Political patronage in health

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I HAD thought that after Congress expanded and strengthened the Philippine Health Insurance Corporation and enacted the Universal Health Care Act (UHCA), political patronage in health would finally come to an end and Filipinos would be freed from dependence on local officials, members of Congress and other government officials for hospitalization or even just a week’s supply of antibiotics.

But the thought remains just that—an idea.

Despite the lofty objective of the UHCA to provide all Filipinos with health care insurance, PhilHealth, the agency given the task, remains unable to do so.  And it is not for lack of funds.  Congress even saw it fit to deny the payment of premiums for sponsored or non-paying PhilHealth members because PhilHealth supposedly has “reserve funds.”

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Instead, our honorable Senators and House members lodged “pork-barrel” health funds with some other departments carefully hidden under some lofty program acronyms.  So, when their constituents (read, voters and supporters) get sick, they can endorse them to the “appropriate” agency for “appropriate” medical assistance.  It is pork barrel masquerading as medical aid.

Add to that the billions held by local officials from barangay kagawads to councilors to provincial board members to vice mayors to mayors to vice governors to governors for medical assistance to their constituents.

These funds are what these elected officials use to secure loyalties, to buy utang na loob—in the end to buy votes. It is worse than actually buying votes during elections because it perpetuates itself.

These come in different names, forms, and doses but the generic name is patronage funds.

The ostensible objective is to “bring health services closer to the people and give help to those who need it.” However, the underlying motive is to secure the loyalty and political support of a certain number of constituents.

Depending on one’s level of connections to the powers that be and the amount of help that one needs, one can have access to these patronage funds for health.

Say, an unemployed father has a son who has flu and needs to buy some medicines for fever and cough, he could run to the kagawad or the barangay chairman and ask for a few hundred pesos.

If the sickness requires hospitalization in a town hospital, relatives of a constituent can go to a councilor, the vice mayor, or the mayor for some cash assistance that could go up to a few thousand pesos, or if not, to a provincial board member, the vice governor, or the governor.

If the sickness is a bit more serious, one could approach his congressman or senator, in which case the “health assistance” could be up to tens of thousands of pesos or even hundreds of thousands, depending on how well-connected one is to the congressman or senator.

Then you have the Philippine Amusement and Gaming Corporation and the Philippine Charity Sweepstakes Office. These two agencies have billions of pesos to spare for “medical assistance” to “indigent patients.” But still, in most cases, how much you get—or whether you can get any assistance at all—is often determined by how close you are to those who run or have connections in these two agencies, or who endorse your request.

But worse, Congress has practically institutionalized this system of patronage with the establishment of the so-called Malasakit Centers in nearly every town or city. 

But come to think of it, if we have a really well-funded and fully functioning health insurance system for all, would there be any need for all these? Do people have to go to a “malasakit” center or to any government official to receive the “compassion” that they should get when they are sick?

So even with the “universal” health care law, politicians run an entirely separate universe of medical care. And they are not about to give up their control over this money at the expense of losing hundreds, thousands, or millions of votes.

Patronage works for them. Unfortunately, hardly for the citizenry.

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