When Health Care Becomes a Commodity: The Impact of Commercialised Health Services on Women

Experience shared by Alliance of Health Workers Philippines, partner of WSM and INSPIR network.  
 

Health system under pressure: triple burden on women

The Philippine public health system is predominantly curative, not preventive, with an emphasis on doctor-centred care that neglects the essential roles of nurses, midwives, and community health workers. Services are concentrated in urban centres, leaving rural populations (where we know poverty is often deepest) without sufficient access to facilities or professionals.

Medicines are prohibitively expensive, reflecting a health sector treated as business rather than a right. In 2022, the high cost of medicines was the single greatest barrier to access to treatment. Households in the lowest income groups, which make up the majority of the population (59%!), are far less able to purchase needed medicines, perpetuating cycles of illness and poverty.

Meanwhile, public health budgets continue to shrink. In 2023, the government reduced the health budget by Php 25.8 billion ($453 million USD), even as billions were allocated to pork barrel projects, confidential funds, and large-scale infrastructure. Public hospitals remain underfunded and severely understaffed, leaving patients dependent on costly private services.

Privatisation has also taken subtler forms: instead of selling entire hospitals, the government has allowed private companies to run hospital machinery and key services, allowing them to charge exorbitant fees that generate profits for corporations while excluding the poor. Insurance schemes, dominated by private providers, now impose a “triple burden” on families: paying taxes, premiums, and additional hospital costs on top of minimal PhilHealth  coverage, the national health insurance program.  

Women as Patients: Facing Barriers to Essential Care

For women as patients, commercialisation translates into limited or no insurance coverage. They have restricted access to maternal and reproductive health services, and inadequate mental health support. Many are forced to work despite illness to take care of their family, lacking paid sick leave. The constant stress and anxiety of navigating an inaccessible, costly health system weighs heavily on women, particularly those in low-income households, since they are the main breadwinner and care takers.

Women and undervaluation of their work: a fuel to global care chain

The impacts are most acutely felt by women health workers, who make up around 70% of the health workforce in the Philippines. While they form the backbone of the system, their labour is chronically undervalued. Health workers endure low wages, job insecurity, and contractualisation (working on temporary, fixed-term, or non-permanent contracts instead of offering permanent employment), often caring for hundreds of patients in a single day under unsafe working conditions.

At the same time, patriarchal norms impose additional unpaid care responsibilities at home, pushing women to juggle the dual burden of professional care and family care. Workplace inequality compounds this reality: women health workers face lower pay and fewer opportunities for leadership, despite their overwhelming presence in the sector.

This undervaluation fuels the global care crisis, as many Filipino nurses and health professionals leave for better-paid jobs abroad. Their departure deepens the staffing crisis at home, further undermining already fragile public services. They also contribute to better health care system and improve social protection in the destination countries by providing essential work, but cannot benefit from it, making them extremely vulnerable to precarity.

The toll on women’s physical and mental health is severe. Long hours, unsafe conditions, and stress erode well-being, while systemic inequality limits career prospects and quality of life.