Medicines and medical services are expensive. With earnings of only PhP48.70 per day, the indigent households in Quezon province cannot afford to buy medicines, much less avail of medical services. But their access to medicines and medical care started to improve in 2010 when the provincial government launched its “Lingap Kalusugan Para sa Barangay” program. The LGU aimed to provide quality health care that is accessible, efficient, evenly distributed, adequately funded, fairly financed and appropriately used by the citizens.
In 2012, the Provincial Council enacted the health coupon ordinance, which would allow indigent families to use coupons supplied by the provincial government to pay for medicines and medical services. Under the program, the provincial government distributes PhP50,000.00 worth of coupons to each of the barangays annually. The barangay captain is responsible for distributing the coupons to deserving indigent families, who are screened and selected with the help of informal leaders in the communities. The amount of coupon given to each indigent family is based on the medical charges billed by the community hospitals and also depends on the availability of coupons.
The beneficiaries surrender the appropriate amount of health coupons to the hospitals as full or partial payment for medicines and medical services. If the amount charged to the beneficiary is greater than the total face value of the coupons, the beneficiary will have to shell out cash for the expenses not covered by said coupons.
A monthly report on the usage of the coupons is submitted by the community hospitals to the Office of the Provincial Accountant to ensure proper accounting. In turn, the provincial government replenishes the medical supplies of the community hospitals based on the submitted monthly reports. The LGU also allocates funds for the improvement of hospital facilities.
From January 2011 to December 2013, a total of 138,547 people benefitted from the program. The coupons were used to pay for a total of PhP128.36 million worth of medicines and medical services. Of the total coupons, 58% were used to buy medicine, while 19% were used to pay for medical, dental and laboratory fees. A fifth or 20% were used to pay for patients’ food and hospital accommodation. The remaining 3% were used for Xrays, CT scans and other radiological services. Based on the number of beneficiaries and total cost of services covered, the typical beneficiary used an average of three to four coupons worth PhP926.50 during a year.
About PhP186 million worth of coupons were distributed to the barangays. Of these, PhP128.36 million were used by the beneficiaries, which meant a utilization rate of 69%. The coupon utilization rate dropped drastically in 2013 only because the use and distribution of the coupons were temporarily halted as part of election ban regulations. A total of PhP110.36 million has also been earmarked by the provincial government for infrastructure projects that will improve hospital facilities and services. Lingap Kalusugan was able to benefit indigent families in all the 1,242 barangays of Quezon Province, including the 147 remote and island barangays, where access is hindered by sheer distance and inadequate public transportation. Some of the beneficiaries travelled between 75 to 80 kilometers by boat and by walking on land for an entire day just so they could avail of the free health services from the community hospitals.
Close interactions between local government officials and the citizens strengthened community bonds. The program empowered the local officials to directly and swiftly address the needs of the beneficiaries, and to implement a more equitable distribution of the health coupons. And because the informal leaders among the indigent families were also tasked to assist the local barangay officials in identifying beneficiaries and in distributing the coupons, community involvement was ensured.
The distribution of coupons instead of cash to the beneficiaries guaranteed that the assistance provided would be used solely for medical and health needs. The potential for corruption is also reduced since the barangay captains and community hospitals do not handle cash. Lastly, funding support is guaranteed through legislation that mandates an annual appropriation from the general fund. All these features added up towards the program’s success.