Privilege speech of Senator Pia Cayetano
On the 6th Asia-Pacific Parliamentarian Forum on Global Health

Good afternoon, colleagues. My speech is about my visit to Korea, representing our Senate. So with the permission of the body, I will now deliver my report.

Let me start with a very common statement, I may not pronounce it well, but for those of you who watch K-drama, Annyeonghaseyo!

Mr. President, I rise today on a matter of personal and collective privilege to report on my participation in the Asia-Pacific Parliamentarian Forum on Global Health held last August 24 and 25, followed by a leadership conference the next day, as the sole representative of the Philippine Congress.

As an overview, the Asia-Pacific Parliamentary Forum is a platform for parliamentarians to exchange ideas, build political will, enhance capacities, and foster collaboration in driving sustainable action for health.

It was established in 2015 by the National Assembly of the Republic of Korea with the support of the World Health Organization (WHO). The Philippines has actually been a host in 2018.

So this meeting is the 6th, which was held in Seoul, Korea.

Mr. President, on the first day there were back-to-back sessions that started at 8 AM, and ended at 8 PM. The first session was on the learnings, and improving COVID response. My takeaway here is that many of us experienced very similar responses. It really was just a matter of how fast or how slow those responses were. Many countries gave some form of ayuda, again depending on the country, it was just a matter of how small or how big the ayuda was.

Session 2 was on investing in resilient health systems. This is the session that I had the opportunity to discuss the frailness of our human health resource. You will recall, especially the members of the last Congress, that the Doktor Para sa Bayan was defended by our Majority Floor Leader and co-sponsored by many of us. So I explained how this bill made use of futures thinking tools to not just provide for scholarships for doctors, but to ensure that there was infrastructure, budget, and capacity building for all the state universities and colleges that would be home to the future doctors. It was also through my interventions that the budget will continue to include, and I hope we will be able to continue it, budgets for the rest of the human healthcare resource. Not just the doctors, because I also shared that we do have the ability to meet our demand for doctors in a number of years, but for nurses, we will not be able to meet that demand unless we change things drastically. So I will not go into detail but I shared this during the second session.

The third session was harnessing innovation, and we had a very interesting presentation by Dr. Gauden Galea, who is the WHO Representative to China. He presented the future vision for public health, which included an operational shift towards innovation. He said there is no way that we will be able to achieve our goals for public health unless we harness the creativity of people from different sectors. He actually presented a photo of an Amorsolo artwork. He used this to [stress] that for innovations in healthcare, we need to look towards art. And without being able to appreciate art in its different forms, it will be even harder to think of technology in healthcare as we need to use it in the future. He also mentioned that the use of Artificial Intelligence (AI) and creativity will be very vital for the healthcare system. Our own Dr. Beverly Ho of the Department of Health also made a presentation virtually in this session.

In session 4, which was Opportunities for Parliamentarians to Support Health System Resilience, the representative from WHO discussed legally binding agreements such as treaties that members of parliaments can use as their tools to strengthen healthcare systems. Interestingly, the very important convention that she used is one of the few that I am very familiar with. This is the Framework Convention on Tobacco Control (FCTC), which the Philippines is a signatory to and which is the first international treaty negotiated under the auspices of WHO. You will recall, dear colleagues, that many of the treaties don't deal with health, they deal with other matters, so this was a very important piece of international agreement which showed how other subject matters, including health, can be the subject of treaties.

This was a long day, Mr. President. As I said, 8 am to 8 pm. For those of us who go to conferences, we look forward to coffee break. But here in this WHO conference, there was not just a coffee break but a mobility break. So I will share this with you [referring to a video to be played in plenary]. I don't think we need this in session, but this may be something of interest to us in long hearings, including the budget hearings. So this is our mobility break, dear colleagues. [video is played] They had a video of K-pop dancers dancing to K-pop, it's not my strength, but I participated nonetheless. And it was one whole song. I proudly will tell you all that for somebody who is not a dancer, I participated for the whole song. There is a 2-minute version but I will spare you that version. And then there was still coffee and tea after that.

The next day, to me, was more interesting. There were two tracks: one was on pandemic preparedness and response, and this group visited the National Biobank of Korea, Korea Disease Control and Prevention Agency, and Osong Advanced Medical Complex. I was very interested in this because I authored and was prepared to sponsor the bill along with the Committee Chairman, with our own version of the CDC. However, I made the tough decision to join track 2, which was on health innovation. The committee I chair is the Committee on SDGs, Innovation, and Futures Thinking, and thus, I felt I should attend this one. So here you are, I am showing you a picture where I am using a virtual reality gadget and I am actually inside an operating room. It didn't feel like I was just watching a video, I felt like I was at the operating table. And apparently, in Korea, they launched this during the pandemic, but now, they are making use of this as much as possible because it will allow medical students and even specialists to share their talents with medical students and other doctors. And I share this with all of you, because especially those who, like me, were sponsors of the Doktor Para sa Bayan, this would actually allow, like I said, med students in far-flung areas to engage or to at least be present. I am not kidding, I was like one meter away from the operating table. So I really felt like I was there. So I am sharing these kinds of innovations because this is what makes our job a little bit more exciting than the usual review of documents.

Another VR experience I had, I watched it, they performed CPR on a mannequin. It shows how a student would be taught. And apparently, he is receiving instructions exactly on how to do CPR, more pressure, less pressure, move your hands, and so on and so forth. Interestingly, dear colleagues, especially those in the last Congress, you will be happy to note that we funded an even more sophisticated version of this, minus the VR part, but the mannequin that would be used in operations for PGH. Na-FLR yan for the 2021 budget, but for 2022, I believe that this will materialize. And I invite all of you to take action when it is actually delivered to PGH. Yung sa atin na dineliver for PGH is the whole body. So it was actually initiated by a professor of OB-GYN in PGH. So yung sa atin, ginagamit yun para turuan ang mga estudyante how to handle births.

The other experience, and this is also very interesting to me. We weren't really allowed to take photos because the information there is confidential, it's not as if you would understand it because it is in Korean. But for those who visited command centers, it looked like a typical command center. We have one in Taguig City, I visited one in Baguio, but this one is a command center in a hospital in Seoul National University wherein they can see the data from a primary healthcare hospital that doesn't have the sophistication and expertise that are available in SNU. So the specialty doctors here can actually see the vital signs and condition of a patient in an ICU of a different hospital and can make interventions as necessary. Again, I believe this is a tool that we could also make use of because that is a problem that we also have in our country, there are not enough specialists to go around the country.

There was also a visit to the Korea Social Security System where they explained to us how the institution was responsible for the overall management and coordination of various social security data in Korea, including data from public health centers. So apparently, and this was explained to me by our Ambassador to Korea, Ambassador Tess De Vega, that your cell phone is connected to all your data, and you cannot change your cell phone on a whim because it will interfere with all the data that the country has collected for you. Hindi naman you have to go to court, but that was the feeling I got, it's very difficult to change it.

Then finally, we went back to session, and we were shown presentations by various startups. I don't know if any of you saw the Korean television program 'Start Up,' parang ganun, I had a live presentation from various startups. One was Crypto Lab, which was a contract tracing app that compares users' routes with the COVID-19 positive user's routes through GPS. Then there was Korea's No. 1 Medical Checkup Platform, Kindoc 2022. And more. So that was the second day.

On the last day, which was an optional event, but it was also hosted in Korea, this was the Executive Leadership Development Course on Social Health Insurance. I decided to attend because no matter how much I've learned about social health insurance, universal healthcare, there is really so much more to learn. And the first session conducted by Prof. Bong Min Yang, Professor Emeritus, graduate studies of public health of SNU, gave us a very good overview of universal health care in Korea, including some comparisons with other countries. It was a great review for me because he discussed the different payment schemes which are at the heart of the equitable and sustainable roll out of our universal healthcare. I know our colleague, the former Chairman of the Committee on Health, Sen. JV Ejercito, is familiar with this because during the time I made amendments to PhilHealth and his honor made further amendments for the latest UHC we have, we've changed our payment systems. For the information of the body, because you may be asking this in future hearings, please be guided by this because this is very important. There are 3 types of payment schemes. The first is 'fee-for-service,' wherein every single treatment procedure and service will be charged. We used to use this on PhilHealth. Ito yung kada karayom, kada bulak, kada dextrose na gagamitin, i-charge sayo bawat isa. So syempre ang mas murang ospital, mas mura ang charge, ang mas mahal, mas mahal. Pero they consider this very costly because there is no limit to what could be charged. And this is actually the system in Korea, which the good professor gently criticized. Thankfully, I was very proud to whisper that to my seatmate. Sabi ko, 'we are no longer in the fee-for-service.' We are now in the 'case-rate system.' In the case-rate, based on studies done, they average the amount that the whole procedure or treatment will cost. So this one is capped. And it is considered to be a much better system than fee-for-service. The problem though is this has to be updated constantly because if it's not up-to-date, nalulugi din ang mga ospital. And, I think some of our colleagues will recall, you remember what they call the ['upcasing' of cases]? They will charge you for pneumonia even if your ailment is just a cough and cold, because our system is not yet sophisticated enough to have those different variances, and we don't have outpatient treatment. So there are many cases where the intention is good, because they want to treat the patient, but the patient does not even have to be confined. But because he will not be able to get any kind of reimbursement for that kind of service, they will 'upcase' him or her to pneumonia. So these are growing pains that we should grow out of soon enough because the case-rate system can be quite effective if it is accurately utilized. Finally, which is considered the best system is the 'capitation' or 'global budget system.' This is where a fee is paid to a provider for the provision of services for a fixed period, usually one year, irrespective of what clinical services are required. So let me illustrate, the way this works is you would roll this out in a city, let's say in Taguig City, you would determine the number of residents and there would be an average amount that would be determined to take care of those people. So one figure given to us in one hearing was, I recall it to be something like PhP1,300. This is outpatient care. So let's say PhP1,300 times 1 million residents. That amount will now be divided among the healthcare providers and bahala sila to make that amount fit for the delivery of healthcare in that particular area. Apparently, this has been tested in a few areas [in the Philippines], and for the last two budget seasons, I have been waiting for clarity on the rollout of these test areas so we could institutionalize it and provide a budget, because this outpatient budget is very important.

Finally, I come to the end of my presentation. This comes after the conference. The 3 sessions ended on Friday, so I had the weekend to myself and I just wanted to share that the South Koreans are known to be very health conscious. I had the opportunity to visit Korea for the first time in the 1990s, and I went hiking and was shocked by the number of Koreans who were hiking. So this is actually Mt. Ansan, which was less than 30 minutes outside of the city. And you can actually see the city from the view. So I just wanted to share that they have done many things to make having a healthy lifestyle easier. And it is even wheelchair friendly.

And then the other one I wanted to share [photograph of a Medical Doctor/Member of Parliament is flashed]: she is a Korean MP, who was our host, if you look closely at the photo, she has this in her calling card and she proudly told me that that is a Filipino baby because she came to [the Philippines during] Yolanda to be part of the rescue mission, and stayed for about 1 week. So she is a doctor and Member of Parliament, and this is her calling card with a Filipino baby. Her name is Dr. Hyunyong Debora Shin.

So these are the things that I wanted to share. I may have a part two, Mr. President, to share my other learnings, of which there are quite a few more. But at least based on the conference, this is my official report for representing the Senate. Thank you, Mr. President.