Health inequalities are not removed simply because the resources are free and access is open to all, with preference for the marginalized.

In a paper published on Sept. 17, 2020 in the “Journal of Economics and Science,” authors Salaheddine El Omari and Mahmoud Karasneh found evidence that contradicts “standard economic theory predict(ing) that people use care services more frequently and regularly when they are free.”

Access to free medical assistance is still challenged by many factors, pointed out the authors of the paper, “Social health insurance in the Philippines: Do the poor really benefit?”.

In the 2013 National Demographic and Health Survey Report, lack of financial resources and remoteness of location constrain people’s access to facilities and their services.

The authors note that the average travel time is greater for those in rural indigent communities to access healthcare facilities (38 minutes), compared to the 28 minutes average travel time for residents in urban poor communities to reach a healthcare facility.

A person needing medical assistance will even walk to seek this. Yet, when gender is considered, the challenge of walking or commuting to a health facility is compounded by other factors, such as child-minding responsibilities.

Who will take care of her children when a mother needs medical help? In rural communities, neighbors or nearby relations may be relied on.

Yet, as the youth and able-bodied leave for the cities, the elderly left at home may not be physically able to look after someone else’s children.

Many women are forced to bring their children with them, rather than risk leaving them home where an accident may occur.

In the study by El Omari and Karasneh, women respondents surfaced cultural factors that continue to limit women’s physical and social mobility.

These women respondents cited as obstacles their need to secure permission to go for treatment; the need for money to use during a trip for transport, food, and other needs, especially when children accompany them; and their need for a companion due to their desire not to go alone.

For Lapu-Lapu City resident Leny and her sister Daya, two unsuccessful trips to the Office of the Vice President (OVP) satellite office in Cebu City have made them leery of making another attempt to get financial aid that would have covered injections Leny needed regularly as an out-patient requiring twice a week maintenance hemodialysis treatments.

After securing medical abstracts and other documentary requirements at the hospital she received dialysis treatments and the Lapu-Lapu City Government, the sisters went on two separate occasions to the OVP to apply for medical assistance.

They failed to get the guarantee letters because each time, OVP security and administrative personnel told them they lacked a required document.

Both women are in their 60s-70s. Directly after her three-hour dialysis session, Leny needs her sister to assist her to commute for hours from Lapu-Lapu City to Escario St., where the OVP satellite office is located. They commuted to the Lapu-Lapu City Government, accredited pharmacies for the signing of their forms, and back to the satellite office, only to be told at the end of each day that they lacked another requirement.

No strangers to waiting patiently for medical aid from various government offices, Leny and Daya say that what discourages them from making a third attempt to seek OVP medical assistance is anxiety over the wasted unexpected out-of-the-pocket expenses, considerable for the elderly unemployed women, one being on dialysis.

Should something happen to my sister (if we make another attempt), will the government just look at her and say, we cannot help you because you lack another requirement, reflected Daya.