HEALTH SYSTEMS IN TRANSITION THE PHILIPPINES HEALTH SYSTEM REVIEW 2011 PHILIPPINE LIVING HITS 2013,2014 Leizel P Lagrada MD MPH PhD Global Forum on Research and Innovation for Health 2015/ PICC
Philippine Health Systems in Transition Comprehensive review of Philippine health system Reviews the core components of health system: organization and governance, physical and human resources, financing, service delivery, health reforms To be updated every 5 years
Chapters 1. Introduction 2. Organization and Governance 3. Financing 4. Physical and Human Resources 5. Provision of Services 6. Principal Health Reforms 7. Assessment of the Health System 8. Conclusions
Philippine Living HiTS Mechanism to update sections of published HiT to ensure relevance September 2013: Health facility planning, Health expenditure, Collection, Payment mechanisms, Recent and future developments December 2013: Purchasing and purchaser-provider relations, Infrastructure February 2014: Regulation and governance of pharmaceutical care
2. Organization and Governance Government (Devolved by Local Government Code of 1991) Department of Health provides national policy direction, technical supervision and guidance Provincial Health Offices provide secondary health care City and Municipal Health Offices provide primary services including MCH and Nutrition Private Regulated through DOH licensing, PhilHealth accreditation, Local ordinances, CHED accreditation and issuances
2. Organization and Governance Patient Empowerment 1. PhilHealth and Patient Information poor appreciation of entitlements and processes 2. Patient Rights enshrined in Constitution but no specific issuances 3. Patient Choice no gatekeeper mechanisms, limited only by ability to pay 4. Patient Safety general provisions of the Code of Ethics of the Medical Profession 5. Patient Participation/Involvement weak or nonexistent formal mechanisms
2. Organization and Governance- Living HiT Update Sept. 2013 2.5.2 Health facility planning
3. Financing summarized in Table 3-1 on page 39, Living HiT Update Sept 2013 Total health spending has slowly but steadily increased since 1995 Inefficient government spending and low PhilHealth utilization PhilHealth contributions to total health spending remains low at 9.1% in 2011 High and increasing proportion of out of pocket expenditures, remaining above 50% despite expansion of SHI (September 2013 Living HiT Update)
3. Financing Living HiT Updates 3.4.2 Collection (September 2013) New sin tax law (RA 10351) provides funding for UHC Updating of PhilHealth premium contribution rates National government paying for full premium of poor families identified through National Household Targeting System 3.8 Payment mechanisms(sept. 2013) Shift from FFS to Case Payment, No Balance Billing for the poor Expansion of PhilHealth out-patient benefit (Primary Care Benefit 1) and introduction of Z benefits of PhilHealth
3. Financing Living HiT Updates 3.4.4 Purchasing and purchaser-provider relations (December 2013) Automatic PhilHealth accreditation for DOHlicensed health facilities and decentralization of key accreditation functions to PhilHealth regional offices Institutionalization of customer service staff and community health teams
4. Physical and Human Resources Physical infrastructure Number of hospital beds overall bed to population ratio follows DOH prescribed standard (1:1000) Distribution concentration in developed areas except for DOH Regional Medical Centers Quality range from basic to most sophisticated; private facilities perceived to be of higher quality than government institutions
4. Physical and Human Resources- Living HiT Update December 2013 4.2.1 Infrastructure Caution in comparing facility data after 2012 different categories of facility as provided by Administrative Order 2012-0012
4. Physical and Human Resources Human resources for health Health professional training programs dominated by private institutions responsive to market (overseas) demands
4. Physical and Human Resources Technology-driven overspecialization (Table 4-9 on page 85 showing 67% of physicians are specialists) Concentration in high income urban areas
5. Provision of Services Public health and primary care services local service delivery supported by national programmes in disease control (TB, malaria,etc), reproductive health (maternal and child health and family planning) Hospital Services provided by district and provincial hospitals as well national tertiary and specialty hospitals with capabilities ranging from basic medical specialties to whole range of subspecialties Other special services including mental health, dental care, care of older persons, and traditional and alternative health
6. Principal Health Reforms Summarized in Table 6-1 on page 103 Health Service Delivery 1980 Primary Health Care Approach and Integration of Health Services 1987 reorganization of the Ministry (later Department) of Health through EO 119 1991 devolution of health services (RA 7160 Local Government Code) 1999 Introduction of inter-local health zones under Health Sector Reform Agenda
6. Principal Health Reforms Regulatory Reforms 1988 - Reforming pharmaceutical marketing practices and prescribing norms through RA 6675 the Generics Law 2008 Rationalizing patent protection and pricing of pharmaceutical products through RA 9502 the Universally Accessible, Cheaper, and Quality Medicines Law 2009 Strengthening FDA and expanding its powers to regulate health goods and services through the Food and Drug Administration Law
6. Principal Health Reforms Health Financing Reforms 1995 National Health Insurance Law creates the Philippine Health Insurance Corporation with a mandate to expand health insurance coverage to all Filipinos 2010 Universal Health Care restructures premium payments for poorest income quintiles comprising 40 percent of population 2011 Universal Health Care restructures benefits through No Balance Billing Policy for defined diagnostic groups
6. Principal Health Reforms- Living HiT Updates December 2013 6.4 Recent and future developments Summarized health reforms 2010-2012 in Table 6.1 2010 -Kalusugan Pangkalahatan: Aquino Health Agenda 2012 -RA 10351: Sin Tax Reform Law of 2012 2012 -RA 10354: Responsible Parenthood and Reproductive Health Act of 2012
7. Assessment of the Health System Major improvements in immunization coverage, TB DOTS, and childhood TB. Disparities in immunization rates and implementation of other programs persist between poor and well-to-do provinces Low utilization of government hospitals due to perceived low quality being addressed by facilities enhancement program Maldistribution of human resources for health
7. Assessment of the Health System High out-of-pocket expenditures are being addressed by expanded PhilHealth coverage and increased DOH budget Absence of integrated curative and preventive services network; being addressed by developmental primary care networks Lack of quality assurance mechanisms and low utilization of existing one (e.g. PhilHealth bench-book)
8. Conclusion Inequity persists as the Philippines main health problem Present DOH KP or Universal Health Care can provide the appropriate responses The KP thrusts should include measures to specifically address persistent defects in the health system building blocks, particularly: out of pocket expenses and quality of services
Summarizing thoughts on Philippine HiT development Presents a systematic and comprehensive review of Philippine health system Identifies gaps in knowledge and evidence in health sector performance basis for research agenda Living HiT provides updates to capture the improvements in health sector performance in between Philippine HiT publications Local authors, international editors, standardized template across Asia Pacific Region
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