UHC at six: Is health care truly universal?

More than six years after the passage of the Universal Health Care (UHC) Act, two Filipinos can enter the same health system and experience very different realities. One may leave a government hospital without paying a centavo; another may still struggle to obtain the benefits the law says should be available to all.

This contradiction was at the heart of the fourth Dr. Stephen Zuellig Memorial Public Health Lecture, held on Aug. 6 by the University of the Philippines Manila College of Public Health (UP CPH)/TROPMED Philippines under the theme “UHC at Six: Gains, Gaps, and the Future of Health Equity in the Philippines.”

The lecture was delivered by Dr. Carlo Panelo, a UP Manila professor and health economist currently on secondment to PhilHealth. He reminded us of the UHC law’s promises: stronger primary care, universal enrollment and immediate eligibility for benefits, and the integration of a fragmented, devolved system into coordinated province- and city-wide health networks.

Despite the enormous disruption caused by COVID-19, there have been important gains. For the first time since 1995, aggregate government health spending—combining national, local, and social health insurance funds—has overtaken out-of-pocket spending.

PhilHealth benefit payouts have increased significantly, while primary care initiatives such as Yakap and Gamot are gaining traction. Zero Balance Billing in public facilities and the Department of Health’s Bagong Urgent Care and Ambulatory Service centers are also bringing comprehensive coverage closer to reality.

But progress remains uneven. National averages can conceal profound inequities. Estimates presented during the lecture suggest that life expectancy may differ by as much as 20 years across provinces. In many geographically isolated and disadvantaged areas, health services remain underutilized not because people do not need them, but because facilities and health workers are simply unavailable.

More money has also not automatically translated into better services. Constraints in government spending capacity and delays in reimbursements mean that resources do not always reach patients when and where they are needed. Expanding insurance benefits without improving efficiency also risks having additional resources absorbed by rising medical costs rather than translated into better health outcomes.

The discussions among governors, local health officials, national government leaders, researchers, and academics point to several priorities for the next phase of UHC.

First, local leadership and integration matter. UHC ultimately succeeds or fails where people live. Strong provincial and city governance, integrated local health systems, interoperable digital systems, an adequate health workforce, and effective management of the special health fund are essential.

Second, money must reach services. Allocating more resources is not enough. Health financing succeeds only when funds are efficiently converted into accessible, quality services that Filipinos can actually experience—even in the farthest barangays.

Third, equity must be the ultimate test of UHC. Expanded benefits, new facilities, and integrated networks are means, not ends. The real measure of success is whether these reforms reach poor, geographically isolated, and historically underserved populations.

Fourth, universities must become active partners in implementation. Academic and research institutions should not remain observers of health reform. They can cocreate solutions with government through research, technical assistance, capacity-building, and implementation support.

This is particularly important in strengthening local leadership. As a trainer and coach, I have witnessed how leadership and governance training for local chief executives—from provinces down to barangays—can translate into meaningful improvements in health. Leadership is the steering wheel of the local health system: it influences how resources are mobilized, how services are organized, and how the different parts of the health system work together.

Yet these gains remain vulnerable to electoral turnover. To sustain UHC beyond political cycles, the DOH should work more deliberately with academic and other partner institutions to institutionalize leadership and governance capacity-building across all levels of local government, including barangays and the Sangguniang Kabataan.

More than six years after the UHC law, the question is no longer whether the Philippines has begun implementing universal health care. It clearly has.

The harder question is whether Filipinos—regardless of where they live or how much they earn—can feel its promise in their everyday lives.

Universal health care will not be achieved simply when everyone is enrolled in PhilHealth, when more benefits are available, or when more money is spent. It will be achieved when a Filipino’s chances of receiving quality health care no longer depend on geography, income, privilege, or luck. Only then can we truly call our health care universal.

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Ernesto R. Gregorio Jr. is coordinator of the UP CPH Dr. Stephen Zuellig Program for Health Leadership and Governance.