public health

[Vantage Point] Cancer and the high cost of healthy living

Val A. Villanueva

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[Vantage Point] Cancer and the high cost of healthy living

David Castuciano

The poorest Filipinos allocate around 60% of their family’s income on food. They simply cannot afford to fall ill since over half of health care expenses are paid out-of- pocket.

For those with limited resources, being diagnosed with cancer may seem like an end-of-life verdict. Despite great medical science advances in cancer treatment and prevention, the disease still ranks third in causing morbidity and mortality in the country, with lung, liver, breast, colon cancers, and leukemia as the deadliest.

Many Filipinos simply do not have the wherewithal to get themselves treated. The cost of cancer treatment, ranging from ₱120,000 to as much as over ₱1 million, is beyond the means of poor families already burdened with the rising cost of living. The estimated price of chemotherapy cost per session, depending on the cancer type, starts at ₱20,000 up to over ₱120,000. Pray tell, how then can below-average earners afford to combat this deadly disease?

According to the latest estimates of the Global Cancer Observatory (Globocan), as of 2020, around 153,751 Filipinos have been diagnosed with various types of cancer: 27,163 are breast cancer patients, 19,180 have lung cancer, and 17,364 suffer from colorectum cancer.

While there have been efforts to make cancer treatment – including chemotherapy, targeted therapy, and chemotherapy drugs – available and accessible to more Filipino cancer patients, many have to still scrounge for funds to pay for the medical services they need.

Dr. Valerie Gilbert Ulep, senior research fellow at the Philippine Institute for Development Studies (PIDS) and concurrent director of the Institute’s research projects on health and nutrition, bares that, among cancer patients who receive inpatient medical services in public hospitals, around 15% of the cost of medical care is still paid out-of-pocket (OOP).

Over half – 55% – of the inpatient medical bill is covered by PhilHealth, while the remaining balance is paid by private entities (9%), local government units or the health department (7%), and other sources (14%). On the other hand, OOP expenses for inpatient spending in private hospitals were much higher (41%). PhilHealth covers 46% of the costs of medical services for these patients.

According to Ulep, 92% of the inpatient spending goes to hospital bills, 6% to non-medical bills (including transportation), and 3% covers the cancer drug purchased outside during admission. Data also showed that OOP and other forms of private spending account for the majority of outpatient visits. Outpatient spending in public hospitals is settled through OOP (29%), PhilHealth (24%), religious/other organizations (27%), and donations (20%). Cancer patients receiving outpatient medical care from private hospitals, meanwhile, pay 65% of their bill. Other sources, such as religious/other organizations, PhilHealth, private insurance, and donations, cover 19%, 8%, 5%, and 3%, respectively. The main source of outpatient spending are OOP, which are regressive and “catastrophic,” says Ulep.

“While PhilHealth provides a significant financial protection during admissions episodes,” Ulep adds, “households remain at risk of exposure to catastrophic spending because the support value (SV) of PhilHealth is only 50%, excluding purchases made outside hospitals,” he adds

Financial toxicity 

Acta Medica Philippina, a peer-reviewed general medical and health science journal published by the University of the Philippines (UP), published in 2018 a study that highlighted the economic impact of cancer diagnosis in families.

After analyzing the situation of 909 cancer patients in the Philippines, the study revealed that 40.6% of cancer patients’ families experienced financial toxicity or problems due to the high cost of medical care. The researchers also found that the mean combined OOP of respondents at 3 and 12 months after diagnosis amounted to ₱181,789.00.

Previously published statistics also showed that at least 7 out of 10 cancer patients in the country “drop out of treatment regimen” due to lack of funds.

Last month, instead of being excluded in the 2023 General Appropriations Act (GAA), Congress restored the government funds for cancer to a total of ₱1.56 billion. 

Of the ₱1.56 billion that will be lodged under the Department of Health (DOH), P1.054 billion will subsidize cancer prevention, detection, treatment, and care, in line with Republic Act No. 11215 or the National Integrated Cancer Control Act which aims to prevent cancer, improve cancer survivorship, and make cancer treatment and care more equitable and affordable for all.

A joint memorandum circular outlining the guidelines for using the Cancer Assistance Fund (CAF) was released last year stating that, on top of the restored cancer funds, ₱529.2 million worth of funds for cancer patients will remain valid until the end of 2023.

The restored budget still falls short, laments Dr. Marvin Mendoza, head of the oncology section at the National Kidney and Transplant Institute (NKTI). “We can beat cancer. We can save lives. We can do more if the budget is increased by Congress.” 

Health insurance is supposed to cover for health contingencies, yet many  Filipinos are still unable to afford insurance premiums or health insurance for their family members, according to Numbeo, a Serbian crowd-sourced global database of perceived consumer prices, crime rates, quality of health care, among other statistics.

High cost of healthy lifestyle

A healthy lifestyle should shield us from various ailments including cancer. Unfortunately, access to sufficient, safe, and nutritious food to meet dietary needs and suit individual preferences for an active and healthy life is not cheap.

Recent studies suggest that at least 42.61%, or 44.82 million, Filipinos cannot afford a nutritionally adequate diet. 

Researcher Anna Herforth and her colleagues said in a study that “[f]or the poorest people, acquiring sufficient quantities of essential nutrients and nutritious food groups would consume a very large proportion of their total income, or even exceed it.” They said large populations worldwide had limited to no access to three important types of diets due to high costs: energy-sufficient, nutrient-adequate, and healthy meals.

In the “The State of Food Security and Nutrition in the World” report of the Food and Agricultural Organization (FAO), Herforth and a group of researchers revealed that healthy diets are expensive and beyond the reach of millions of people. In their analysis, the researchers measured the lowest cost for a healthy diet, based on regionally representative dietary guidelines.

So much more needs to be done to make the Philippine health care system responsive to the needs of the poor. Cancer is just one of the larger concerns that needs to be addressed. Funding is sorely lacking. Elected officials display downright apathy towards the poor by prioritizing their “pet projects” in budget allocations over health care.

The poorest Filipinos allocate around 60% of their family’s income on food. They simply cannot afford to fall ill since over half of health care expenses are paid out-of- pocket. While it is the government’s mandate to ensure that each Filipino receives affordable and quality health benefits through human resources, health facilities, and financing, the reality continues to fall short of the ideal. – Rappler.com

Val A. Villanueva is a veteran business journalist. He was a former business editor of the Philippine Star and the Gokongwei-owned Manila Times. For comments, suggestions email him at mvala.v@gmail.com.

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