Turning Puffs Into Pesos

The Philippine’s Secretary of Health, Dr. Paulyn Rossell-Ubial, shares with Asian Scientist Magazine how her country has turned a tax on smoking into a health intervention.

AsianScientist (Aug. 10, 2017) – Although most cancers are the result of a gradual accumulation of genetic errors, about one in forty cancers is caused by a cellular catastrophe, where the genome suddenly shatters into hundreds of fragments.

For patients, receiving a diagnosis of cancer can be similarly devastating. On top of the emotional blow, cancer often leads to financial ruin, particularly for patients in developing countries like the Philippines where the GDP per capita is just US$2,900.

In fact, a study conducted by the George Institute for Global Health in Sydney, Australia found that 56 percent of Filipino cancer patients suffered financial catastrophe within a year of being diagnosed, defined as spending more than 30 percent of their annual income on treatment. Catastrophic illnesses can hasten death by causing patients to skip treatments, or send them into crushing debt as they borrow heavily to finance costly cancer therapies.

But help is on the way, albeit from an unlikely source: smokers. In 2012, the Philippines passed the sin tax reform law, ploughing revenue from the taxation of alcohol and tobacco products back into the healthcare system in the form of universal healthcare, upgraded facilities and medical training.

On the sidelines of The Economist: War On Cancer summit held in Singapore on 30 March 2017, Asian Scientist Magazine caught up with Dr. Paulyn Rossell-Ubial, a long-time smoking cessation advocate and currently Secretary of Health of the Philippines, to find out how the country plans to support its cancer patients and improve the delivery of healthcare.

What is the impact of cancer on the Philippines?

Paulyn Rossell-Ubial: Cancer prevalence is increasing but we don’t actually have a good idea of the exact number as we don’t have a national cancer registry. There are about 50,000 cancer deaths per year—it’s the third leading cause of death in the country. The top cancers are lung cancer and breast cancer for males and females respectively.

What percentage of the healthcare budget is spent on cancer?

PRU: The percentage [of the healthcare budget] spent on cancer is very small, at about one percent or one billion pesos (~US$20 million). This includes spending on preventive measures, as well as curative, diagnostic, palliative and rehabilitative interventions. Cancer takes up a small portion of the total budget because we’ve only just started developing the program. Due to a lack of resources in the past, we only did advocacy and health education; there was no diagnostic, curative or rehabilitative budget.

How has the increased health budget helped improve the lives of cancer patients and Filipinos in general?

PRU: Our situation took a dramatic turn when we implemented the sin tax reform law in 2012. By 2013, the health budget increased by more than 100 percent and since then, it has increased five times compared to 2012. With that, we are seeing more investments in terms of enrolling the poorest Filipinos into the national health insurance program, reaching 92 percent by 2015. In our 2017 budget, we’ve added a sizable portion to enroll the remaining eight percent into the national health insurance program.

“Our situation took a dramatic turn when we implemented the sin tax reform law in 2012.”

In terms of covering cancers, we’ve moved benefits from health insurance to cover more catastrophic cancers. At the moment, coverage is limited to breast cancer, cancers in children and prostate cancer. In the succeeding years, we hope to get additional funding to decrease health insurance premiums and cover other catastrophic cancers.

As I mentioned previously, we’ve also increased funding for preventive and promotive programs. In particular, we are looking at annual check-ups for all Filipinos enrolled in the health insurance program. Last year we started with 20 million of the poorest Filipinos, but we would like to move towards 100 percent coverage.

Why have you personally made smoking cessation such a priority?

PRU: Tobacco is the cause of 50 percent of all preventable deaths in the Philippines, so even if reducing the smoking rate is the only thing that I can put in place during my term as health secretary, I would be able to reduce all preventable deaths in the country by 50 percent.

Taxing tobacco to pay for healthcare is a two-in-one solution that not only increases the funds available for interventions but also helps to deter people from smoking in the first place.

Are there plans to expand the scope of the sin tax?

PRU: At the moment, we are working closely with the finance ministry. The finance minister and I are on the same page; he sees all these interventions as health interventions and not primarily as revenue generation. Right now, we are working on plans to tax sugar-sweetened beverages and use the incremental revenue to fund the health department. We are also working on catching sin tax evaders.

You served in the Department of Health for 28 years before becoming the health secretary. How has that experience shaped the way you lead the Department?

PRU: I’ve handled everything from the most peripheral facilities at a rural health unit to the city health office and programs in the central office. I’ve also handled a wide range of portfolios, from technical programs to regulatory agencies and even handled a hospital and a regional office. I think this experience has given me both depth and breadth in terms of service to the Department of Health.

That’s been an advantage for me as health secretary because I come in with all the institutional memory of what we did well on and what we didn’t do so well on. I have an idea of how to actually make systems in the Department of Health more efficient and effective because I’ve been through all the stages and I know the sentiments of the people. I personally know who the directors are, and am able to place responsibilities and duties on them that they can actually handle.

What are your priorities for healthcare in the Philippines?

PRU: I have convened a technical working group to outline what it takes to provide minimum or basic services for all life stages of the average Filipino. We looked at everything from the womb to infancy, childhood, adolescence, adulthood and old age, and we tried to map out what services would be needed and then identify who pays for what, whether it is the government, out-of-pocket, health insurance or a tax subsidy of some sort.

It’s a work in progress, but it will help us to prioritize. For example, should we focus on human papillomavirus vaccination or do we go for cervical cancer screening? Also, should we continue to procure chemotherapeutic drugs for childhood cancers or do we let health insurance fund the treatments? Those are the questions I hope that this technical working group can answer.

This article was first published in the July 2017 print version of Asian Scientist Magazine. Click here to subscribe to Asian Scientist Magazine in print.


Copyright: Asian Scientist Magazine.
Disclaimer: This article does not necessarily reflect the views of AsianScientist or its staff.

Rebecca did her PhD at the National University of Singapore where she studied how macrophages integrate multiple signals from the toll-like receptor system. She was formerly the editor-in-chief of Asian Scientist Magazine.

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