For many Filipinos, the promise of Universal Health Care (UHC) represents a future where access to quality health care services is no longer a privilege but a guaranteed right. Since the enactment of the Universal Health Care Act in 2019, the country has made significant strides, including the rollout of PhilHealth’s outpatient package, the Konsultasyong Sulit at Tama (Konsulta) program. Yet, much work remains on the road to fully achieving UHC – there is a need to expand the network of accredited Konsulta service providers and enhance communication efforts to ensure that providers and beneficiaries are fully informed about these vital services.

To take the lead in addressing these gaps and support PhilHealth in expanding the implementation of Konsulta, the Unilab Center for Health Policy (UCHP) of the Unilab Foundation convened over 70 stakeholders from PhilHealth, NCR city health offices, private providers, and patient groups on September 13 in a roundtable discussion titled “Working Towards UHC’s Comprehensive Outpatient Benefit Package.” Through this collaborative platform, UCHP introduced the Konsulta Manual of Operations (MOP), a guidebook for healthcare providers and Local Government Units (LGUs) to streamline the implementation of PhilHealth’s Konsulta.

“We all have a unique opportunity to address the challenges of primary health care, which has been characterized as fragmented, uncoordinated, and isolated,” said Unilab Foundation Executive Director Atty. Jose Maria Ochave. “In this roundtable discussion, we can take small, yet deliberate and steady steps that will advance the 'health for all' promise of Universal Health Care,” he added.

Paving the Way for a Comprehensive Outpatient Benefit Package

As a country accustomed to fee-for-service healthcare, Filipinos often seek medical attention only when faced with serious health issues. PhilHealth’s Konsulta is shifting this mindset by promoting the importance of proactive healthcare through its comprehensive outpatient benefits program. Konsulta aims to ensure equitable access to quality and affordable healthcare for all Filipinos while protecting them against financial risks.

Launched nationwide in 2020, Konsulta aims to enhance health by preventing chronic illnesses, promoting early detection, and offering affordable medications. Through Konsulta, Filipinos can register with accredited providers to access a range of services including consultations, health risk screenings, 15  laboratory tests, and 21 essential medicines.

With over 2,600 accredited public and private primary care facilities as of April 2024, the Philippine health system is still struggling to meet the ideal ratio of one facility for every 20,000 Filipinos. This discrepancy highlights a broader issue: while programs like Konsulta have the potential to transform healthcare access in the Philippines, their consistent and effective rollout requires more than just the efforts of PhilHealth. Government agencies, local governments, private institutions, and communities must work together to ensure no Filipino is left behind.

A Guidebook for Konsulta

PhilHealth has already made significant progress in its rollout of Konsulta. In its commitment to further improvement, PhilHealth engaged in an open discussion with public and private Konsulta providers, LGUs, and patient groups, which revealed the challenges encountered in the implementation of Konsulta. Among these are difficulties with navigating finances, facility accreditation and patient registration, patients’ unfamiliarity with the importance of the program, and the need for clearer processes and better information dissemination.

“The Unilab Center for Health Policy believes in PhilHealth’s Konsulta, which is why, when it was launched, one of UCHP’s first priority projects was to develop the Manual of Operations for the Konsulta package,” stated UCHP Program Director Ruben Basa.

The Manual of Operations, authored by physician-leaders Dr. Maeda Gonda and Dr. Shirley Domingo, is a comprehensive guidebook that aims to address implementation challenges by providing a clear, step-by-step guide on key aspects such as membership registration, provider accreditation, and social mobilization. Additionally, the Manual of Operations covers practical aspects of the Konsulta program, including benefits availment, provider billing, payment processes, and information systems, to foster a more structured and efficient approach.

“Our top priority is the convenience of our providers, our end users, and our administrators. They need to understand how to go about Konsulta—from the requirements to the actual implementation of the program,” said Dr. Gonda.

Change in Progress

The path towards Universal Health Care in the Philippines is not perfect. It is easy to see only the bumps in the road as we experience new health care challenges each day. Nevertheless, if we assess the incremental improvements we have accomplished through collaboration, such as PhilHealth’s implementation of Konsulta, the future of Philippine healthcare appears to be more promising.

Dr. Israel Pargas, Senior Vice President and Spokesperson of PhilHealth, also shared plans for the future of Konsulta.

“Starting new things is always hard because it’s a change. And that’s what PhilHealth and the DOH are doing through Konsulta,” said Dr. Maria Eufemia Yap, Member of the UCHP Advisory Council. Dr. Yap emphasized that the key to seeing the glass half full lies in effective communication. With the joint contributions of public and private providers, LGUs, and health leaders who understand their communities best, they can also help PhilHealth by conveying the government’s UHC efforts in a way that resonates with the people they serve.

Through the Konsulta Manual of Operations, the financial assessment framework, and strengthened collaboration among stakeholders, the Unilab Center for Health Policy reaffirms its commitment to helping PhilHealth expand Konsulta's reach. Together, these efforts aim to advance Universal Health Care and build a healthier, future-ready Philippines.