Is it really possible for our country to have totally free public hospitals? I believe it is — if only the government would make a firm commitment to treat healthcare not as a market commodity, but as a public good and a human right.
To be fair, the government has already taken a big step through the Zero Balance Billing (ZBB) program in Department of Health (DOH)-managed hospitals. This means that indigent patients no longer have to pay anything for confinement in public hospitals. That’s a major milestone — something that previous generations could only dream of.
However, confusion arises when some of these same hospitals offer private rooms. Private rooms in public hospitals? It sounds like an oxymoron, but it’s the present reality.
Apparently, the DOH allows this setup so that hospitals can generate additional income. The idea is understandable — many hospitals struggle to pay for equipment, staff salaries, and maintenance, so they turn to “premium rooms” as a source of revenue. But this system creates confusion, and sometimes even frustration.
Imagine an indigent patient being admitted to a private room not by choice, but because there are no vacant beds in the wards — and then being billed for it. The intent of the ZBB program is noble, but the implementation becomes murky when hospital infrastructure and funding don’t align with policy.
I am not blaming the DOH nor the hospitals; the problem is budgetary. If Congress would increase the health budget — not just for national hospitals but also for LGU-managed ones — we could move closer to truly free confinement for all.
How Other Countries Did It
When I looked into how other nations made their public hospitals totally free, the answer was clear: political will and progressive taxation.
Norway funds its hospitals through high progressive taxes and oil revenues. Citizens pay no hospital fees at all. Transparency and strong governance keep corruption low and services efficient.
The United Kingdom established the National Health Service (NHS) in 1948. Funded by general taxation, the NHS provides hospital care, surgeries, and emergency services for free. Centralized procurement keeps costs down, while accountability remains high.
Sweden relies on income and payroll taxes, with regional governments managing hospitals. Most hospital care is free or heavily subsidized, and preventive healthcare keeps long-term costs low.
Canada’s Medicare system is jointly funded by federal and provincial taxes. Hospital stays, surgeries, and diagnostics are all free at the point of service — no one is turned away for inability to pay.
Cuba is a unique case. Despite limited resources, it provides free healthcare for all through a fully state-run system that prioritizes preventive and community-based care.
If these countries — each with their own political and economic systems — can make public hospitals totally free, then why can’t we?
The Common Denominators
Across these nations, success came from six pillars:
Universal Health Coverage (UHC) – healthcare is enshrined as a right, not a privilege.
Progressive Taxation – the rich contribute more to sustain public services.
Public Ownership and Infrastructure – hospitals, medicines, and logistics are state-run or publicly regulated.
Anti-Corruption Safeguards – transparent procurement, independent audits, and citizen oversight keep funds from leaking.
Preventive Care Focus – by keeping people healthy, governments reduce hospital congestion and long-term costs.
Investment in Health Workers – doctors and nurses are paid fairly, minimizing the temptation to “moonlight” or migrate.
What the Philippines Can Do
In our case, achieving totally free public hospitals would require a strategic shift in how we finance and manage healthcare. Here are some pathways worth considering:
Expand PhilHealth into a fully tax-funded universal health system, not just an insurance model.
Integrate LGU-run hospitals and barangay clinics into the national health network, ensuring equal service quality.
Increase DOH funding to reduce reliance on hospital-generated income from private rooms.
Leverage sin taxes and green levies (from tobacco, alcohol, and carbon emissions) to fund health infrastructure.
Digitize procurement and billing systems to cut corruption and make costs transparent.
Mobilize community health workers for preventive care and early diagnosis to reduce hospital admissions.
The Issue of Private Rooms
Why do public hospitals need private rooms in the first place? The short answer: to survive.
Because Congress often fails to allocate enough funding, hospitals rely on these private accommodations to generate income. Some patients willingly pay extra for privacy, comfort, or infection control. But the downside is that this creates a two-tier system — one for those who can pay, and one for those who cannot.
Ethically, that’s troubling. Public hospitals should be equalizers, not mirrors of inequality.
So what can the government do? For one, it could fully fund public hospitals to eliminate the need for private rooms altogether. Another option is to expand the No Balance Billing policy to cover all room types, not just wards. The DOH could also standardize care quality across rooms — ensuring that medical attention, not amenities, is the equalizer.
Long-term, if we strengthen barangay-level health systems, fewer patients will need hospital confinement in the first place. This is how preventive care ties into equity: when fewer people get sick, limited hospital resources go farther.
A Hopeful Vision
It is already a great achievement that we have the Zero Balance Billing program. But we can do more — if we have the same political will that other nations have shown.
Totally free public hospitals are not a fantasy. They are a reflection of a government’s priorities — a measure of how much a nation values its people’s lives.
If Norway can do it with oil, if the UK can do it with taxes, and if Cuba can do it despite sanctions, then surely the Philippines can do it too — if we choose to.
Health is not a privilege. It is the foundation of productivity, dignity, and nationhood. And if we are truly serious about national transformation, it should begin not in rhetoric, but in reality — in hospitals where no Filipino is ever turned away.
RAMON IKE V. SENERES
www.facebook.com/ike.seneres iseneres@yahoo.comsenseneres.blogspot.com 09088877292/05-25-2026
