Nevertheless, great disparities remained between and among various populations and geographic groups. The wide differences in the real state of basic health services up to the first referral or secondary care level available at every community are, to a significant extent, responsible for the continuing inequity.

Filipinos who can afford it receive basic health services at private clinics and hospitals that are staffed by specialists and equipped with sophisticated medical equipment.

The less affluent majority go to government health centers or hospitals. Except for a few localities, these facilities are poorly equipped and often lack supplies. Quality of care is dependent on the degree of commitment of local governments or individual health staff.

A number of public health interventions where there is strong support and coordination at national and local government levels appear to be relatively successful. An example is tuberculosis control where the TB DOTS strategy has reached internationally accepted targets in terms of case finding, treatment success rates and other program measures.

Even with the success of programs like these, however, great disparities in health outcomes among different groups remain. Consider maternal and child health status indicators.

Poor people in greatest need for health care, namely, pregnant women, the newborn, infants, and children, are underserved. Less than half of poor pregnant women in the country receive iron supplementation while 80% of pregnant women from the top quintile get this vital supplement. While 83% of children from top quintile homes get the EPI vaccines, while only half of those from low quintile families do so.

The national maternal mortality ratio is now estimated at 170 per 100,000 live births. Data limitations prevent us from estimating this ratio for the two income quintiles. But some process indicators suggest that the burden of maternal deaths is probably much higher among women in the lowest income quintiles. Among poor women giving birth, less than two percent undergo caesarian sections compared to 20 percent among their rich counterparts. Only a quarter of poor women give birth with professional attendance as compared to 92percent% of rich women.

As for child health indicators, the mortality rates for newborns, infants, and under-fives are significantly higher among the lowest quintile than among the highest.

Many factors contribute to entrenched health inequities in the Philippines, despite past attempts at reform – from primary health care and health for all in the 70s and 80s to today’s "Fourmula One for Health". Let me cite the factors dealing with the health sector’s complicity in these health inequities.

Disparities in access to basic care have persisted and worsened because of the fragmentation of the country’s health system. First, too much of our basic health resources are privately provided, privately funded and privately used mainly for the benefit of those who can afford to pay for these. Second, our public sector in health, which is the segment most amendable to equitable re-distribution on basis of the democratic principle of the greatest good for the greatest number, has been kept too small to make a real difference. And third, this already small public sector in health has been further cut up into smaller pieces by the faulty design of our public sector devolution of health services.

This structure of our basic health care delivery system explains the following features of the observed fragmentation: public/private segregation, over-specialization, and discontinuities between levels of care. This fragmented system has to contend with a population that has doubled since the days of primary health care while total resources allocated for health have not kept pace with this rapid population growth.

Meanwhile, even as we are still struggling to control health problems related to poor development (communicable diseases, maternal and child deaths, and malnutrition), there are significant indications that the so-called life-style and development-related diseases such as cardio-vascular disease, cancer, diabetes and other degenerative diseases are beginning to rise in prevalence. Unfortunately, even for these diseases, the poor, with their lack of access to information and services related to healthy lifestyles, are likely to suffer more from this so called "double burden of disease" than the rich.

For this reason, the government is under pressure to maintain tertiary care institutions. Erecting and sustaining these types of health facilities are expensive and, often these are put up at the expense of primary and secondary care programs. Although effective health promotion programs can mitigate the situation by reducing the chances of individuals falling prey to degenerative diseases, those who do get sick from complications of diabetes, cardiovascular disease, and cancer will still need access to technology intensive interventions available only at tertiary hospitals.

For sure a significant portion of the need for tertiary care could be avoided if our health care system did a better job of providing good quality basic care for all. Our failures in primary care only worsen our subsequent failures in tertiary care. Yet it is also clear that, if we are to deliver the benefits of life-saving technologies equally to all Filipinos in need, we should have a combination of: (a) regulatory measures to control the supply and distribution of capital-intensive tertiary care capabilities for greater efficiency and equity; and (b) a system of targeted public subsidies to make effective and appropriately-used tertiary care accessible, affordable and convenient for the poor and the middle class.