[OPINION] Philippines’ peculiar health policy: Waiting until kidneys fail

Raphael Reyes/Rappler

The issue is not a choice between prevention and dialysis. The central issue is why public financing becomes so much more generous after kidneys fail than before they do. 

AT A GLANCE

• Chronic kidney disease is a growing health issue in the Philippines, largely driven by high consumption of salt and sugar, leading to hypertension and diabetes.
• The government spends significantly on dialysis treatment after kidneys fail, but much less on preventive measures, despite the cost-effectiveness of early detection and intervention.
• CKD is often asymptomatic until advanced stages, highlighting the importance of early screening and prevention to reduce the emotional and financial burden on patients and the healthcare system.

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This is not a story about kidneys. It is about what happens long before kidneys fail.

Consider two very ordinary things Filipinos eat and drink. A packet of instant noodles can contain about 800 to 2,000 milligrams of sodium. And that sachet of 3-in-1 coffee? Sugar is often its largest ingredient; there is surprisingly little actual coffee in it.

The problem is not one packet of noodles or one cup of coffee. It is the habit of consuming too much salt and sugar, often without thinking about the hypertension, diabetes, and obesity that may follow. These are among the major risk factors for chronic kidney disease or CKD.

Which brings us to a peculiar public policy choice: why is the government willing to spend enormous sums of money once kidneys fail, but much less to prevent them from failing?

CKD has emerged as one of the world’s fastest-growing non-communicable diseases. The World Health Organization ranks it as the ninth leading cause of death worldwide and projects it will rise to fifth by 2050.

The Philippine Renal Disease Registry shows a steady rise in patients needing dialysis or transplantation. CKD is becoming not only a serious health problem but an increasingly costly one. That makes prevention and early treatment all the more important.

In the Philippines, 57.44% of diagnosed CKD patients are aged 20–59, outnumbering senior citizens. Among patients starting dialysis, however, the largest age group is 51-70. In 2025, diabetes was the leading cause of chronic dialysis, followed closely by hypertension, and chronic glomerulonephritis, a disease that gradually damages the kidneys’ filtering system.

PhilHealth financing of dialysis

There are three main treatments for kidney failure: hemodialysis, peritoneal dialysis, and kidney transplantation. In the first six months of 2025, PhilHealth paid nearly ₱27 billion for over two million hemodialysis claims — almost matching the ₱28 billion paid for the entire year of 2024.

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• Rethinking renal healthcare in the Philippines

CKD is a silent disease: An opportunity for prevention

CKD is often described as a “silent disease” because most patients do not experience any symptoms until their kidneys have already been damaged. 

This silent period is a precious opportunity: health workers can identify people at high risk — particularly those with hypertension or diabetes — before further kidney damage occurs. 

The government is now experimenting with a more accessible model. It is offering free tests at selected drugstore branches to determine urine albumin-to-creatinine ratio, or uACR. This test examines urine for protein that can signal early kidney damage. The same test can reportedly cost ₱1,500 to ₱3,500 in hospitals and diagnostic centers. Between 2024 and 2025, more than 44,000 Filipinos were screened under an earlier initiative, with nearly 2,000 receiving positive results.

Costs of the progression of CKD

Living with CKD is not cheap. 

Several measures to prevent and control the conditions that lead to CKD, such as hypertension and diabetes, do not come with a single price tag. But evidence suggests that screening and treating people at greatest risk can be cost-effective. 

Once CKD develops, the interventions are more specific: early detection, control of hypertension and diabetes, the use of kidney-protective medicines, monitoring of kidney function, and prevention of progression toward kidney failure. 

As the disease progresses, the emotional and financial costs grow. We cannot quantify the emotional costs, but the financial burden increases dramatically as CKD progresses and kidney function declines. 

A study covering 31 countries, including the Philippines, projected that by 2027, patients requiring dialysis or transplantation would make up just 5.3% of diagnosed CKD patients but account for nearly 46% of CKD-related healthcare costs. In other words, roughly one patient in 20 accounts for almost half of the spending. That is extraordinary.

Another study shows that cost rises steeply as CKD progresses toward kidney failure. A Philippine cost-of-illness study estimated annual CKD management costs at about ₱45,000 in earlier disease, rising to nearly ₱117,000 as the disease advanced. Once a patient required chronic hemodialysis, the annual direct medical cost was about ₱560,000.

In these studies, the differences between early and late interventions are staggering. Yet much of our health spending becomes visible only at the expensive end of the disease — when patients need dialysis to stay alive. 

The economics should make prevention an easy choice. But it does not.

A better measure of success

The government knows CKD is costly and is pursuing both prevention and treatment. The issue is not a choice between prevention and dialysis. People need both. The central issue is why public financing becomes so much more generous after kidneys fail than before they do. 

Perhaps it is because the success of dialysis is visible. A patient arrives at a dialysis center three times a week and receives treatment that keeps her alive. Governments can count dialysis stations, treatment sessions, financing packages, and new facilities. And politicians like to cut ribbons to open new dialysis centers.

But the success of prevention is absence.

People with hypertension or diabetes whose CKD was detected early and who never progressed to kidney failure are invisible. They do not appear in a dialysis registry. Neither do the families spared the anxiety, expense, and disruption of reorganizing their lives around treatment several times a week. 

These are successes, but they are invisible. 

The Philippines cannot solve the growing problem of CKD one dialysis center at a time. The better measure of success may ultimately be the patient who never needs one. – Rappler.com

Marilen J. Danguilan, a medical doctor, is external affairs officer of Salubris Medical Center in Solano, Nueva Vizcaya, and an adviser to the Sasakawa Peace Foundation in Tokyo. She previously worked on legislation in the Philippine Senate.