Innovation in Access to Healthcare The Social Contract through Universal Health Care. Teodoro J. Herbosa, MD Undersecretary Department of Health

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1 Innovation in Access to Healthcare The Social Contract through Universal Health Care Teodoro J. Herbosa, MD Undersecretary Department of Health

2 Investing in Filipinos, especially the poor niversal Health Care Education Housing Good Governance

3 UHC: synchronized reforms in DOH and PhilHealth PhilHealth Expand Coverage Improve Benefits 5.2M to 14.7M families DOH Strengthen Preventive & Promotive Care Governance Reforms for Hospital Upgrade Health Facilities Improve Policy, Regulation and Sector Management

4 UHC financing requirements What we have (DBM Forward Estimates, in billion PHP) Total A Preventive & Promotive Health B PhilHealth Premiums C Hospital Operations D Health Facilities Enhancement Program E Policy and Regulation and Sector TOTAL What we need (DOH estimates, in billion PhP) Total A Preventive & Promotive Health B PhilHealth Premiums C Hospital Operations D Health Facilities Enhancement Program E Policy and Regulation and Sector TOTAL

5 Population Column1 Total PhilHealth Enrollment Where are we in UHC implementation? Year 17% 65% 95.8 M Increase in PhilHealth enrolment rate 100% coverage of NHTS-PR identified poorest households (14.7m families/40 M with annual premium P 2,400 or totalling P 35.7billion. 2013, enrolment increased to 82.4M 200+%inc in enrolment of the poor universal coverage achieved Introduction of More PhilHealth Benefits Primary Care Benefit Package Case rates for most common medical and surgical conditions and selected catastrophic diseases with No Balance Billing Policy for the poor or Sponsored members

6 Health Financing Implementation of Primary Care Benefit Packages (PCB): a. PCB 1 consultation, screening and diagnostics for NCDs i.e. Visual Inspection Using Acetic Acid Wash (VIA) b. PCB 2 - management and provision of medications for NCDs i.e. Complete Treatment Packs for DM and HPN Z Packages for catastrophic illnesses i.e. breast cancer and ALL Case payment rates

7 CHTs deployed Rnheals nurses/ others deployed What needs to be done to achieve UHC? Refocus preventive and promotive services to NHTS-PR/CCT families; Deploy Community Health Teams (CHTs) to increase use of services 50,000 22, ,000 22, ,000 11, ,000 11, ,000 11,000 Enroll/register, inform, and guide families on their PhilHealth benefits/entitlements Households covered by PhilHealth Poorest identified using NHTS- PR *Catastrophic care package introduced Expand to next poorest (Q2); Universal Coverage *Catastrophic care package fully implemented Universal Coverage 14.7m poorest families Upgrade quality of care at health facilities Universal Coverage 14.7m poorest families Universal Coverage 14.7m poorest families Facilities upgraded RHUs/Main Health Centers 2,243 District Hospitals 403 Provincial and City Hospitals 100 DOH-retained Hospitals 37* *Will take more than 3 years Note: Incentives to sustain delivery of quality care introduced by 2014 Maintainenance and upkeep of upgraded facilities; construction of new ones to ensure service capacity

8 UHC implementation status Treatment Pack (Medicines) and Vaccines Basic medicine packs for outpatient care (antihypertensives, antidiabetic, antibiotics, antiasthma etc.) distributed quarterly to all Rural Health Units nationwide Rotavirus vaccination for diarrhea for 700,000 poor children Pneumonia vaccines for 700,000 poor children and 1M senior citizens Influenza vaccines for senior citizens Health Human Resources Deployed Doctors to the Barrios: 62 in 2010, 113 in 2011, 221 in 2013 Nurses (RN Heals): 2010: 12,500, : 22,500 annually Community Health Teams: 164,456 members deployed in 2012 Health facilities upgraded 3,258 hospitals, rural health units and barangay health stations upgraded and rehabilitated from , P 18 billion spent for infrastructure and equipment

9 National Center for Health Promotion NCHP is the Department of Health s arm in promoting health in settings where people live, work, learn and play.

10 Some Health Promotion Activities LAKBAY BUHAY KALUSUGAN KALUSUGAN PANGKALAHATAN ON WHEELS - 1 Victory Liner-donated Bus - Transformation of 8 China-donated Mobile Clinic buses to LBK-KP

11 Health Promotion & ISO 9001:2008 In the pursuit to continuously improve, meet, and even exceed people s expectations of a QUALITY MANAGEMENT SYSTEM that enhances health care service delivery...

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13 Recommendations for DRRM Increase the logistics capacity and lifelines for health sector response: Emergency communications system Air Transport to, and within the affected areas Emergency logistical needs such as generators, hospital tents, etc. Build resilient health facilities Hospitals as the last facility standing Hospitals as hubs for energy, water, logistics, communications, and shelter Develop self-sufficient teams Properly equipped Mobile surgical, public health teams Physically and psychologically prepared teams to withstand the disaster conditions

14 PPP

15 Service Beneficiaries Sponsored Patients Cost of treatment is covered by PhilHealth case rates No co payment by the patient PhilHealth/Insurer reimburses hospital operator for service 70% 700 Beds 30% Pay Patients Patients with copayment ( i.e. balance exceeding insurance coverage paid by patient) Point of Care Patients Beds Reserved Beds Available

16 Philippine Health Information Exchange

17 Equity Equity Equity G OV ER NA NC E Equity

18 Department of Health Sin Tax National Budget Foreign Assistance Health facilities: infrastructure, equipment, operations, human resource Public health programs: FP, MCH, TB, NCDs, WASH, Health Promotion SUPPLY 4,000 mothers per year saved from deaths due to pregnancy and childbirth 2 million unwanted pregnancies prevented 2.5 million children per year immunized 5.6 million saved from malaria MDGs achieved DEMAND PhilHealth Premiums 14.7million poor families enrolled in PhilHealth and assigned to primary care facility by Community Health Teams 200 doctors, 2,000 midwives, 11,000 nurses deployed yearly (100% municipalities with health professionals) 100% of government hospitals able to provide all services at No Balance Billing 2,783 modernized BHS, RHUs, hospitals Poor and near poor financially-protected Affordable and accessible quality care for all Filipinos HEALTHIER FILIPINOS INCREASED PRODUCTIVITY INCLUSIVE GROWTH

19 Universal Health Care Better health outcomes Responsive health system Equitable health financing Health Financing Service Delivery Policy, standards and regulation Health Human Resource Health Information Governance for Health

20 What full UHC implementation will achieve by Save lives of 16,000 mothers from dying due to pregnancy and childbirth complications 2. Prevent 2M unplanned pregnancies, including abortions 3. Save and protect over 5.6M Filipinos from malaria, dengue and other preventable diseases 4. Immunize 10M children against vaccine preventable diseases 5. Reduce death and disability from non communicable diseases (e.g. heart disease, diabetes, cancers)longer life expectancy at birth 6. Poor and near poor families not pushed to poverty by high cost of health care 7. Access to 2,783 modern community health centers and hospitals

21 Fully implementing UHC: Scaling-up programs and resourcing % % 70.6 Scale Up Current PhilHealth DOH PhilHealth insures an additional 5.6M families with improved package covering all poor and near poor families (from the current 5.2 million poorest) DoH ensures the Philippines attains MDGs, and all Filipinos are provided with the preventive & promotive care fit for a middle income country

22 Scale up priorities by program 140 PHP Billions Scale up Current A. Preventive & Promotive Health Programs E. Policy and Regulation and Sector Management Total Gap for Rest of Aquino Administration PHP billion