Several governments in the Asian region are grappling with under-financed and under-resourced cancer care and control systems while a few others are discussing how to spend “scarce money” wisely.
The Economist, at its recently concluded event “War on Cancer 2017” shed light on this issue by bringing in the health minister of Philippines and Taiwan to explain about the various approaches taken by their governments to healthcare and cancer funding in a panel discussion. They discussed about the various factors that influence their decision-making and how they could get more priority funding for cancer control in their respective countries.
The Secretary of Health of Philippines, Paulyn Rossell Ubial, started the discussion by telling about how the evolving landscape for financing healthcare in the Philippines took a turn around with the implementation of the Sin tax law. In 2012, the Philippines implemented excise taxes on tobacco and alcohol, dubbed the Sin Tax.
Paulyn stated that the Sin tax resulted in over 100% increase in the health budget in 2013 and that it had increased five times since then. This enabled the government to enroll the poorest Filipinos in the national health insurance program with the highest enrollment rate of 92% in 2015. Paulyn added that the government is taking steps to allocate more funds in 2017, so as to enroll the remaining 8% in the national health insurance program.
With regard to funding cancer care in the Philippines, the benefits of health insurance cover a limited number of catastrophic cancers like breast cancer, cancer in children and prostate cancer. The Philippines government believes in covering more such cancers in future by gaining more funding with an increased health insurance premium.
The government has also increased funding for preventive programs such as the annual checkup for all Filipinos enrolled in the health insurance program.
Presently, the annual checkup serves as a basic screening strategy involving breast examination, visual screening for cervical cancer, digital rectal examination for prostate cancer and blood chemistry for diabetes and hyper leukemia. With improving infrastructure via building more number of polyclinics and cancer centers, the government aims to make this checkup a more comprehensive screening. The program covered about 20 million poorest Filipinos in 2016 and is now aiming to cover 100% of the 102 million poorest Filipinos.
While a significant part of the incremental revenue from Sin tax goes into cancer care and screening, about 30 to 40 billion of the funds is used for programs such as screening and promoting healthy lifestyle.
She stated that, the successful implementation of the various health care programs can be attributed to the cooperation of the finance ministry that views all the various intervention in taxation, particularly of sin tax as a health intervention and not as a revenue generation. In order to improve the absorptive capacity of the health department in terms of utilizing a much bigger budget, the health ministry is planning to outsource the various health programs to private sector and NGOs.
As a means to track outcomes of the various programs, the health ministry of Philippines is focusing on integrating the various individual electronic medical records, into a national database in the coming years. Through this, the country aims at having real time data of detection and screening. With all the various measures, the country still spends only 4.2% of their GDP on healthcare which is way below the WHO recommendation of 5%.
The discussion also included the Vice-minister of Health and Welfare of Taiwan, Sen -Tien Tsai, who shared about the success of cancer care in Taiwan. Health care in Taiwan is considered one of the most highly efficient health care systems in the world. The National Health Insurance of Taiwan with the single-player insurance plan centralizes the disbursement of health care funds. About 11% of the health insurance expenditure in Taiwan is towards cancer care and treatment. Almost 99% of cancers in Taiwan are registered and this enables the health ministry to find potential cause for cancer, monitor results and design programs for the future.
The key takeaway from this session with the key policymakers of Philippines and Taiwan is that “Every country needs to improve its registry as fundamental equipment for fighting cancer.”