马尼拉大都会地区：米歇尔·帕隆波原以为，保持健康的生活方式——只吃有机食品、使用全天然产品——能让自己远离严重疾病。然而，2021年，她被诊断出患有二期乳腺癌。
METRO MANILA: Michelle Palompo thought her healthy lifestyle – eating only organic food and using all-natural products – would protect her from serious illness. Then, in 2021, she was diagnosed with stage 2 breast cancer.
“我当时真觉得自己要死了，”她说，“我心想，‘主啊，我的孩子还在学步，大儿子甚至还没到少年时期。我该怎么办？’”但帕隆波拥有许多菲律宾人都没有的东西：商业医疗保险。
“I really felt like I was going to die,” she said. “I said, ‘Lord, my child is still a toddler. My eldest isn’t even a teenager yet. What am I going to do?’”But Palompo had something many Filipinos do not: private insurance.
多年前，她丈夫为她购买的一份保险使她能够为治疗申领逾1.1万美元。
A policy her husband had taken out years earlier allowed her to claim more than US$11,000 for treatment.
菲律宾统计署的数据显示，五分之三的菲律宾人没有商业医疗保险。尽管国家实行全民医疗保障，许多人仍不得不面对高昂的医疗账单。
Three in five Filipinos lack private health insurance, according to the Philippine Statistics Authority, leaving many exposed to hefty medical bills despite universal state health coverage.
“如果我没有商业医疗保险，癌症可能已经发展到四期了，”帕隆波说。她指出，有些患者因无力承担药品费用而中断了治疗。
“If I didn’t have private insurance, the cancer might have reached stage 4,” said Palompo, pointing to patients whose treatment was interrupted because they could not afford medicine.
全民医疗保障仍存在缺口。根据《全民医疗保健法》，所有菲律宾人都是菲律宾健康保险公司（PhilHealth）的成员。
GAPS IN UNIVERSAL COVERAGE Under the Universal Health Care Law, all Filipinos are members of the Philippine Health Insurance Corporation (PhilHealth).
这家国家医保机构为药品提供补贴，并承担包括癌症、结核病和慢性肾病在内的疾病治疗费用。但其中仍有缺口，尤其是在患者不得不前往私立医院接受治疗时。
The state insurer subsidises medicines and covers treatments for illnesses including cancer, tuberculosis and chronic kidney disease. But gaps remain, particularly when patients have to seek treatment at private hospitals.
制药公司Unilab于2022年开展的一项研究发现，菲律宾家庭自付了全国近一半的医疗支出。
A 2022 study by pharmaceutical company Unilab found that Filipino households paid nearly half of the country’s healthcare expenditure out of pocket.
商业医疗保险可以帮助承担这些费用，但其可负担性仍是主要障碍。
Private insurance can help cover those costs, but affordability remains a major obstacle.
菲律宾人寿保险承保人协会主席克里斯廷·马纳拉赛表示，许多家庭会优先处理眼前更紧迫的开支。
Christine Manalaysay, president of the Life Underwriters Association of the Philippines, said many households prioritise more immediate expenses.
她补充说：“在菲律宾，很多家庭 focuses on 食品开支、住房和日常预算，因此往往会推迟购买这类保障产品。”
“They tend to postpone these types of protection instruments because in the Philippines, a lot of households are focusing on food expenses, housing and their daily budget,” she added.
对奥蕾莉娅·德拉克鲁兹而言，在被诊断出患有二期乳腺癌时，公共医疗服务的局限便显现出来。她本可以在公立医院免费接受手术，但那里没有空余床位。
For Aurelia Dela Cruz, the limits of public healthcare became clear when she was diagnosed with stage 2 breast cancer. She could have undergone surgery for free at a public hospital, but there was no room available.
于是，她转往一家私立医院就医，手术费用接近1000美元——以她做女佣的微薄收入，根本无力承担。
Instead, she went to a private hospital, where the procedure cost nearly US$1,000 – a bill she could not afford on her salary as a maid.
“我的雇主给了我一些帮助，我的朋友们也帮了我，”她说，“在爱我的人们的帮助下，我才凑够了手术费。”九年后，她的癌症复发，这次已发展到四期。
“My employer gave me some assistance, and so did my friends,” she said. “I was only able to pay for the surgery with the help of people who loved me.”Nine years later, her cancer returned, this time at stage four.
德拉克鲁兹如今在菲律宾总医院接受免费治疗。她认为自己能住在马尼拉附近是一种幸运，因为当地更容易获得这类服务。
Dela Cruz now receives free treatment at the Philippine General Hospital and considers herself fortunate to live near Manila, where such services are more accessible.
将服务拓展至马尼拉以外 农村地区的患者选择可能更少，因为许多免费公共医疗项目都集中在大马尼拉地区。
EXPANDING ACCESS BEYOND MANILA Patients in rural areas may have fewer options, with many free public healthcare programmes concentrated in Metro Manila.
菲律宾健康保险署正通过与私营医疗机构合作，为患者提供“慈善病床”，以扩大医疗服务的可及性。
PhilHealth is seeking to expand access by partnering private healthcare facilities to provide “charity beds” for patients.
菲律宾健康保险署发言人兼质量保障组副主席阿尔弗雷德·菲利普·德迪奥斯说：“因此，我们目前正与私营机构合作，以确保医疗质量不会有差异，也确保这些患者不会产生任何自付费用。”这家国有保险机构还希望扩大对所谓“夹心层”的保障范围——这些人并不被视为贫困者，但仍可能难以负担私人保险。
Alfred Phillip De Dios, PhilHealth spokesperson and vice-president of its quality assurance group, said: “That's why we're engaging private institutions right now, to make sure that the quality of care will not differ and that these patients will not incur any out-of-pocket expenses.”The state insurer is also seeking to expand benefits for what it calls the “missing middle” – people who are not considered poor but may still struggle to afford private insurance.
德迪奥斯说：“仅仅一场灾难性疾病，就会让这些人跌破贫困线。”
“Just one catastrophic illness will push these people below the poverty line,” said De Dios.
与此同时，私营保险公司正在为无力承担传统保险计划的人开发价格更低的产品，其中包括每月费用仅为数百比索的微额保险计划。
Meanwhile, private insurers are developing cheaper products for those who cannot afford conventional policies, including microinsurance plans costing a few hundred pesos a month.
“每份保险保单的保障都没有上限，”马纳拉伊赛说。“我们可以根据客户的实际情况、预算、需求和目标为其量身定制，更重要的是，保单能够提供相应的保障。”观察人士表示，仍需采取更多措施来提高金融素养、增加实际工资收入，使菲律宾人不必在基本生活需求和医疗保健之间作出选择。
“Each insurance policy is limitless,” Manalaysay said. “We can custom-fit it to the client, to their budget, to their need, to their goal, and more so, the protection is there.”Observers say more needs to be done to improve financial literacy and raise real wages, so Filipinos do not have to choose between basic necessities and healthcare.