health emergencies, like what happened at the height of the COVID-19 pandemic in 2020.
Roughly half of the country’s 82 provinces, or 40, do not have a DOH hospital, forcing residents to travel long distances to the nearest city or municipality with government health facilities, adding another financial burden to poor patients.
Additionally, 80 percent of the population relies on public hospitals because they cannot afford private hospital fees. Thus, many government hospitals overflow with patients accommodated on beds placed in the hallways or in cramped waiting areas.
This is not to belittle the program, which has benefited almost 300,000 patients over the past three months, translating to around P26.4 billion worth of bill payments. The DOH also reported that daily average admissions have increased from 3,297 to 4,067 due to the policy.
However, ZBB has also highlighted the need to establish government hospitals in all provinces with sufficient capacity to accommodate patients.
Critical shortage
Looking at the agency’s budget proposal for next year, P126 billion or 54 percent of its P260 billion budget, will go to the health facilities operation program. This is a good sign.
However, as the Congressional Policy and Budget Research Department (CPBRD), think tank of the House of Representatives, pointed out in its notes on the DOH budget, increasing hospital bed capacity in DOH-supervised hospitals requires legislation. This process can take years, and the delay would only worsen the already critical shortage of beds in public hospitals.
The CPBRD has instead proposed that DOH be allowed to determine the number of hospital beds to ensure that health facilities are responsive to population needs, emergencies, and service demands.
At the same time, any expansion of government programs should be supported by an adequate number of capable staff members to implement them; otherwise, their objective will remain largely unmet. The government must also ensure that it has enough funds to pay for personnel, given that health care professionals who worked during the pandemic have waited years for their allowances to be paid out.
Preventive health care
Last September, Malacañang announced that it had finally released P6.77 billion to cover claims from 2021 to 2023. This should not happen again, where health care workers are made to beg for payment of services that have already been rendered.
Another challenge for the government is to pour more resources into primary health care, which is crucial in ensuring the health and well-being of the general population. This would help lessen hospital admissions by strengthening preventive health care.
More importantly, the government needs to sustain funding for the ZBB and ensure its continuity even when leadership changes, considering the notorious practice of political patronage at the expense of crucial social programs. The program itself, according to the Department of Budget and Management, needs at least P20 billion in annual funding to be sustained.
As the adage goes: health is wealth. The government must simply invest in it and make sure that universal health care exists not only on paper but in reality, and is sustained regardless of who is in power.
