This will have repercussions with the private hospitals depending on early release of reimbursement claims or number of denials of payments.

In February 2019, Philippine president Rodrigo Duterte signed the Universal Health Care (UHC) Act into law, allowing all Filipinos to be enrolled to the National Health Insurance Program of the Philippine Health Insurance Corporation (PhilHealth). This gives citizens access to a full range of health care services, from preventive to promotive, curative, rehabilitative, and palliative.

By law, UHC will ensure that there is no balance billing for the non-contributory group members or ward admissions and sets fixed co-payment for contributory group members or private room accommodation. Amongst the reforms that will be implemented over time include designating PhilHealth as the national purchaser for health goods and services for individuals, improvement of health facilities especially in underserved areas, responding to the gap in health workers throughout the country, strategic engagement of the private sector; and creating and expanding new functions in the Department of Health (DOH) to improve the delivery of health services.

Healthcare Asia sat down with Dr Teodoro Herbosa, MD FPCS, executive vice president at the University of the Philippines and former Chief, Division of Trauma Surgery, Philippine General Hospital as he discusses the challenges in the new UHC Bill and how it can affect the operations of smaller private hospitals in the Philippines.

HCA: How does the UHC Bill affect the operations of private hospitals in the Philippines, especially the smaller private players?

The UHC bill strengthen the single payer health insurance by the government through PhilHealth. This will have repercussions with the private hospitals depending on early release of reimbursement claims or number of denials of payments. We will have to await the implementing rules and regulations or IRR to fully understand any changes in coverage of illnesses and payment schemes.

A case Payment System has been implemented which benefited the public hospitals as it added revenue to the high volume public hospitals but disadvantaged the private hospitals. Also, the PhilHealth has passed on the payment of doctors to the hospital administration. This has led to friction between hospital admin and physicians when the payment system is inefficient. Doctors needed to hire people to follow up such payments to prevent losses or unpaid claims.

HCA: What are the challenges that you see in its rollout and implementation?

The biggest challenges include the infrastructure gap in the health system which requires the increase in the capacity or numbers of public hospitals. Together with this is the human health resources gap as well and the concomitant brain drain of health professionals to other countries with higher paying jobs in the health sector.

I believe these solutions will take time, money and more work to be realised. The biggest threat we see is the question whether access to health and services will be adequate as we have increased the base of population that will be covered by UHC.

HCA: During the Healthcare Asia Forum - Manila leg in 2018, you predicted the demise of ‘mom and pop’ or small family owned hospitals- will the UHC Bill be able to provide a solution to this dilemma?

This threat continues. This threat is cash liquidity of the small hospital operations. They will have to partner with banks for loans for their cash flow and payment whilst awaiting. Delayed reimbursement which has become more with UHC.

Some solutions by the mom and pop hospitals have been to sell to the consolidators or capitalist buying hospitals through financial investment to allow them to be in operation and liquid.
 

It will drive future work to significantly slow down the disease.

After a grueling five-year study, a team of scientists from the National University of Singapore (NUS) have discovered a new link in the mechanism of Amyotrophic Lateral Sclerosis (ALS).

A study, led by Dr. Ling Shuo-Chien of NUS Medicine, revealed that neighbouring cells known as oligodendrocytes also participate in the spread of the disease. Prior to the study, it was widely believed that ALS only affected motor nerve cells.

This will help scientists better understand ALS, leading to the possibility of an eventual treatment for the condition. Healthcare Asia spoke with Dr. Ling to better understand the nuances of her study.

Healthcare Asia: Please share in brief the findings of your study. What were the challenges that you encountered?

Dr. Ling: TDP-43 is the defining pathological hallmark protein for two overlapping adult-onset neurodegenerative diseases, amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). TDP-43 proteinopathies are also found in other major neurodegenerative diseases, such as Alzheimer’s disease, further highlighting the pivotal role of TDP-43 in the nervous system. Curiously, TDP-43 aggregates are also found in oligodendrocytes, which provide myelination and metabolic support for the neurons.

Here, we show, for the first time, that TDP-43 is indispensable, in a cell-autonomous manner, for the proper functioning of mature oligodendrocytes, in particular, myelination and cell survival. Specifically, TDP-43 depletion leads to RIPK1-mediated necroptosis of mature oligodendrocytes and down-regulation of myelin proteins that are essential for myelination, but exerts no apparent toxicity on motor neurons.

Healthcare Asia: How can patients and hospitals leverage from the findings?

Dr. Ling: Given the prevalence of TDP-43 proteinopathies in ALS/FTD, AD and aged brains, boosting oligodendrocyte function may be considered as an additional therapeutic intervention for ALS/FTD, AD and age-related cognitive decline. It is worth noting that anterior white matter is preferentially vulnerable to degradation in aging and white matter integrity correlated negatively with cognitive decline associated with aging and AD.

Furthermore, FTD patients with a risk variant in the MOBP gene (myelin-associated oligodendrocyte basic protein) showed more severe white matter degeneration with shorter disease duration. Critically, recent genome-wide association analyses also identified MOBP as a risk factor for ALS. Thus, given the prevalence of TDP-43 proteinopathies in ALS/FTD, AD and aged brains, boosting oligodendrocyte function may be considered as an additional therapeutic intervention for ALS/FTD, AD and age-related cognitive decline.

Healthcare Asia: What is the current data on ALS across Asia and which countries stand best to leverage in this new information from your study?

Dr. Ling: The prevalence of ALS in Asia is similar to those in the US and Europe, which is about 5 per 100,000 people per year (incident should be about 1-2 per 100,000 people per year). Since ALS is an adult-onset neurodegenerative disease, the projection of ALS cases will increase by 70% by 2040.

Healthcare Asia: Can you share why there was a particular interest in ALS?

Dr. Ling: ALS is a fast-progressing and lethal neurodegenerative disease that typically kill patients within 1-5 years of diagnosis. Unfortunately, the approved FDA medicine could only extend the life span for a few months. Given the prevalence of TDP-43 proteinopathies in ALS/FTD, AD and aged brains, boosting oligodendrocyte function may be considered as an additional therapeutic intervention for ALS/FTD, AD and age-related cognitive decline.

Healthcare Asia: Moving forward, how can key players in the healthcare scene utilise the findings of this study in providing a cure from ALS?

Dr. Ling: As mentioned, given the prevalence of TDP-43 proteinopathies in ALS/FTD, AD and aged brains, boosting oligodendrocyte function may be considered as an additional therapeutic intervention for ALS/FTD, AD and age-related cognitive decline.