Dr. John Q. Wong
2016 Roux Prize Winner
As a young physician, Dr. John Q. Wong worked in an urban community clinic providing services and free medicine to tuberculosis (TB) patients. The clinic staff faced a problem, though, when they realized that many of the TB patients came in with chronic diseases – like hypertension, diabetes, or heart disease – but the clinic could not provide any of the services or medicines for these conditions. This story, told by Dr. Wong, encapsulates the situation in the Philippines and many parts of the world. People are suffering from diseases but do not have access to services.
In 2010, the Philippines began tackling this challenge head on when they established the Aquino Health Agenda to achieve universal health care coverage.
One of the main goals was to rapidly expand the National Health Insurance Program’s enrollment and benefit delivery. Providing health care for an entire country with a population of almost 100 million is no easy task, and the Philippine Health Insurance Corporation (PhilHealth) was created to lead this charge.
Previously, insurance was provided by both public and private sectors. Over the years wide-range coverage and low-cost services produced inadequate quantity and quality of public services, driving high- to middle-class Filipinos who wanted higher-quality benefit packages (and who could afford it) to the private insurers and services. This meant that the majority of those receiving insurance and low-quality services from the government were the poor.
If the National Health Insurance Program’s goal was to insure the entire nation, the government was going to need to maximize impact, save on costs, and ensure that the worse-off were not left behind.
But how should these benefit packages be chosen? Up until this point, PhilHealth had seemingly made ad hoc decisions about what packages would be covered under the National Health Insurance Program. There was no clear and definite decision-making process. They needed a systematic approach.
UNICEF, a partner in this initiative, approached Dr. John Wong to develop a new, evidence-driven process to help PhilHealth select services to include in the country’s universal health plan.
Now an epidemiologist and Associate Professor at Ateneo de Manila University, Dr. Wong specializes in using his skills with numbers to look for evidence that could help identify problems and solutions, and eventually translate these into policy.
“Since I have been working in epidemiology, I have begun to realize that it’s very true, public health is saving lives, millions at a time, and that is what I want to do,” said Dr. Wong.
Dr. Wong and his team needed to identify what was causing the most health burden to all Filipinos. Looking to disability-adjusted life years (DALYs), the cornerstone metric for the Global Burden of Disease study (GBD), Dr. Wong and his team identified the top 48 causes contributing to 80% of all health problems in the Philippines. They then paired this list with the interventions for these conditions that would be the most cost-effective to implement. Dr. Wong found that some of these interventions were already being implemented, but many new ones could be added inexpensively.
His recommendation not only became the core of the new prioritization process, but it also inspired a new comprehensive benefit package called the Guaranteed Health Benefit Package (GHBP). The GHBP would be rolled out to the 92% of Filipinos covered under PhilHealth.
Many benefit packages fall under GHPB, including one for premature birth. This package had already been under development for two years prior to Dr. Wong’s work, but it had never been passed by the PhilHealth board.
“For a long time we were grappling, we were struggling with statistics,” said Dr. Mianne Silvestre, Lead Consultant for the Prematurity Benefit Package. “We were having trouble showing to the National Finance Corporation that this is a package worth investing in.”
What would it take to finally get this package approved? Data.
Using Global Burden of Disease data, Dr. Wong and his team were able to show PhilHealth decision-makers that premature birth ranked number four for total disease burden in the Philippines out of the top 48 causes.
Mianne Silvestre’s team – and other benefit package teams who had worked tirelessly on getting approval for services that would greatly benefit Filipinos – finally had the data they needed to prove what they knew to be true. They were able to present to PhilHealth once again, but this time with compelling evidence in hand.
The GHBP will initially cover 15 million Filipinos in the most need.
However, nearly 8 million Filipinos still lack health insurance. Those who are covered still pay 60% of their health expenses out of pocket. As a result, many poor families cannot afford critical services.
Under the new expanded benefits plan, patients will have to pay little or nothing.
“There is a sizeable gap in the Philippines between those who can pay for health care and those who can’t,” said Dr. Wong. “If there is no help from government, if there is no push for universal health coverage, it will be very difficult to address the most pressing health problems, and families will continue to struggle to pull themselves out of poverty.”
The priority-setting process Dr. Wong has put in place will also have a lasting impact on the services and diseases covered into the future. This tool can now be used by PhilHealth when stakeholders approach them to pass particular packages of interest. PhilHealth can now provide a rationale to these stakeholders based on GBD data that shows which services should be provided for different diseases and how much burden these diseases are having on the population.
“The world can look at what the Philippines has done, because it used burden of disease data to set priorities and lead to more efficient use of its resources,” said Dr. Wong.
David and Barbara Roux established the Roux Prize in 2013 to award innovation in the application of Global Burden of Disease (GBD) research. The prize recognizes the person who has used burden of disease data in bold ways to make people healthier.
Mr. Roux is a founding board member of IHME and, over the past decade, he championed IHME’s most ambitious project, the updating of the Global Burden of Disease. And he encouraged IHME, as the coordinating center for researchers around the world, to find ways to make the information more useful, so that it would actually have an impact on the ground.
Since the first GBD publication in 1993, GBD data have been used in a wide variety of ways to inform better policymaking at the local and international levels. Mr. Roux wanted to reward that kind of evidence-based innovation and to encourage even bolder attempts to improve population health through better measurement of disease burden.
The Global Burden of Disease (GBD) is a systematic, scientific effort to quantify the comparative magnitude of health loss due to diseases, injuries, and risk factors. In 1993, the original GBD study was funded by the World Bank and featured in its landmark World Development Report 1993: Investing in Health. Co-authored by Dr. Christopher Murray, now Director of IHME, this study included estimates for 107 diseases and 483 nonfatal health consequences in eight regions and five age groups.
Now an ongoing enterprise with annual updates, GBD is an international, collaborative effort with more than 1,400 researchers in over 100 countries, led by IHME. Results are regularly published in peer-reviewed journals for more than 300 diseases, injuries, and risk factors, by age, gender, and country. For more information about GBD, visit IHME’s website.