 Welcome back to Kalusuga Naikarapatan. Good day to our viewers. We're being on hiatus lately, but we're certainly resuming our program to give you more information about your health rights. Yes, Dr. Lilly. We miss them and hopefully they also miss us, our dear viewers. Good day to our viewers and to you, Dr. Lilly. Our episode today is about the universal healthcare law and how our citizens can freely access this service. Good day to my Chancellor co-host, Dr. Carmen Cita Padilla. We have another exciting episode today. In fact, a recent and a time for us Filipinos to celebrate the universal healthcare law. This UHC law automatically enrolls all Filipino citizens in the National Health Insurance Program. It prescribes complementary reforms in the health system, such as expanding the health coverage of Philippine health members. They can now avail of re-medical consultations and laboratory tests. UHC is called a land mic law because it introduces major reforms, especially in the area of financing healthcare needs, ensuring that even the financially challenged can access the much needed health services and expensive but lifesaving medicine. This law is really relevant and useful. We know that healthcare in the Philippines is dependent on your financial capacity. It ranges from excellent quality if you have the money to dire or poor quality if you do not have the resources. You can see the economic divide. Hospitals in the major urban cities are of a high or excellent standard while many in rural areas have substandard service and sorely lacking in infrastructure. So there is hope in this law that even if you are poor, you may be given first rate health service. So how can Juan de la Cruz access the UHC service? I think we have distinguished resource persons to help us answer this question. It is about time, chance, or mention that we introduce them. Would you like to do the honors? Yes, Dr. Lili. So may I start with the chief of staff and undersecretary of health regulation team at the Department of Health. And concurrently, he is also officer in charge of the Food and Drug Administration. He is a graduate of the InterMed program of the UP College of Medicine and obtained his residency in Ophthalmology at the Philippine General Hospital and fellowship in Ophthalmic Pathology and Oncology at the University of Valladolid, Spain. He finished a master of science in clinical epidemiology and has a diploma in international public health at Institute of Salud, Carlos III, Escuela Nacional de Salidad, Madrid, Spain. Concurrently, he is an associate professor of the College of Medicine University of the Philippines Manila. He served as director of the Philippine General Hospital, City Councilor of San Fernando Pampanga and country coordinator for the Philippines at the World Health Organization, LCIF, Prevention of Blindness in Children Project. He was involved in the crafting and implementation of health policy from the municipal level to the national legislation to the first ever Global Health Treaty ratified by WHO member countries. Ladies and gentlemen, please welcome Dr. Rolando Enrique Domingo. Dr. Eric. Hi, ma'am Menchit. Hi, ma'am Lili. I'm very happy to be here. We have another illustrious resource person, a professor at the University of the Philippines College of Medicine in an academician of our country's National Academy of Science and Technology. He graduated from the UP College of Medicine and pursued residency on the internal medicine at the Philippine General Hospital, specializing in cardiology. He also obtained a master's science in clinical epidemiology at McMaster University, Ontario, Canada. Our resource speaker practices internal medicine at the Philippine General Hospital. His research and publications range from clinical trials on Nobel drives for primary and secondary prevention and epidemiologic studies on the burden of illness and causes of cardiovascular disease. He's one of the advocates who lobbied for stronger tobacco control to increase an excise tax on tobacco. His research on Philippine studies on primary care will give major insights into the implementation of the universal healthcare. Dear viewers, let us welcome Dr. Antonio Danz. Good morning, everyone. Thank you for inviting us here. Okay. So, let's start the... This is the first question, Yusek Eric. Can you tell us the components of the universal healthcare law? Well, when we say universal healthcare, it means, first of all, all Filipinos by virtue of birth are members of the National Health Insurance Program, whether you're contributing or indirectly being paid for by other sources. It also means that all resources for health will be pooled in one big fund. So, hindi na po kailangan humingi ang mga tao sa kong kanikanino para sa mga pangangailangan nila. We want to make sure that everybody will be assigned to a primary care physician and that everybody has access to quality care enough to make them better without exposing them to financial hardship. Yon po bang itung may makakasakit, hindi kailangan maghira pang bawat Filipino. So, the law has been signed, but have we started on the crafting of the implementing rules and regulations? Yes, we're doing the IRR now and it will probably be out by August or September this year which means we're going to have early implementation towards the last quarter of the year and then early 2020. When you say implementation, are we talking about a national implementation or is it going to be by stages? Yeah, it will probably take quite a few years before it's implemented nationally but we have advanced implementation sites. We have already identified provinces and cities that have systems that are ready to go. So, we're probably starting at about 30, 31 advanced implementation sites starting end of the year and 2020. And the implementation sites have been identified? Yes, they have already been identified and we've been doing groundwork already in these areas. So, we've been coordinating with the local government units, the governors and the mayors and trying to set up that system that will be ready for it by like towards the end of the year. So, how do you qualify as an advanced implementation site? So, the pre-selection was made. We had to look at the LGUs that had this. We had this interlocal health zones program that has been being done by the department that fell from years back and then we're looking at the readiness of that another of that area. The presence, for example, of primary care facilities of secondary and tertiary hospitals and of course, willingness of the local chief executives to join us. When we look at the total picture, how many sites are we talking about and when you say third implementation sites, what's the percentage of that number in the total picture? Oh, that will be about less than 20% of the total picture. So, we see this as happening in the next 5 to 10 years to cover the whole country. 5 to 10 years. Okay, but you intend to start towards the end of this year. As the IRR is finally approved and implementable. And you're talking about being accessed by everybody, no? So, can you give us some information on how the poor can access universal health care in the advanced implementation sites? How is it going to work, Papa? Ano ba in music, Eric? Bawat po kasi Pilipido, makakaroon ka ng assigned ka sa isang primary care practitioner. It can be a doctor, maybe a team of health professionals that might be a nurse, you know, a midwife. But you have somebody to go to for your daily needs. Nang kung meron kang sakit, kung may nararamdaman, dito tayo magpapatingin. And this will help you navigate the health system. Kung kailangan pumunta sa hospital, kung kailangan dalin sa ibang specialized centers, ito pa rin ang point of access natin at matutulungan natin ikaw na pumunta. Kung saan yung level of care na yung kinakailangan? I understand. Dr. Eric, primary care provider is needed to implement this law. Who will qualify again, please? Well, there's going to be a set of standards that we're going to put up. So makakaroon tayo ng pamantayan, kung sino yung primary care physician, it could be a doctor who's practicing now, who might be a specialist but might have to get extra training, it could be a fresh graduate who will have to undergo a module, training and then take a qualifying exam and then the person will be certified as a primary care practitioner. So, Dr. Tony, so you're an internist on your cardiology. So my question now is can you qualify as a primary care provider? Yes. So, kailangan, one thing we want to achieve in the future is to make primary care a specialty. So para lang maintindihan ng nakikinig, ano ba yung primary care? Apat huang tungkuli ng primary care, siya yung first contact, unang pupuntahan, pag meron kang naram naman. So, pag meron naram naman ka, hindi nakapitbaha yang tatanong mo, meron ka ng pupuntahan. Second, comprehensive care. So, hindi yung may doctor ka sa mata, may doctor ka sa tena, sa puso, sa bituka, sa bibig. So, to see most of all your illnesses, or one provider, not necessarily a doctor. So, first contact, comprehensive, tapos coordinator siya, alam niya kung kailangan kang ma-admit, mating na ng specialist, kailangan mo ng gamot or test. So, not too late, not too early rin yung healthcare mo, and not too much and not too little naman, and then the last obligation ng primary care is yung principal point of continuing care. Alam niyo, hindi natin na iisip, pag nabipask ka, nga rin, tagatawi-tawi ka, nabipask ka sa heart center, uuwi ka rin, di ba? Sinong mag-aalaga sa yung pagowi mo, yung primary care, pag na stroke ka, uuwi ka rin. So, someone has to take care of you, where you live, hindi naman pwede ng li-lipat ka na sa east avenue dahil nabipask ka. So first contact, comprehensive, coordinating care, coordinated care, and principal point of continuing care. So, sino bang gagampan ng tongkulin niyan, sa current workforce, ang primary care ng maraming tao, meron na tayong, yung iba meron, marami wala pa, alam, 66% of Filipinos die without seeing any healthcare provider. So, yung mga meron na, dapat, wag na natin galawin nyo, trusted na nila yung primary care provider nila. Pero we need to build that workforce in the future. So, ang tanong mo, pwede ba akong maging primary care, cardiologist ako yun? Alam mo kung magiging strict tayo and insist natin na specialist kagad in primary care, like in the UK, merong primary care specialist, but we can't do that right away. Right now, everyone has to help in primary care. So, whether you're a cardiologist, lung specialist, family physician, or GP, we even need the help of the nurses and the midwives. And in many areas, we will need the help of the barangay health workers to provide primary care. Ang responsibility natin is to provide training for them to understand that primary care is an important component of healthcare, of the healthcare system. So, ang sinasabi mo, it's going to be a teamwork. It's going to be teamwork. Pero kung pakikinggang ko yung sinabi ninyusik Eric na, well, okay, there will be training for all levels. There has to be a standard, a set of standards, cutting across from batanes to tawi-tawi. Pero pagsinabi natin may set of standards. It will be something that can be achieved by either a nurse or a physician. Am I correct? Of course, but not necessarily a barangay health worker. The barangay health worker will be a team player. Yes, support. Support yon. So, this is achievable. Actually, pwede natin, ibahin yung tingin natin sa mga barangay health worker. Pero kasi kung may exam ka, sa I'm just looking at that angle we're in, there will be training, and then there will be an exam. But of course, when I look at that set of standards, pwede tayo mag-level off siguro between the nurses and the physician because they meron silang kinuhang courses talaga during their... Yes, yes, yes. But I see everybody else around them as a partner, as a midwife, pwede pa siguro mag-level off. Alam mo, we have areas where there's neither a doctor nurse nor a midwife. In the U.S., they have the so-called physicians assistants. These are not doctors. They're lay people who trained one or two years in medicine. And they're allowed to see patients and give medications. But there's a requirement. They have to live within a certain distance from a primary care provider. So konwari, I'm not sure. I think 10 miles, there should be a primary care provider whom you can consult. And they're authorized. So community health workers in China are allowed to see patients. So dito, if we provide training for our community workers, for lay people, they can actually augment our primary care workforce. Ang problema, we give them obligations now on BHW ko atong kulin mo to. But we don't give them enough training. We need to professionalize our community health workers and make sure that when we assign them something, they are well-prepared to render those functions. I want to throw the question to Yusek Eric. I mean, is this the big picture when you say that you are looking for the primary care provider? Because earlier you talked about the different professions who can come and board. It can be one person, a physician or it can be a team. I think that's what we're going with the IRR. You need a licensed professional to be a part of the team, a nurse at least probably or a midwife. But you can have, if one person does not all have all the competencies in the set standards, then you can have members of the team who can compliment. So pwede pung isang tao, pwede rin mga groupo, but a team can be working up to the level of course of the community health workers. Okay. So in the upcoming advanced implementation size, this is going to be the setup. Yes. Well, no, the advanced implementation size are really more prepared. So these are, you know, provinces or cities which probably have a tertiary hospital, a few secondary hospitals and rural health units or barangay health centers in most of the barangay. So in the advanced implementation size. Parang sinasabi natin kompleto na yung ating. Medyo may, kompleto na yung recipe. Medyo may reseta na tayo na nanjahan na. So it's not going to be as difficult in the advanced implementation sites as in the sites later probably especially the more isolated and the disadvantaged areas. So when will we start, when will we start going into the more difficult areas? Well immediately, not as quickly of course as the advanced implementation sites, but the law also very clearly says that you have to have preference, preferential treatment for the geographically isolated and disadvantaged areas. Because these are areas that actually do not have health care access right now. So at the same time that we're doing the advanced implementation areas, we're also preparing the GIDA areas already. Actually some of the advanced implementation sites have isolated areas. Okay. So makikinabang na yung ibang areas na to sa by being advanced implementation sites. We can address the problems in those areas. For example, SORSOGON will be an advanced implementation site. And they have some municipalities with barang guys that are remote and disadvantaged. So advanced implementation sites are a mix of the urban, the rural and the the GIDA area. Because one, the provinces usually having almost provinces in the Philippines still have geographically isolated areas or barang guys that are really cut off in the rest of the province or the big cities. So these areas are also included when we do the advanced implementation. You know, earlier you said that we're looking at the full implementation in five to ten years. And so what do you see as the major concerns, major challenges in going forward in implementing it 100 percent. I'll start off with you say Eric. Well, the main challenges infrastructure, we know for example that we have 40,000 barang guys and communities in the Philippines and about half of them, only half of them have a barang guy health station. So in some areas you can probably tap private clinics and make them part of the primary care but there are areas with none. So we have to build those and the human resources. We know that we sorely lack human resources, especially in the far flung areas. We do have a lot of doctors and nurses but they're concentrated in the big cities. So have distributing them and have been making sure that we have primary care practitioners in all 40,000 communities in the Philippines. That's going to be a big challenge. Dr. Eric. Health is a matter of right. And I got sick recently for example and the local government tune it. Health center is not in accordance to your classification not just ready to practice primary care. If it is a matter of right how can I avail of this universal healthcare law? Well once it's fully running all community centers all primary care centers should reach that certain level of standard. We have a menu of the services that they should be able to give and the quality level that they should be able to deliver it. So what we really want is to everybody for everybody to have uniform access to uniform quality healthcare without spending money out of pocket and without going into debt just because you want to get better. So that's the dream. Everybody should be able to go somewhere near. We all know that care is better, cheaper and has best outcomes if it's closer to you and more generalized and more continuous. So that's the goal of primary care. We want it there in your community at a good enough quality for you to be better after you seek care at that center. Dr. Eric may I pursue my question. Considering the current healthcare service delivery system we know very well that different local government units have different levels of readiness. Some big cities or mega cities would have more resources and perhaps would be readily be able to respond to direct receipts to comply with the universal healthcare law. What would happen to local government units with less resources with similar problems? How will the universal healthcare law be able to give this privilege to have easy access to be diagnosed and be managed by the primary care team? So that's where the national government comes in. We have to give preferential assistance to those that need more help. We want, for example, to help deploy our health human resources and develop human resources from that area, give them scholarships and in the turn they will share with that area and build some facilities that are needed in those areas where they are sorely lacking. We understand that we have even provinces or cities have different levels of economic development and of infrastructure but the government will have to step in and try to help to equalize that but not only the infrastructure but also the human resources. So help is a matter of right, Dr. Danz and I understand it is alright but cannot be absolutely be asserted. So is there such a thing as shared responsibility here to make it successful? Well, yes. So nakaka-tua itong universal healthcare lo kasi we are now going to expand our coverage and you know it's healthcare regardless of ability to pay. Date binabayaran lang pag na-hospitalize ka pag malapit ka ng mamatay pero yung sakit that led to your hospitalization hindi natin binabayaran. O pag-uwimo kailangan mong gamot to prevent recurrence hindi yan covered date. Now it will be covered that's one of the main things in the universal healthcare lo. So yung karapatan natin mas ano na mas inaalagaan na because of that lo pero we also have to remember na meron din tayong tongkulin. We have a role to make it successful at isang nakihirapan kami explain doon sa aming study sites itong concept of risk sharing kailangan itong pull of funds from field health. Isipin natin o yung pull of funds nabibigay sa province nyo sa advanced implementation sites. Atin lahat yan ang bagan tayo dyan. We should not look at it and say may pera ako dyan I have 2,000 pesos of healthcare upunta ako doon ngayon and I want a urinalysis and my cholesterol and all my tests done. And begin nyo na ako ng antibiotics in case magkasakita ko this year magagamit ko na at siya ka parasetamol hindi po ganon dapat dahil ang bagan nyan ang bagan isipin natin na okay lang na hindi ako magkasakit ngayong taon na to okay lang na hindi ko maggamit yung pera na para sa akin kasi kung hindi ako nagkasakit una dapat masaya ka hindi ka nagkasakiti pangalawa yung pera na gagamitin saan sa iyo pwede ng gamitin sa ibang tao next year baka ikaw na yun ni so ang bagan tayo let's share the risk wag natin abusuhin na pupunta tayo doon lahat and we will demand yung funds na para sa atin we need to think ang bagan tayo let's share that fund let's stay healthy and let's take good care of it wag natin abusuhin alam mo napakagandan nyan Dr. Tony pero ang when you talk about funding from promotion to preventive to diagnostic hanggang treatment do we have the money for that so pwede natin pagusapan siguro kung samban natin koko yun yung pera nito because you talk about 110 Filipinos who probably million who will need this kind of share so Dr. Eric are we ready for the funds when we say universal health care of course hindi dapat isipin na lahat ng kailangan natin may bibigay ng gobierno sa lahat ng panahon for example there will be some illnesses that are catastrophic and maybe we might have to help we might have to have some out of pocket expenses but for most cases for most common illnesses and with the most basic basic accommodations and the most basic amenities in a hospital we want to be able to give that out of pocket ang ibig upusabihin kung pang merong nagsakit at nag-admit siya sa hospital kung dun siya sa ward na mga anim sila na tao sa isang kwarto wala ng aircon naman pero lahat ng gamot na kakailanganin mo may bibigay sayo maari kang wala nga gasto sin na ilalabas na pera but if you want for example a room with a private with a television and aircondition or a suite then you might have to shell out a little more money but what you want to give is to be able to give the basic service good quality service with the least amenities without out of pocket expenses okay, maganda yun na basic services okay para malino lang kasi para yung mga nakikiming natin kala natin you can just take in any any room but you're saying is that your responsibility is to make sure that the basic services are actually provided pero ang tanong ko ngayon yung sources of sa ampamang gagaling yung pera you okay yun kasing ayaw nat yung nangyari nga yun I'm most people especially sa province as the poor ones would this is a common experience you get out of the hospital you get the bill babawas yung fill out tas nalapit ka sa congressman mo sa mayor mo yung hindi ka sa PCSO hanggang makaubika parang na mamalim mo sa ang Pilipino so ito yung gusto natin yung avoid so all of those funds will be pooled magkakasama na po yung pera sa fill out yung galing sa tobacco tax sa sintaxis natin sa PCSO sa pag-core sa isang pooled ano na lang fund so that every time we get a sick as long as we are in the basic basic accommodations we would call them lahat po ng pool na yun na pera doy na gagamitin pambaya pero hindi na tayo kailangan umikot hindi na kawawa yung Pilipino at kakayani natin kakayani natin for the most basic for basic services and basic accommodations so looks like now may I ask Dr. Eric given the 100 million Filipinos and approximately how much are we talking about in terms of implementation of the universal healthcare how many billions to have full access to universal healthcare given the so many millions of Filipinos how much do we need well our budget for the first years about 257 billion and this incrementally grows to the next 10 years so that we are able to cover the gaps especially the infrastructure that we need to build and of course to increase the packages not the benefit packages in under filled health and the incremental increase is dependable on the Filipinos population growth rate yes and inflation and expanding we want expanding benefits now we want to start probably with the most basic benefits but to expand them little by little especially to include to expand yung outpatient packages that people should seek on a regular basis so my question to Dr. Tony Dance who is researcher, cardiologist looking at the population pyramid of the Filipinos and who would be what in the population pyramid would have the most need for this universal healthcare would it be geriatric care pediatric care maternal and child healthcare chronic diseases infectious diseases in terms of your casting right now half of the population is above 20 about half of us are below 20 so I'd say medyo balance naman yung pediatric and elderly but I think what we need to concentrate on now is the type of diseases that we will see because of development we are dying less and less of pneumonia so it's more chronic and tuberculosis so we're getting older lifestyle diseases so now we need to look at chronic illnesses because our system is ill prepared for chronic illnesses when our health system was developed in the 50s ang talagang hinaharap natin yan mga maternal and child illness infectious diseases but now since then our lifespan has increased by more than around 10 years and so now we need to look at people with chronic diseases of aging of related to lifestyle that need medication na hindi na one week lang na medication in series it's now life long medication pag may hypertension ka so we need to prepare our workforce to handle that our midwives and nurses need to we need to enhance their training so that they are now capable not just of infectious maternal and child care but they're now ready to manage chronic diseases in adults and in the elderly population so the department of health agenda would be able to really lay down the focus of this universal health care and I understand the health agenda of DOH is also focusing on lifestyle diseases geriatric care yes we still have that double burden we have TB and we have the infectious diseases but really the NCDs the non-communicable diseases this is the future it's diabetes and hypertension and heart disease and cancer and this is what we have to prepare for the thing is our population is going to get older much faster than the other countries did they had the time to prepare their longevity of their people grew in a longer span of time but the countries now are getting older faster and like I think like Tony said our health system is not prepared for that we're still ready for a young population but we have to get ready to take care of the older population in the next 10 to 20 years and it's something that we have to forecast actually Dr. Lilly sabi nila in about 10 years the geriatric age will almost double and we have to prepare for that one am I right? yes and are we preparing for that one? right now we have one or two geriatric centers for example in the whole department of health system but we have to start replicating this in all regions and at least in probably in all provinces very soon so we can foresee that it will happen but we have to actively prepare for it some you were mentioning something about population based and individual based services can you expand on that line? because well health insurance is supposed to take care of individual based needs for example I need I have pneumonia then Phil health will pay for my antibiotics but there are ways to prevent me from getting pneumonia which are population based making sure for example that the environment is clean prevent diarrhea by making sure the water for everybody is safe and clean and these are population based measures to help improve the health condition of the people and they should be taken care by other government agencies like the local government units for example or the ENR and the other departments so we have both population based and individual based care so in individual based this goes to Phil health but we should not forgo the population based measures that have to be taken care of by other agencies too So meron ba tayong agencies that are focusing on that one? You did those advanced implementation sites natin can we give an example to our viewers on an area we're in they've covered not only the health but also this population based service na example ka bang ngayin siptoni because it will be nice I think a lot of the population based services are already ongoing and I think the LGUs and the DOH and all the other departments are equipped to do that pero if I understand it right Eric you need to correct me on this all the funds from that are given to the special health fund for an LGU sometimes there will be savings and I think savings are important hindi po'y ding masyadong sa aid the LGUs need a profit margin that's one of the basic requirements for capitation and global payments to work there should be some profit margin and the law provides and you have to correct me on this if I'm wrong that profit margin some of it can go to population based measures as the LGU sees appropriate as an example for example Bataan Bataan the province is one of our early implementation sites and they have a very very strong program against tobacco so they spend a lot of money on health promotion and they have very strong legislation against smoking against selling cigarettes in front of schools and they have people going around and making sure that nobody smoking in public areas so this part is taken care of it's going to prevent a lot of disease it's going to stop a lot of children from starting that habit and in the end it will help conserve resources for our individual based care so you can see there are a lot of very creative and very good local government executives and we just have to self support them on that kasi ang sinasabi natin ang sinabi natin universal healthcare we're not just looking at fill health we have this perception that we're talking only about marabi misconceptions na hospital based kailangan lang fill health what we're saying now is that it has to be a coordinated effort from all sectors the funding component just pulling the resources is one that takes care of the funding but then engaging the local government now is another component that we have to consider to make it succeed it won't succeed without the local government now because once we have those systems it's really up to the governors and up to the city mayors to make sure that the system works so it's not optional the local government has to be very involved in this and we have to create that capability for the local chief executives to be able to manage the health system if you consider for example the major lifestyle related the major lifestyle problems we've been addressing smoking alcohol use lack of exercise and a healthy diet we've spent a lot of effort educating populations about this foreign you shouldn't smoke you shouldn't drink too much eat healthy exercise but no matter how much you tell people they will not change their lifestyle if we do not change the environment they live in we have to enable them for example we tell them to exercise here in Manila where will you exercise we need open space and alternative modes of transport to motorized traffic you tell them to eat healthy salads are more expensive than yung cup noodles and we tell them to smoke we did that I did that for 20 years in my career and nothing worked until we increased the taxes on tobacco big lang 4 million less Filipino smokers and these interventions we cannot say that they are DOH responsibilities if you want to provide open space kailangan kasama dyan ng LGU ang DPWH if you want healthy food kailangan kasama dyan ng Department of Agriculture Trade and Industry ang DEX kasama dyan because food in the schools so tobacco tax DOH will push it kaya lang actually increasing tax on tobacco is the work of senators and congressmen so yung Promotive aspects of health we should stop thinking na trabaho yan ng DOH trabaho yan ng buong lipunan lahat ng departments of the executive and our legislative sector this is their role to improve the health of the Filipino people so napakalawa ko ng scope of health promotion it should not be the soul function or it should not look at DOH as the soul implementer of Promotive health intervention so Dr. Eric we know very well the the pek of eating unhealthy food we know very well also but this is the most accessible as you have said Dr. Dan I myself I don't like fast food not because it is unhealthy but because it's quite boring already if you eat it because it's the most accessible if you are very busy person my excitement about this is introducing a new concept of practice of primary care I think this is very brilliant and developing countries like us would always need the practice of primary care and we can drum bit interest for Filipinos to have a thinking a paradigm shape about primary care as not a specialization of practice of medicine before so the practice of primary care for position would now be encouraging more physicians to be involved in the preventive and the promoting care and my last point about this primary care is for how long training should be should be done or how long will it take for the full implementation of universal healthcare considering the department of health is just trying to do some determination of the readiness of the different health system delivery in locally and nationally well for primary care practitioners for primary care providers we are going to develop curriculum we are getting the help of CHED of the Philippine Regulation Commission PRC and the Philippine Academy of Family Physicians to create a training program hopefully it's not going to be a long one maybe six months to a year for each health professional to enroll in that and then of course take an exam and to be a certified primary care practitioner I'm very happy to hear that from the point of view of commission and higher education in charge of health professionals we are trying to look into the possibility of making primary care as a specialization in the field of medicine so we are trying to consider a medical education focusing on the primary healthcare looking at the universal healthcare as the framework as basis to practice medicine we recently have approved two medical schools with a strength on primary healthcare one is in Davao it's a private school it's pattern after universal healthcare and Davao is so proud of this so that's the point of view of CHED CHED is very ready to be able to be part of this primary care medical education or health service approach to the application of the universal healthcare and goal right now we want to equip people and train people but in maybe 10 years from now it will be such a big part of the curriculum but by the time they graduate all medical graduates should be primary care physicians already we are in CHED and CHED would really like to be part of the OH and other agencies we really need to be comprehensive in our approach and I think that makes it universal there are two philosophies there I think one philosophy is everyone who graduates in medicine should be competent primary care providers and that provides us a short term solution kasi as they graduate then we can already assess them to render primary care services the other philosophy though if you look at the experience UK, Australia and Canada and even the US now the other trend is to make primary care a specialty so you require additional training and many believe that the single most important thing that pushed primary care forward in these countries is when primary care was recognized as a specialty so they are no longer the lowest rung in the ladder they now need additional specialization in Canada you cannot practice right after medicine you have to either go to a traditional organ specialty like the heart or the lungs or you go to primary care as a specialty for additional two or three years of training so we need a short term goal where we provide as many primary care providers as possible and we need a long term goal where we elevate the image of primary care because that's one of the problems now is people regard primary care kung GP ka o internist ka o family med ka pagtina nung mo saan ka ba nagpatingin family med lang or internist lang or GP lang tawag nga namin ang lang specialist laging may karutong na lang kasi doctor does not blame because the college of medicine in the Philippines that's the orientation professors will show you the glamour of being a specialist but if you look at studies now two things when you have primary care it means better care not too early, not too late not too much, not too little you need pag nagguno ka chest pain ka hindi lang naman puso yan pwede yan sa buto, sa balat sa laman, pwede yan sa baga pwede yan sa esophagus pwede rin psychogenic and the primary care people have the right attitude for that and then if you have multiple illnesses and multiple doctors na hindi naguusap your medications can be conflicting already or interacting and leading to adverse events the primary care with a global view who looks at your whole person not just at one part of your body provides better care and in fact a recent study shows if you have one doctor looking after your overall care you live longer that's a 2019 publication if you have one person in charge of your health longer kung merong kang doctor sa kaliwang tega at sa kanang tega at sa bawat, bahagin ng katawan mo right, no, no you have more crowd then so better quality and second at a lower cost so it is more efficient so we need to promote the value of primary care we need to recognize it the government has to recognize it doctors, nurses and midwives need to appreciate na we have an important role when we are in primary care and the community needs to recognize that so we can all say primary care is mentioned 13 times in the law but for that to work we need to make sure the image changes from top to bottom that we give it the appropriate importance that it actually has in making sure UHC is success so medical education is very important nursing education and public health education I think we need the second episode we'd like to request I guess to give a last message parting message Doctor Eric universal care is almost here and we need everybody's help this will come once in a lifetime we have to make it work there's no choice and this is something that we will leave for the next generation so we really need the support of everybody on universal healthcare so yes I just echo that it's so exciting to think that we may our children may live in a society where healthcare is provided regardless of ability to pay kaya lang there's a lot of anxiety accompanying this law and we need to replace that anxiety with determination we all have to make it work maraming anxiety ang specialists ang hospital ang private clinics ang public facilities they need to replace their anxiety with determination to make it work even the people are anxious but they have a role understanding yung sinasabi natin and risk sharing and protecting it and not abusing it so they have a role in making it work and we have one thing in mind that our children and our grandchildren should live in this world where there is healthcare regardless of ability to pay so Filipinos especially the poor are peening so much hope in this universal healthcare law it is really good that our resource persons have clarified some issues in the implementation of this law I hope our audience has benefitted from this episode we would like to say thank you to our resource persons Dr. Tony, Dr. Eric for ensuring and making us understand better the UHC law thank you to our viewers for joining us once more in this KK episode kalo suga na ikarapatan I hope you have found this episode relevant goodbye and mabuhay ang kalo sugan ay karapatan