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PHILIPPINE NATIONALHEALTH ACCOUNTS

Republika ng PilipinasPAMBANSANG LUPON SA UGNAYANG PANG-ESTADISTIKA(NATIONAL STATISTICAL COORDINATION BOARD)http://www.nscb.gov.ph October 2013

2005-2011

ISSN-1655-8936

The Philippine National Health Accounts (PNHA) is a publication prepared by the Social Sectors A Division of the Social Statistics Office (SSO)

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TTAABBLLEESS OOFF CCOONNTTEENNTTSS Foreword iNSCB Publication ii-iiiOther NSCB Products and Services ivTable of Contents v-viiList of Tables viiiList of Figures ixList or Acronyms x-xiiiExecutive Summary 1-2

1. Highlights of the 2011 PNHA Results 3-91.1 Total Health Expenditure 3

1.1.1 Total health expenditure up by 13.2 percent in 2011 1.1.2 Per capita health spending also improves 1.1.3 Share of health expenditure to GDP goes up

1.2 Sources of Funds for Health 4-51.2.1 Government expenditures and health benefit payments from

social insurance lead increases in health spending 4

1.2.2 Out-of-pocket expenditures comprise more than half of health care expenditure

4

1.2.3 Per capita health expenditure from the rest of the world declines 51.3 Government Expenditure on Health 5-7

1.3.1 DOH agencies continue to provide bulk of national government health expenditure

5

1.3.2 Spending of DOH agencies exhibits positive growth 61.3.3 Government health spending remains far from HSRA target 61.3.4 Health expenditure from local government increases 7

1.4 Uses of Funds for Health 7-81.4.1 Spending for personal health care remains the same 71.4.2 Bulk of government expenditure shifts to public health care 81.4.3 Local government is still the biggest spender in public health

care 8

1.5 Health expenditure of ASEAN Countries 9

2. Historical Tables and Charts, 2005-2011 10-272.1 Total Health Expenditure 122.2 Per Capital Health Expenditure 132.3 Share of Health Expenditure to GDP and GNI 14

2.3.1 Comparison of Growth Rates of Health Expenditure and GNI 152.4 Amount of Health Expenditure by Source of Funds 162.5 Distribution of Health Expenditure by Source of Funds 172.6 Per Capital Health Expenditure by Source of Funds 182.7 Details of National Government Health Expenditure 19

vi

2.8 Total Health Expenditure by Use of Funds 202.9 Government Health Expenditure by Use of Funds 212.10 DOH Health Expenditure by Use of Funds 222.11 Local Government Health Expenditure by Use of Funds 232.12 Government Health Expenditure by Use of Funds and by Type of

Expenditure 24

2.13 Health Care Financing Indicators: Target versus Actual Levels 252.14 Selected National Health Accounts Indicators for the Philippines and

Other ASEAN Countries 26

2.15 Health Expenditure and Health Status 27

3. Philippine National Health Accounts Matrix 28-353.1 Philippine National Health Accounts, 2005 283.2 Philippine National Health Accounts, 2006 293.3 Philippine National Health Accounts, 2007 303.4 Philippine National Health Accounts, 2008 313.5 Philippine National Health Accounts, 2009 323.6 Philippine National Health Accounts, 2010 333.7 Philippine National Health Accounts, 2011 343.8 Government Health Expenditures by Type, 2011 35

4. The PNHA Framework 36-48

4.1 Concepts and Definitions 36-394.1.1 Health Care Expenditure 4.1.2 Health Care Goods and Services

4.2 Design/Matrix 39-404.2.1 Uses of Funds 4.2.2 Sources of Funds

4.3 The PNHA Operational Framework 41-484.3.1 Uses of Funds

4.3.1.1 Categories of Uses of Funds 4.3.1.2 Operational Definition of Uses of Funds

4.3.1.2.a Personal Health Care 4.3.1.2.b Public Health Care 4.3.1.2.c Others

4.3.2 Sources of Funds 4.3.2.1 Categories of Uses of Funds 4.3.2.2 Operational Definition of Uses of Funds

4.3.2.2.a Government 4.3.2.2.b Social Insurance 4.3.2.2.c Private Sources

4.3.3 Full operational Matrix

5. Technical Notes 495.1 National Government 49

5.1.1 DOH and Other National Government Agencies 5.1.2 Foreign-Assisted Projects 5.1.3 Local Government

5.2 Social Insurance 54

vii

5.3 Private Sources 555.3.1 Out-of-Pocket 5.3.2 Private Insurance 5.3.3 Health Maintenance Organizations 5.3.4 Private Establishments 5.3.5 Private Schools

5.4 Rest of the World 59

6. List of NSCB Staff 60

1. HIGHLIGHTS OF THE 2011 PNHA

RESULTS

10

HIGHLIGHTS OF PNHA 2005-2011 The following trends are observed in PNHA estimates from 2005-2011:

Total Health Expenditure continuously increased from 2005 to 2011 at an average annual growth rate of 11.7 percent The total health expenditure (THE) grew from P222 billion in 2005 to P431 billion in 2011, an average annual increase of 11.7 percent at current prices or 6.4 percent at constant 2000 prices, (Table 2.1). The growth slowed down by half from 2007 to 2008 (at constant 2000 prices), but picked up again from 2008 increasing at a rate of 7.3 percent in 2009 up to 9.9 percent in 2011. Since the rate of increase in population was slower than the increase in THE, per capita health expenditure also grew at 9.7 percent at current prices and at 4.5 percent at constant 2000 prices, (Table 2.2). The share of THE to GDP ranged from 3.9 percent to 4.4 percent from 2005 to 2011. The share of THE to GNP, on the other hand, was almost constant at 3.1 percent to 3.3 percent from 2005 to 2011, (Table 2.3). .

Health spending from all funding sources increases, but out-of-pocket health spending continues to account for slightly more than half of the Total Health Expenditure throughout 2005 to 2011 Among the sources that had a 2005-2011 growth rate in expenditure higher than the THE average growth rate of 11.7 percent are HMOs at 16.3 percent, the National Health Insurance Program of the PhilHealth at 12.5 percent, Local Government at 12.4 percent, and out-of-pocket at 12.0 percent, (Table 2.4). Out-of-pocket health expenditures continued to comprise more than half of the THE, ranging from 51.9 percent to a high of 56.7 percent within the period, (Table 2.5). The share of the local government fluctuated but it is the second largest source in 2011, accounting for 14.7 of the total health expenditure. The share of the National showed a decreasing trend from 2005 to 2009, thereafter the share increased reaching12.3 percent in 2011. PhilHealth’s share also dipped from 8.7 percent in 2005 to 7.1 percent in 2008, managing to rise in 2009 accounting for 9.1 percent in 2011, still below the target of 19 percent by 2016 based on the DOH Health Care Financing Strategy 2010-2020.

The share of Foreign Assisted Projects (FAPs) and Loans in national government health expenditure decreases by 21 percentage points from 2005 to 2011 The national government relied less and less on FAPs and loans for its health expenditure. FAPS spending registered a negative 31.0 percent growth from

11

P7.1 billion in 2005 to only P0.8 billion in 2011, with the share in national government health spending decreasing from 22.0 percent to 1.4 percent; GOP counterpart decreased accordingly, (Table 2.7). About half of the national government spending is contributed by the DOH and its attached agencies, ranging from 46.8 percent to 56.6 percent. The health spending of Other National Agencies tripled from P7.8 billion in 2005 to P22.4 billion in 2011, with the share in national government health spending almost doubling from 24.2 percent to 42.1 percent for the same period, (Table 2.7).

Trend in use of health expenditures remains almost the same There were only slight movements in the share of public health care, personal care, and other types of health care in the total health expenditure from 2005 to 2011, (Table 2.8). The share of public health care ranged from 9.8 percent to 12.7 percent, although there was a 1.6 percentage points increase from 2010 to 2011. The share of personal care ranged from 77.6 percent to 81.2 percent, and remained constant at 78.6 percent in 2010 and 2011. Other types of care comprised 8.8 percent to 10.7 percent of the THE.

Government health expenditure shifts to public health care There was an observed shift in the use of government funds from personal care and other types of care to public health care, which was more pronounced from 2010 to 2011 with the share of public health care increasing from 34.0 percent to 43.1 percent, (Table 2.9). This can be mainly attributed to DOH which doubled its public health care spending from 2010 to 2011.

The Local Government is consistently the largest spender for public health care Among all funding sources, the local government accounts for more than half of total public health spending from 2005 to 2011, (Table 2.11). Public health comprised 44.4 percent to 45.3 percent of local government health expenditure for this period.

Highlights of the 2011 PNHA Results

20091/

20101/ 2011

342,164 380,826 431,047

13.3 11.3 13.2

209,147 226,144 248,585

7.3 8.1 9.9

ITEM 20091/

20101/ 2011

Per Capita Health Expenditure

(in pesos, at current prices)3,759 4,112 4,577


(in pesos, at constant 2000 prices) 2/ 2,298 2,442 2,639

Population (million) 3/ 91.0 92.6 94.2

Population Growth Rate (in percent) 1.8 1.7 1.7


Growth Rate (in percent, at current

prices)

11.3 9.4 11.3


Growth Rate (in percent, at constant

2000 prices

5.5 6.3 8.1

1.1.3 Share of health expenditure to GDP goes up

3

Total Health Expenditure (in million

pesos, at constant 2000 prices) 2/

Total Health Expenditure Growth

Rate (in percent, at current prices)

Total Health Expenditure (in million

pesos, at current prices)

1/ Revised

2/ Derived using the consumer price index (CPI) for all items

3/ Computed annual population estimates by the NSO and the NSCB-TS using interpolation at

decelerating rates, with the 2000 and 2010 Censuses of Population and Housing (CPH) as start and

end dates of the reference population

Total Health Expenditure Growth

Rate (in percent, at constant 2000

prices)

1.1 TOTAL HEALTH EXPENDITURE

1.1.1 Total health expenditure up by 13.2 percent in 2011

1.1.2 Per capita health spending also improves2/ Derived using the consumer price index (CPI) for all items

ITEM

1/ Revised

2.0

2.5

3.0

3.5

4.0

4.5

2009 2010 2011

4.3 4.2 4.4

Pe

rce

nt

Share of Health Expenditure to GDP

Total health expenditure (THE) of the country reached P431.0 billion in 2011, growing at a faster rate of 13.2 percent compared to 11.3 percent growth in 2010. In real terms, total health expenditure went up by 9.9 percent, higher than the 8.1 percent growth in 2010.

With the total health expenditure growing faster than the population, per capita health spending increased by P465 or an 11.3 percent growth between the period 2010 and 2011. In real terms, per capita health spending increased by 8.1 percent in 2011, higher than the 6.3 percent growth in 2010.

The share of health expenditure to GDP was higher at 4.4 percent in 2011 compared to 4.2 percent in 2010. It is still below the desired 5 percent. On the other hand, the share of health expenditure to GNI increased to 3.3 percent which is within the National Objectives for Health (NOH) target of 3-4 percent.


20091/

20101/ 2011

GOVERNMENT88,722 101,378 116,433 14.9

National Government36,949 43,375 53,069 22.3

Local Government51,773 58,003 63,364 9.2

SOCIAL INSURANCE27,897 33,925 39,126 15.3

National Health Insurance Program27,791 33,799 39,022 15.5

Employees' Compensation107 126 104 (17.1)

PRIVATE SOURCES217,865 239,139 272,009 13.7

Out-of-Pocket182,370 199,983 227,215 13.6

Private Insurance6,083 6,401 7,222 12.8

Health Maintenance Organizations18,199 21,170 24,570 16.1

Private Establishments7,809 7,937 9,297 17.1

Private Schools3,404 3,649 3,706 1.6

REST OF THE WORLD 7,681 6,384 3,478 (45.5)

Grants7,681 6,384 3,478 (45.5)

ALL SOURCES 342,164 380,826 431,047 13.2

4

1.2 SOURCES OF FUNDS FOR HEALTH

Growth

Rate

2010-

2011

SOURCE OF FUNDS

AMOUNT

(in million pesos)

1/ Revised

1.2.1 Government expenditures and health benefit payments from social

insurance lead increases in health spending

1.2.2 Out-of-pocket expenditures comprise more than half of health care

expenditure

25.9 26.6 27.0

8.2 8.9 9.1

53.3 52.5 52.7

10.4 10.3 10.4 2.2 1.7 0.8

2009 2010 2011Gov't Social Ins. OOP Other private sources ROW

Government expenditures and social insurance led increases in health spending, but the private sector remained the highest health spender. The government increased spending from P101.4 billion in 2010 to P116.4 billion in 2011, demonstrating a 14.9 percent growth. Both the national and local governments contributed to this increase, registering a growth of 22.3 percent and 9.2 percent, respectively. Social insurance benefit payments hiked from P33.9 billion to P39.1 billion, translating to a 15.3 percent increase. This was mainly due to the National Health Insurance Program (NHIP) whose spending increased by 15.5 percent. Employees’ Compensation decreased further by 17.1 percent.

Although the private sector registered a relatively lower growth of 13.7 percent in 2011, it continued to be the highest spender at P272.0 billion, with out-of-pocket accounting for P227.2 billion.

For the rest of the world, there was a significant decrease of 45.5 percent from P6.4 billion in 2010 to P3.5 billion in 2011.

The shares of the different sectors remained almost the same, with slight increases for the following from 2010 to 2011: social insurance from 8.9 percent to 9.1 percent, and government from 26.6 percent to 27.0 percent. The share of grants and loans from the rest of the world decreased from 1.7 percent to 0.8 percent. Within the private sources, out-of-pocket alone also still accounted for more than half of the THE, from 52.5 percent in 2010 to 52.7 percent in 2011.


1.2.3 Per capita health expenditures increase for all funding sources

except the rest of the world

20091/

20101/ 2011

975 1,095 1,236 12.9

306 366 415 13.4

2,394 2,582 2,888 11.8

84 69 37 (46.4)

596 650 713 9.7

187 218 240 10.1

1,463 1,534 1,666 8.6

52 41 21 (48.0) 1/ Revised

DOH and

its

Attached

Agencies

Other

National

Agencies

GOP

counter-

part

FAPS

LoansTotal DOH

Other

National

Agencies

GOP

counter-

part

FAPS

Loans

20,926 15,403 115 505 36,949 56.6 41.7 0.3 1.4

24,208 18,442 147 578 43,375 55.8 42.5 0.3 1.3

29,816 22,360 133 761 53,069 56.2 42.1 0.2 1.4

23.2 21.2 (9.7) 31.6 22.3

1/ Revised

5


1.3 GOVERNMENT EXPENDITURE ON HEALTH

Growth

Rate

2010-

2011

At current prices

Private Sources

Government

Social Insurance

Government

SOURCE OF FUNDS

Amount (in pesos)

Rest of the world

Social Insurance

Private Sources

Rest of the World

At constant 2000 prices 2/

2011

Growth Rate

2010-2011

1.3.1 DOH agencies continue to provide bulk of national government

health expenditure

YEAR

AMOUNT (in million pesos) PERCENT SHARE

20091/

20101/

The share of health The share of health

With the increases in expenditure from social insurance, government and private sources, the per capita health expenditure went up by 13.4, 12.9 and 11.8 percent, respectively. However, a large decrease in expenditure from the rest of the world resulted in a 46.4 percent decline in the per capita health expenditure for the rest of the world. In real terms, there was an increase of 10.1 percent in social insurance, 9.7 percent in government sources and 8.6 percent in private sources. On the other hand, decrease in per capita health expenditure was reflected in the rest of the world at 48.0 percent.

Total national government health expenditure registered a 22.3 percent growth, from P43.4 billion in 2010 to P53.1 billion in 2011. This was largely due to the 31.6, 23.2, and 21.2 percent increases in Loans, DOH expenditure, and expenditure of Other National Agencies, respectively. A decline was, however, noted in the GOP counterpart expenditure by 9.7 percent. Other national agencies include Philippine Charity Sweepstakes Office, Philippine Amusements and Gaming Corporation, Department of Social Welfare and Development, University of the Philippine System, Armed Forces of the Philippines - General Headquarters, Food and Nutrition Research Institute, Department of Labor and Employment, Department of Education and Bureau of Fire Protection. The DOH agencies continued to provide the bulk of health expenditure, funding 56.2 percent of the national government expenditure for health care in 2011.


1.3.2 Spending of DOH agencies exhibits positive growth

20101/ 2011 2010

1/ 2011 20101/ 2011 2010

1/ 2011 20101/ 2011

Personal

Health Care 10 10 10 25 8 8 20 53 53 7 8 8 62 79 79

Public

Health Care 20 9 12 - - - - - - - - - 20 11 12

Others 10 7 6 5 1 1 - - - 3 2 2 18 11 9

TOTAL BY

SOURCE 40 27 27 30 9 9 20 53 53 10 10 10 100 100 100

6

ActualActual Target

22.2 24.4

TOTAL BY USE

Target

53.4

Note: To allow for comparison with HSRA targets, the percentage distribution of actual expediture by source of funds was adjusted by excluding the

"other sources." Others under private sector include private insurance, HMOs, employer-based plans and private schools. As such, this is not exactly

the same as the percentage share in table 2.5 on page 17.

Actual

(in percent)

Out of Pocket

1/ Revised

Actual

USE OF

FUNDSTarget Target

Target

GOVERNMENT SOCIAL INSURANCE

11,119

14,164

20091/

100.8

SOURCE OF FUNDS

1.3.3 Government health spending remains far from the HSRA target

PRIVATE SECTOR

Expenditure of DOH Agencies by Use of Funds

6,378

12.6

Personal Public

3,769

20101/ 12,916 5,917

29,816

Year

20,926 30.5 3,430

(29.9)

ActualOthers

Others


16.4

Others TOTAL Personal Public

5,376

53.1

47.5

24,208

Growth Rate

2010-20119.7

11,883

Note: DOH agencies include PHC, NKTI, LCP, PCMC, NNC, PopCom, and PITAHC.

2011

1/ Revised

39.9

23.2

The

The share of government on health expenditure remained at 27 percent which is still below the target of 40 percent based on the Health Sector Reform Agenda (HSRA). The government's target to depend less on out-of-pocket payments and provide more social health insurance is still far from being realized as the share of out-of-pocket payments still remained at 53 percent while the share of social insurance payments is also unmoved at 9 percent in 2011. Based on the HSRA, the target for out-of-pocket is 20 percent while the target for social insurance is 30 percent.

Spending of DOH and its attached agencies increased by 23.2 percent, from P24.2 billion in 2010 to P29.8 billion in 2011. Spending on public health care doubled from P5.9 billion in 2010 to P11.9 billion in 2011, resulting to a large increase in share from 24.4 percent to 39.9 percent.


1.3.4 Health expenditure from local government increases

Personal Public Others TOTAL Personal Public Others

20091/ 14,367 23,469 13,937 51,773 27.7 45.3 26.9

20101/ 16,037 26,108 15,857 58,003 27.6 45.0 27.3

2011 17,487 28,586 17,290 63,364 27.6 45.1 27.3

Growth Rate

2010-20119.0 9.5 9.0 9.2

1.4 USES OF FUNDS FOR HEALTH

1.4.1 Spending for public health care increased

7

1/ Revised

Local Government Health Expenditure by Use of Fund

YEAR


Personal 78.6%

Public 10.7%

Others 10.7%

Total Health Expenditure by Use of Funds, 2010

The

Personal 77.6%

Public 12.7%

Others 9.7%


Personal 78.6%

Public 12.3%

Others 9.1%


Local government spending on health went up by 9.2 percent or around P5.3 billion in 2011. This was reflected by the 9.0 percent increase in both personal and other services, and the 9.5 percent increase in public health care services. The largest share of local government expenses on health consists of expenditure on public health care at 45.1 percent.

Spending for public health care increased from 10.7 percent in 2010 to 12.3 percent in 2011. Personal health care, however, continues to account for bulk of total health expenditure, having a consistent share of 78.6 percent in 2010 and 2011.


1.4.2 Bulk of government expenditure shifts to public health care


31,386 35,662 21,674 88,722 35.4 40.2 24.4

39,145 34,466 27,767 101,378 38.6 34.0 27.4

41,693 50,125 24,615 116,433 35.8 43.1 21.1

6.5 45.4 (11.4) 14.9

1.4.3 Local government is still the biggest spender in public health care

PS MOOE CO Total PS MOOE CO

DOH and its Attached Agencies 11,531 13,308 4,977 29,816 38.7 44.6 16.7

Personal Health Care 8,438 4,102 1,624 14,164 59.6 29.0 11.5

Public Health Care 1,541 7,692 2,649 11,883 13.0 64.7 22.3

Others 1,552 1,513 704 3,769 41.2 40.1 18.7

Gen. Admin. & Operating Cost 1,386 1,399 690 3,475 39.9 40.3 19.9

Research and Training 166 114 14 294 56.4 38.9 4.7

Other National Agencies 4,844 13,214 1,830 19,887 24.4 66.4 9.2


Public Health Care 519 8,320 26 8,864 5.9 93.9 0.3

Others 1,024 2,264 268 3,556 28.8 63.7 7.5

Gen. Admin. & Operating Cost 963 2,200 217 3,381 28.5 65.1 6.4

Research and Training 1/

61 63 51 175 34.8 36.1 29.0

Local Government 26,325 28,547 8,491 63,364 41.5 45.1 13.4



Others 6,869 7,999 2,422 17,290 39.7 46.3 14.0

Gen. Admin. & Operating Cost 6,869 7,999 2,422 17,290 39.7 46.3 14.0

Research and Training - - - - - - -

8

1/ Includes bio-medical research, operation/policy research, survey and monitoring, and manpower training activities.

In this particular table, government health expenditure does not include foreign-assisted projects (FAPs) since available data on FAPs spending has no

breakdown by type of expenditure (i.e., whether PS. MOOE, CO).

20091/

2011

SOURCE OF FUNDAMOUNT (in million pesos) PERCENT SHARE

Growth Rate 2010-2011

2011 Government Health Expenditures by Use of Fund and by Type of Expenditure

20101/

1/ Revised

Government Health Expenditures by Use of Funds

YEARAMOUNT (in billion pesos) PERCENT SHARE

The share

The share

The share

The

The share of public health care in government health expenditure increased by 9.1 percentage points from 2010 to 2011. The public health care increased from 34.0 percent in 2010 to 43.1 percent in 2011, while the share of personal care declined from 38.6 percent in 2010 to 35.8 in 2011.

The local government remained as the biggest source of public health care spending, accounting for as much as 57.9 percent of the government’s expenditure on public health care. While public health care spending in local government and other national agencies amounted to P28.6 billion and P8.9 billion, respectively, the DOH allocated a large chunk of their budget to personal health

care, amounting to P14.2 billion.


2008 2009 2010 2008 2009 2010 2008 2009 2010 2008 2009 2010

Brunei Darussalam 2.3 3.0 2.9 85.5 85.2 85.4 14.5 14.8 14.6 n/a n/a …

Cambodia 5.7 5.3 6.0 23.8 36.6 21.5 76.2 63.4 78.5 17.1 22.0 20.1

Indonesia 2.3 2.5 2.8 54.4 46.1 36.1 45.6 53.9 63.9 1.7 1.4 1.2

Lao People's

Democratic Rep. 4.0 4.3 2.6 17.6 28.3 46.5 82.4 71.7 53.5 16.1 18.8 28.7

Malaysia 4.3 4.6 4.4 44.1 55.7 55.5 55.9 44.3 44.5 n/a n/a -

Myanmar 2.3 2.1 2.0 7.5 11.3 12.1 92.5 88.7 87.9 9.1 9.2 …

Philippines - WHO 3.7 3.6 4.1 34.7 35.1 36.1 65.3 64.9 63.9 1.5 1.0 1.7

Philippines 2/

3.9 4.3 4.2 24.8 25.9 26.6 66.9 63.7 62.8 1.2 2.2 1.7

Singapore 3.3 4.1 4.5 34.1 36.1 31.4 65.9 63.9 62.8 n/a n/a n/a

Thailand 4.1 4.2 3.9 74.3 74.6 75.0 25.7 25.4 25.0 0.3 0.3 0.3

Viet Nam 7.2 6.9 6.8 38.5 37.5 37.1 61.5 62.5 62.9 1.7 3.0 3.2

1/ The World Health Statistics Report 2010, 2011, 2012, WHO website

2 / 2007-2010 PNHA, NSCB.

n/a - not available

9

General government

expenditure on health

as % of total


Private expenditure on

health as % of total


External resources for

health as % of total


1.5 HEALTH EXPENDITURE OF ASEAN COUNTRIES

Health spending in the Philippines still at par with majority of ASEAN countries

Selected National Health Accounts Indicators for the Philippines

Member State

Total expenditure on

health as % of GDP

The The The The The The The The The The The The The The The The The The The The The The The The The The The The The The The The The The The The

Based on the report of the World Health Organization (WHO), the share of total health expenditure to GDP in the Philippines reached 3.6 percent in 2009, a decrease of 0.1 percentage point from the previous year. While based on the NSCB report, total health expenditure as percentage of GDP increased to 4.3 percent in 2009. Among the other ASEAN countries, Brunei Darussalam, Indonesia, Myanmar, Singapore and Thailand had lower percentage share of total health expenditure to GDP than the Philippines. Those countries in the ASEAN Region in which their governments contributed more than half of their respective total health expenditure include Brunei Darrusalam at 85.2 percent, Thailand at 74.6 percent, and Malaysia at 55.7 percent. While the Philippine government merely posted 25.9 percent on the total health spending of the country. Private expenditure on health in the Philippines decreased slightly from 66.9 percent in 2008 to 63.7 percent in 2009, but still maintaining a share of more than 50 percent. The only countries that showed higher private health expenditure shares are Myanmar with 88.7 percent, Singapore with 63.9 percent, and Lao People’s Democratic Republic at 71.7 percent.

2. HISTORICAL TABLES and CHARTS

2005-2011

Historical Tables and Charts, 2005-2011

2005 2006 2007 2008 20091/

20101/ 2011

Growth Rate

2010-2011

222,219 247,815 268,928 302,043 342,164 380,826 431,047

11.5 8.5 12.3 13.3 11.3 13.2 11.7

171,201 179,707 189,653 194,867 209,147 226,144 248,585

5.0 5.5 2.7 7.3 8.1 9.9 6.4

1/ Revised

12

2.1 TOTAL HEALTH EXPENDITURE, 2005-2011

ITEM

Total Health

Expenditure (in million

pesos, at current prices)

Total Health

Expenditure Growth

Rate (in percent, at

current prices)

Total Health

Expenditure Growth

Rate (in percent, at

constant 2000 prices)

Total Health

Expenditure (in million

pesos, at constant 2000

prices)2/


Figure 1: Total Health Expenditure

222,219 247,815

268,928

302,043

342,164

380,826

431,047

171,201 179,707 189,653

194,867 209,147

226,144 248,585

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

500,000

2005 2006 2007 2008 2009 2010 2011

in m

illio

n p

eso

s

at current prices

at constant 2000 prices


2005 2006 2007 2008 20091/

20101/ 2011

Average

Annual

Growth Rate

2005-2011

2,624 2,873 3,061 3,377 3,759 4,112 4,577

2,022 2,083 2,159 2,179 2,298 2,442 2,639

84.7 86.3 87.9 89.4 91.0 92.6 94.2 1.8

9.5 6.6 10.3 11.3 9.4 11.3 9.7

3.0 3.6 0.9 5.5 6.3 8.1 4.5

1/ Revised

13

Per Capita Health

Expenditure Growth Rate

(in percent, at current

prices)


2.2 PER CAPITA HEALTH EXPENDITURE, 2005-2011

ITEM

3/ Computed annual population estimates by the NSO and the NSCB-TS using interpolation at decelerating rates, with the 2000 and 2010 Censuses of

Population and Housing (CPH) as start and end dates of the reference population

Figure 2: Per Capita Health Expenditure

Population (million) 3/

Per Capita Health

Expenditure (in pesos, at

current prices)

Per Capita Health

Expenditure (in pesos, at

constant 2000 prices) 2/

Per Capita Health

Expenditure Growth Rate

(in percent, at constant

2000 prices)

2,624 2,873

3,061

3,377

3,759

4,112

4,577

2,022 2,083 2,159 2,179 2,298

2,442 2,639

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

2005 2006 2007 2008 2009 2010 2011

in p

eso

s

at current prices



2005 2006 2007 2008 20091/

20101/ 2011

Average

Annual

Growth Rate

2005-2011

222.2 247.8 268.9 302.0 342.2 380.8 431.0 11.7

5,677.7 6,271.2 6,892.7 7,720.9 8,026.1 9,003.5 9,735.5 9.4

7,150.3 7,883.1 8,634.1 9,776.2 10,652.5 11,996.1 12,878.1 10.3

3.9 4.0 3.9 3.9 4.3 4.2 4.4 2.1

3.1 3.1 3.1 3.1 3.2 3.2 3.3 1.2

765.3 849.4 903.5 1,015.6 1,434.1 1,473.0 1,580.0 12.8

63.6 67.5 74.0 74.9 88.7 101.4 116.4 10.6

55.1 51.3 46.1 44.5 47.6 45.1 43.2 (4.0)

1/ Revised

Figure 3: Share of Health Expenditure to GDP and GNI, 2005-2011

14

2.3 SHARE OF HEALTH EXPENDITURE TO GDP AND GNI, 2005-2011

Total Government

Expenditure (in

billion pesos)3/

Government Health

Expenditure (in

billion pesos)3/

Exchange

Rate4/

4/ Exchange rate from Bangko Sentral ng Pilipinas, http://www.bsp.gov.ph/statistics/spei/tab13.htm, Date: May 6, 2013.

3/ 2007-2013 Budget of Expenditures and Sources of Financing (BESF), Table A.4 Sectoral Distribution of Public Expenditures for National Government.

2/ Revised/Rebased National Accounts of the Philippines, National Statistical Coordination Board, March 2012

GDP (in billion

pesos, at current

prices) 2/

Share of Health

Expenditure to GNI

(in percent)

ITEM

Total Health

Expenditure (in

billion pesos, at

current prices)

GNI (in billion

pesos, at current

prices) 2/

Share of Health

Expenditure to GDP

(in percent)

3.1 3.1 3.1 3.1 3.2 3.2

3.3

3.9 4.0 3.9 3.9

4.3 4.2 4.4

2.3

2.8

3.3

3.8

4.3

4.8

2005 2006 2007 2008 2009 2010 2011

pe

rce

nt

Share to GNI Share to GDP


2005 2006 2007 2008 20091/

20101/ 2011

Average

Annual

Growth Rate

2005-2011

171 180 190 195 209 226 249 6.4

5.0 5.5 2.7 7.3 8.1 9.9 12.2

5,630 5,911 6,276 6,590 6,989 7,561 7,803 5.6

5.0 6.2 5.0 6.1 8.2 3.2 (7.2)

1/ Revised

15

2/ Derived using the consumer price index (CPI) for all itemsSource: 2005-2010 PNHA, NSCB.

2.3.1 COMPARISON OF GROWTH RATES OF HEALTH EXPENDITURE AND

GNI, 2005-2011

Figure 4: Growth Rates of Health Expenditure and

GNI (at 2000 prices), 2006-2011

Health Expenditure

Growth Rate (in percent)


ITEM

Total Health Expenditure

(in billion pesos, at

constant 2000 prices) 2/

GNI (in billion pesos, at

constant 2000 prices)

GNI Growth Rate (in

percent) at constant

2000 prices

5.0

6.2

5.0 6.1

8.2

3.2 5.0

5.5

2.7

7.3

8.1

9.9

0

2

4

6

8

10

12

2006 2007 2008 2009 2010 2011

in p

erc

en

t

GNI

Health expenditure


2005 2006 2007 2008 20091/ 20101/ 2011

GOVERNMENT 63,629 67,509 74,036 74,875 88,722 101,378 116,433 14.9 10.6

National 32,139 33,687 32,749 36,554 36,949 43,375 53,069 22.3 8.7

Local 31,490 33,821 41,288 38,320 51,773 58,003 63,364 9.2 12.4

SOCIAL INSURANCE 19,360 19,098 19,972 21,434 27,897 33,925 39,126 15.3 12.4

National Health Insurance Program 19,270 19,005 19,838 21,345 27,791 33,799 39,022 15.5 12.5

Employees' Compensation 90 93 134 88 107 126 104 (17.1) 2.4

PRIVATE SOURCES 136,959 156,745 173,986 202,054 217,865 239,139 272,009 13.7 12.1

Out-of-Pocket 115,393 133,711 147,873 171,116 182,370 199,983 227,215 13.6 12.0

Private Insurance 4,112 3,925 4,175 5,108 6,083 6,401 7,222 12.8 9.8

HMOs 9,905 11,188 13,123 15,638 18,199 21,170 24,570 16.1 16.3

Private Establishments 5,411 5,520 5,996 7,043 7,809 7,937 9,297 17.1 9.4

Private Schools 2,138 2,401 2,820 3,148 3,404 3,649 3,706 1.6 9.6

REST OF THE WORLD 2,271 4,463 933 3,682 7,681 6,384 3,478 (45.5) 7.4

Grants 2,271 4,463 933 3,682 7,681 6,384 3,478 (45.5) 7.4

ALL SOURCES 222,219 247,815 268,928 302,043 342,164 380,826 431,047 13.2 11.7

1/ Revised

16

Figure 5: Health Expenditure by Source of Funds

(in billion pesos), 2005-2011

2.4 AMOUNT OF HEALTH EXPENDITURE BY SOURCE OF FUNDS, 2005-2011

SOURCE OF FUNDS

Growth

Rate

2010-2011

AMOUNT (in million pesos), at current prices Average

Annual

Growth Rate

2005-2011

63.6 67.5 74.0 74.9

88.7 101.4

116.4

19.4 19.1 20.0 21.4 27.9

33.9 39.1

137.0

156.7

174.0

202.1

217.9

239.1

272.0

2.3 4.5 0.9 3.7 7.7 6.4 3.5 0

50

100

150

200

250

300

2005 2006 2007 2008 2009 2010 2011

in b

illio

n p

eso

s

GOVERNMENT

SOCIAL INSURANCE

PRIVATE SOURCES

OTHERS


2005 2006 2007 2008 20091/ 20101/ 2011

GOVERNMENT 28.6 27.2 27.5 24.8 25.9 26.6 27.0

National Government 14.5 13.6 12.2 12.1 10.8 11.4 12.3

Local Government 14.2 13.6 15.4 12.7 15.1 15.2 14.7

SOCIAL INSURANCE 8.7 7.7 7.4 7.1 8.2 8.9 9.1

National Health Insurance Program 8.7 7.7 7.4 7.1 8.1 8.9 9.1

Employees' Compensation2/ 0.0 0.0 0.0 0.0 0.0 0.0 0.0

PRIVATE SOURCES 61.6 63.3 64.7 66.9 63.7 62.8 63.1

Out-of-Pocket 51.9 54.0 55.0 56.7 53.3 52.5 52.7

Private Insurance 1.9 1.6 1.6 1.7 1.8 1.7 1.7

Health Maintenance Organizations 4.5 4.5 4.9 5.2 5.3 5.6 5.7

Private Establishments 2.4 2.2 2.2 2.3 2.3 2.1 2.2

Private Schools 1.0 1.0 1.0 1.0 1.0 1.0 0.9

REST OF THE WORLD 1.0 1.8 0.3 1.2 2.2 1.7 0.8

Grants 1.0 1.8 0.3 1.2 2.2 1.7 0.8

ALL SOURCES 100.0 100.0 100.0 100.0 100.0 100.0 100.0 1/ Revised

2/ Less than 0.05 in 2005-2011

Figure 6. Distribution of Health Expenditure by Source of Funds, 2005-2011

17

SOURCE OF FUNDS

2.5 DISTRIBUTION OF HEALTH EXPENDITURE BY SOURCE OF FUNDS, 2005-2011

PERCENT SHARE

28.6 27.2 27.5 24.8 25.9 26.6 27.0

8.7 7.7 7.4 7.1 8.2 8.9 9.1

1.0 1.8 0.3

1.2 2.2 1.7 0.8

61.6 63.3 64.7 66.9 63.7 62.8 63.1

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2005 2006 2007 2008 2009 2010 2011

GOV'T SOCIAL INSURANCE REST OF THE WORLD PRIVATE SOURCES


2005 2006 2007 2008 20091/ 20101/ 2011

At Current Prices

Government 751 783 843 837 975 1,095 1,236 12.9 8.7

Social Insurance 229 221 227 240 306 366 415 13.4 10.5

Private Sources 1,617 1,817 1,980 2,259 2,394 2,582 2,888 11.8 10.1

Rest of the world 27 52 11 41 84 69 37 (46.4) 5.5

Government 579 567 594 540 596 650 713 9.7 3.5

Social Insurance 176 161 160 155 187 218 240 10.1 5.3

Private Sources 1,246 1,318 1,397 1,458 1,463 1,534 1,666 8.6 5.0

Rest of the world 21 38 7 27 52 41 21 (48.0) 0.5

1/ Revised

18

AMOUNT (in pesos)

Figure 7.1 Per Capita Health Expenditure by Source of Funds

at current prices, 2005-2011

Figure 7.2 Per Capita Health Expenditure by Source of Funds

at 2000 prices, 2005-2011


2.6 PER CAPITA HEALTH EXPENDITURE BY SOURCE OF FUNDS, 2005-2011

At Constant 2000

Prices 2/

SOURCE OF

FUNDS

Average

Annual

Growth

Rate 2005-

2011

Growth

Rate

2010-

2011

751 783 843 837 975 1,095

1,236

229 221 227 240 306 366 415

1,617 1,817

1,980 2,259

2,394 2,582

2,888

27 52 11 41 84 69 37 0

500

1,000

1,500

2,000

2,500

3,000

3,500

2005 2006 2007 2008 2009 2010 2011

in p

eso

s

579 567 594 540 596 650 713

176 161 160 155 187 218 240

1,246 1,318

1,397 1,458 1,463 1,534 1,666

21 38 7 27 52 41 21 0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2005 2006 2007 2008 2009 2010 2011

in p

eso

s

Government Social Insurance Private Sources Rest of the world


DOH and

its

Attached

Agencies1/

Other

National

Agencies

GOP

counterp

art

FAPS

LoansTotal

DOH and

its

Attached

Agencies1/

Other

National

Agencies

GOP

counterp

art

FAPS

Loans

16,954 7,763 358 7,064 32,139 52.8 24.2 1.1 22.0

15,775 12,617 279 5,016 33,687 46.8 37.5 0.8 14.9

17,053 10,969 380 4,346 32,749 52.1 33.5 1.2 13.3

18,977 16,328 303 946 36,554 51.9 44.7 0.8 2.6

20,926 15,403 115 505 36,949 56.6 41.7 0.3 1.4

24,208 18,442 147 578 43,375 55.8 42.5 0.3 1.3

29,816 22,360 133 761 53,069 56.2 42.1 0.2 1.4

23.2 21.2 (9.7) 31.6 22.3

9.9 19.3 (15.3) (31.0) 8.7

2/ Revised

19

2011

20092/

Note: Government health service provision and financing underwent a transition in the period 1992 to 1994 as devolution was gradually being

implemented. 1992-1994 is pre-devolution period while 1995 onwards is post devolution period.

20102/

2005

2007

Growth Rate

2010-2011

Average

Annual

Growth Rate

2005-2011

2008

2.7 DETAILS OF NATIONAL GOVERNMENT HEALTH EXPENDITURE, 2005-2011

1/ DOH includes the following agencies: Philippine Heart Center, National Kidney and Transplant Institute, Lung Center of the

Philippines, Philippine Children's Medical Center, Commission on Population, National Nutrition Council, and Philippine Institute of Traditional and Alternative Health

Care.

YEAR

PERCENT SHAREAMOUNT (in million pesos)

2006


Personal Public Others Total Personal Public Others

177,880 24,796 19,542 222,219 80.0 11.2 8.8

197,339 28,385 22,092 247,815 79.6 11.5 8.9

214,463 28,251 26,214 268,928 79.7 10.5 9.7

245,182 29,464 27,397 302,043 81.2 9.8 9.1

265,633 43,284 33,247 342,164 77.6 12.7 9.7

299,463 40,637 40,726 380,826 78.6 10.7 10.7

338,921 53,061 39,065 431,047 78.6 12.3 9.1

1/ Revised

20

PERCENT SHARE

2006

YEARAMOUNT (in million pesos)

2011

2008

2.8 TOTAL HEALTH EXPENDITURE BY USE OF FUNDS, 2005-2011

Figure 8. Health Expenditure by Use of Funds, 2005-2011

20101/

2005

2007

20091/

177,880

197,339

214,463

245,182

265,633

299,463

338,921

24,796 28,385 28,251 29,464 43,284

40,637

53,061

19,542 22,092 26,214 27,397 33,247

40,726

39,065

222,219

247,815

268,928

302,043

342,164

380,826

431,047

-

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

500,000

2005 2006 2007 2008 2009 2010 2011

Personal Public Others Total



27,195 23,819 12,615 63,629 42.7 37.4 19.8

28,658 23,922 14,929 67,509 42.5 35.4 22.1

29,093 27,357 17,586 74,036 39.3 37.0 23.8

31,654 26,025 17,196 74,875 42.3 34.8 23.0

31,386 35,662 21,674 88,722 35.4 40.2 24.4

39,145 34,466 27,767 101,378 38.6 34.0 27.4

41,693 50,125 24,615 116,433 35.8 43.1 21.1

6.5 45.4 (11.4) 14.9

1/ Revised

21

2.9 GOVERNMENT HEALTH EXPENDITURE BY USE OF FUNDS, 2005-2011

PERCENT SHAREAMOUNT (in million pesos)

YEAR

2006

2008

20091/

20101/

2007

Figure 9: Percentage Distribution of Government Expenditure by Use of

Funds, 2011

2011

Growth Rate

2010-2011

2005

Personal 35.8%

Public 43.1%

Others 21.1%



12,024 2,302 2,627 16,954 70.9 13.6 15.5

10,437 2,005 3,333 15,775 66.2 12.7 21.1

10,518 2,460 4,076 17,053 61.7 14.4 23.9

11,027 3,855 4,095 18,977 58.1 20.3 21.6

11,119 6,378 3,430 20,926 53.1 30.5 16.4

12,916 5,917 5,376 24,208 53.4 24.4 22.2

14,164 11,883 3,769 29,816 47.5 39.9 12.6

9.7 100.8 (29.9) 23.2

2.8 31.5 6.2 9.9

1/

2/

22

2.10 DOH1/

HEALTH EXPENDITURE BY USE OF FUNDS, 2005-2011

Figure 10.1: Percentage Distribution of DOH

Expenditure by Use of Funds, 2009





20102/

2008

PERCENT SHAREAMOUNT (in million pesos)YEAR

2007

2006

2005

Revised

DOH includes the following agencies: Philippine Heart Center, National Kidney and Transplant Institute, Lung Center of the Philippines, Philippine

Children's Medical Center, Commission on Population, National Nutrition Council, and Philippine Institute of Traditional and Alternative Health Care.

Average

Annual Growth

Rate

2005-2011

2011

20092/

Growth Rate

2010-2011

Personal 53.1%

Public 30.5%

Others 16.4%

Personal 53.4%

Public 24.4%

Others 22.2%

Personal 47.5%

Public 39.9%

Others 12.6%


Personal Public Others Total Personal Public Others

8,243 13,997 9,250 31,490 26.2 44.4 29.4

9,446 15,677 8,698 33,821 27.9 46.4 25.7

11,434 18,540 11,313 41,288 27.7 44.9 27.4

10,481 17,274 10,566 38,320 27.3 45.1 27.6

14,367 23,469 13,937 51,773 27.7 45.3 26.9

16,037 26,108 15,857 58,003 27.6 45.0 27.3

17,487 28,586 17,290 63,364 27.6 45.1 27.3

9.0 9.5 9.0 9.2

13.4 12.6 11.0 12.4

1/ Revised

23

2.11 LOCAL GOVERNMENT HEALTH EXPENDITURE BY USE OF FUNDS,

2005-2011

Figure 11: Local Government Health Expenditure by Use of Funds,

2005-2011

Figure 12: Percentage Distribution of Local Government Health


2006

2007

2008

20101/

2011

20091/

Average Annual

Growth Rate

2005-2011

2005

AMOUNT (in million pesos)YEAR

Growth Rate

2010-2011

PERCENT SHARE

Personal 27.6%

Public 45.1%

Others 27.3%

8.2

9.4

11.4

10.5

14.4

16.0 17.5

14.0 15.7

18.5 17.3

23.5

26.1

28.6

9.3

8.7 11.3

10.6 13.9

15.9 17.3

0

5

10

15

20

25

30

2005 2006 2007 2008 2009 2010 2011

in b

illio

n p

eso

s

Personal

Public

Others


PS MOOE CO Total PS MOOE CO


Personal 7,438 3,566 1,912 12,916 57.6 27.6 14.8

Public 1,427 4,368 122 5,917 24.1 73.8 2.1

Others 1,584 2,626 1,167 5,376 29.5 48.8 21.7

General Administration & Operating Cost 1,433 2,487 1,147 5,066 28.3 49.1 22.6

Research and Training 3/ 151 139 20 310 48.8 44.9 6.4


Personal 4,236 2,669 1,360 8,265 51.3 32.3 16.5

Public 491 1,119 122 1,733 28.4 64.6 7.1

Others 5,878 602 53 6,534 90.0 9.2 0.8

General Administration & Operating Cost 5,837 536 35 6,408 91.1 8.4 0.5



Personal 6,192 7,810 2,035 16,037 38.6 48.7 12.7

Public 11,509 10,939 3,660 26,108 44.1 41.9 14.0

Others 6,253 7,323 2,281 15,857 39.4 46.2 14.4

General Administration & Operating Cost 6,253 7,323 2,281 15,857 39.4 46.2 14.4

Research and Training 3/ - - - - - - -




Others 1,552 1,513 704 3,769 41.2 40.1 18.7

Gen. Admin. & Operating Cost 1,386 1,399 690 3,475 39.9 40.3 19.9




Public Health Care 519 8,320 26 8,864 5.9 93.9 0.3

Others 1,024 2,264 268 3,556 28.8 63.7 7.5

Gen. Admin. & Operating Cost 963 2,200 217 3,381 28.5 65.1 6.4





Others 6,869 7,999 2,422 17,290 39.7 46.3 14.0 Gen. Admin. & Operating Cost 6,869 7,999 2,422 17,290 39.7 46.3 14.0

Research and Training 3/ - - - - - - -

1 /

2 / Revised

3 /

24

2.12 GOVERNMENT HEALTH EXPENDITURE1/ BY USE OF FUNDS AND BY TYPE

OF EXPENDITURE, 2010-2011

PERCENT SHARESOURCE OF FUND

AMOUNT (in million pesos)

20102/

Includes bio-medical research, operations/policy research, survey and monitoring, and manpower training activities.

2011

In this particular table, health expenditures of Other National Agencies for 2010 and 2011 do not include spending of PCSO and PAGCOR since

available data has no breakdown by type of expenditure (i.e., whether PS. MOOE, CO). As a result, figures appearing in tables 3.6 and 3.7 do not

match the data presented in this table.

The

The

The


2005 2/

2006 2/ 2007 2008 2009 2010 2011

Total health expenditure as

percentage of GNI3 to 4 3.1 3.8 3.1 3.1 3.2 3.2 3.3

Per capita health expenditure

(in pesos)2,000 2,629 3,377 3,061 3,377 3,759 4,112 4,577

Total government health

expenditures as percentage of

total health expenditure

40 28.8 26.8 27.5 24.8 25.9 26.6 27.0

National government 18 14.7 13.1 12.2 12.1 10.8 11.4 12.3

Local government 22 14.1 13.7 15.4 12.7 15.1 15.2 14.7

Total social health insurance

expenditures as percentage of

total health expenditure

15 8.7 7.8 7.4 7.1 8.2 8.9 9.1

Total public health care

expenditure as percentage of

total health expenditure 3/

20 11.3 11.2 10.5 9.8 12.7 10.7 12.3



Total public health care

expenditure as percentage of

total government health

expenditure

50 36.6 34.3 37.0 34.8 40.2 34.0 43.1



Out-of-pocket health spending

as percentage of total health

expenditure

20 51.8 54.3 55.0 56.7 53.3 52.5 52.7

1/ Based on the National Objectives for Health 2005-2010 prepared and published by the Department of Health.

2/ Revised

3/ Aside from the national government and the local government units, the rest of the world sector also contributes to public health care.

25

2.13 HEALTH CARE FINANCING INDICATORS: TARGET VERSUS ACTUAL LEVELS,

2009-2011

Indicator Target 1/

PNHA Estimates Actual versus

Target


2.14 SELECTED NATIONAL HEALTH ACCOUNTS INDICATORS for the PHILIPPINES and OTHER ASEAN

COUNTRIES, 2008-2010 1/

2008 2009 2010 2008 2009 2010 2008 2009 2010 2008 2009 2010 2008 2009 2010

Bangladesh 3.3 3.4 3.7 31.4 33.0 36.5 68.6 67.0 63.5 7.4 7.4 8.9 5.8 7.9 7.1

Bhutan 5.5 5.1 4.3 82.5 86.5 84.6 17.5 13.5 15.4 13.0 12.2 8.4 22.6 8.1 13.3

Brunei Darussalam 2.3 3.0 2.9 85.5 85.2 85.4 14.5 14.8 14.6 7.0 7.5 8.8 0.0 - ..

Cambodia 5.7 5.3 6.0 23.8 36.6 21.5 76.2 63.4 78.5 9.0 9.8 6.1 17.1 22.0 20.1

China 4.3 5.1 5.0 47.3 52.5 54.3 52.7 47.5 45.7 10.3 12.1 12.1 0.2 0.1 0.1

India 4.2 4.2 3.7 32.4 30.3 28.2 67.6 69.7 71.8 4.4 3.7 6.8 1.6 1.1 1.3

Indonesia 2.3 2.5 2.8 54.4 46.1 36.1 45.6 53.9 63.9 6.2 6.8 6.2 1.7 1.4 1.2

Japan 8.3 9.5 9.2 80.5 82.3 80.3 18.0 17.7 19.7 17.9 18.4 18.2 0.0 0.0 ..

Lao People's Democratic Republic 4.0 4.3 2.6 17.6 28.3 46.5 82.4 71.7 53.5 3.7 5.9 5.4 16.1 18.8 28.7

Malaysia 4.3 4.6 4.4 44.1 55.7 55.5 55.9 44.3 44.5 6.9 8.4 9.2 0.0 0.0 0

Maldives 13.7 6.4 6.2 61.2 60.7 60.8 38.8 39.3 39.2 13.8 7.9 9.3 1.2 1.1 0.5

Mongolia 3.8 5.7 5.5 81.4 54.8 57.0 18.6 45.2 43.0 7.5 8.8 8.6 7.5 4.0 3.8

Myanmar 2.3 2.1 2.0 7.5 11.3 12.1 92.5 88.7 87.9 0.7 1.0 1.3 9.1 9.2 …

Nepal 6.0 5.5 5.1 37.7 32.0 37.4 62.3 68.0 62.6 11.3 7.7 9.5 11.0 16.4 12.3

Pakistan 2.6 2.2 1.0 32.2 34.8 76.6 67.7 65.2 23.4 3.1 3.3 3.4 4.8 4.4 10.2

Papua New Guinea 3.2 3.7 4.1 80.1 70.6 75.2 19.9 29.4 24.8 7.4 8.5 9.8 20.6 21.5 20.9

Philippines 1/

3.7 3.6 4.1 34.7 35.1 36.1 65.3 64.9 63.9 6.1 7.1 8.8 1.5 1.0 1.7

Philippines 4/ 3.9 4.3 4.2 24.8 25.9 26.6 66.9 63.7 62.8 5.2 5.6 5.8 1.2 2.2 1.7

Republic of Korea 6.5 6.9 7.1 53.9 58.2 58.2 40.2 41.8 41.8 12.3 12.2 13.7 0.0 0.0 ..

Singapore 3.3 4.1 4.5 34.1 36.1 31.4 65.9 63.9 68.6 7.8 8.3 9.0 0.0 0.0 0.0

Thailand 4.1 4.2 3.9 74.3 74.6 75.0 25.7 25.4 25.0 14.2 13.3 14.3 0.3 0.3 0.3Viet Nam 7.2 6.9 6.8 38.5 37.5 37.1 61.5 62.5 62.9 9.3 7.8 7.7 1.7 3.0 3.2

2008 2009 2010 2008 2009 2010 2008 2009 2010 2008 2009 2010 2008 2009 2010

Bangladesh 0.0 0.0 0.0 96.5 96.5 96.6 0.3 0.3 0.3 17 21 25 5 7 9

Bhutan 0.0 0.0 0.0 100.0 96.3 94.7 0.0 0.0 1.2 100 91 89 83 78 75

Brunei Darussalam 0.0 - - 0.7 98.9 98.9 0.7 0.5 0.5 834 833 915 713 710 781

Cambodia 0.0 - - 84.6 66.8 75.4 0.0 0.0 0.2 43 41 48 10 15 10

China 66.3 64.7 64.2 82.6 78.9 77.2 6.2 6.9 7.4 146 191 219 69 100 119

India 17.2 17.4 19.0 74.4 86.4 86.0 2.3 4.6 4.7 45 44 51 15 13 14

Indonesia 12.3 15.1 17.4 70.3 75.2 75.8 4.5 3.1 3.7 51 56 84 28 26 30

Japan 81.5 87.7 87.3 80.6 82.1 82.0 13.8 12.7 12.5 3190 3754 3958 2568 3090 3179

Lao People's Democratic Republic 12.1 5.0 5.5 75.9 70.7 78.2 0.4 0.5 .. 34 39 30 6 11 14

Malaysia 0.8 0.8 0.7 73.2 76.8 76.8 14.4 14.7 14.7 353 316 368 156 176 204

Maldives 3.6 1.1 1.0 72.0 71.6 71.6 4.6 4.6 4.6 566 355 409 346 216 249

Mongolia 33.0 37.1 30.4 78.6 92.1 93.1 0.0 0.0 0.0 73 97 124 60 53 71

Myanmar 1.7 1.3 1.3 95.7 92.4 92.7 0.0 0.0 0.0 12 14 17 <1 2 2

Nepal 0.0 4.6 4.1 72.4 72.4 90.4 0.4 0.4 0.2 24 24 28 9 8 10

Pakistan 4.4 4.1 3.4 79.4 81.9 .. 0.3 0.4 2.3 22 20 10 7 7 8

Papua New Guinea 0.0 0.0 0.0 41.3 55.9 55.9 6.2 5.5 5.5 39 44 57 31 31 43

Philippines 1/

21.7 27.5 25.5 82.5 83.6 83.8 12.2 10.6 11.3 68 66 89 24 23 32

Philippines 4/

22.3 23.9 84.7 83.7 7.7 8.4 76 79 19 20

Republic of Korea 78.8 76.9 77.5 87.1 77.5 76.8 10.8 12.5 13.3 1245 1184 1452 671 689 845

Singapore 13.2 16.1 15.5 94.3 85.5 87.8 2.6 11.9 10.1 1404 1531 2005 479 553 629

Thailand 9.0 10.1 10.1 68.1 59.6 55.8 24.2 28.5 31.4 164 160 179 122 119 134

Viet Nam 32.2 36.0 38.4 90.2 92.7 93.0 2.7 0.0 76 77 83 29 29 31

1/ World Health Statistics 2013, World Health Organization, Date accessed: 22 October 2013 (http://www.who.int/gho/publications/world_health_statistics/2013/en/)

2 / 2007 to 2009 Budget of Expenditures and Sources of Finacing (BESF)

n/a - not available

26

General government expenditure

on health as % of total

government expenditure 2/

External resources for health as

% of total expenditure on healthMember State

Total expenditure on health as %

of GDP

General government expenditure

on health as % of total


Private expenditure in health as

% of total expenditure on health

4 / 2007-2010 PNHA, NSCB.

3 / Exchange rate from Bangko Sentral ng Pilipinas (http://www.bsp.gov.ph/statistics/spei_pub/Table%2037.pdf)

Accounts Link Series, Annual, Economic Statistics Office, NSCB.

Member State

Social security expenditure on

health as % of general

government expenditure in

health

Out-of-Pocket expenditure as %

of private expenditure on health

Private Prepaid plans as % of

private expenditure on health

Per capita total expenditure on

health at average exhange rate

(US$) 3/

Per capita government

expenditure on health at average

exchange rate (US$) 3/


2005 2006 2007 2008 20091/

20101/ 2011

2,022 2,083 2,159 2,179 2,298 2,442 2,639

3.1 3.1 3.1 3.1 3.2 3.2 3.3

Male na

Female na

na

na

na

na 23.0 na 24.9 na na 22.0

na 162.0 na na na na 221.0

20.0 na na 20.6 na na 20.2

4,766 8,242 10,222 11,224 na na na

84.1 83.2 82.7 79.2 90.6 78.02 68.74

68.4 70.4 72.9 74 74.3 79.5 85.6

73.0 63.0 na 72.0 na na 75.0

82.0 83.0 na 79.0 na na 85.0

na na 82.9 84.1 na 84.8 na

na na 88.4 89.0 na 92.5 na

1,574 1,589 1,554 1,531 1,654 1,602 1,622

21,148 21,428 21,019 21,143 23,501 21,338 24,197

919 1,149 1,252 1,217 1,301 1,404 1,602

Acute Watery Diarrhea 707.6 707.7 640.0 485.4 354.5 288.7 157.0

Bronchitis/Bronchiolitis 722.5 689.9 577.8 580.8 380.7 232.6 273.5

Acute Lower Respiratory Tract Infection and

Pneumonia 809.9 828.8 718.0 871.8 612.6 768.8 594.8

Influenza 476.5 435.0 414.6 404.8 297.7 176.0 231.5

TB Respiratory 448.8 169.9 136.0 107.8 80.9 39.7 50.1

Malaria 42.3 27.8 27.5 13.1 5.8 na 9.5

Diseases of the heart 90.4 95.5 99.7 101.9 109.4 na na

n.a. - not available

27

3/ National Statistics Office, 2006 Family Planning Survey, 2008 National Demographic and Health Survey, 2011 Family Health Survey

6.1

2.96

Health Expenditure Per Capita (in pesos, at 2000 prices)

Share of Health Expenditure to GNI, %

Life Expectancy at birth (in years) 2/

Crude Death Rate (deaths per 1,000 population) 2/

Proportion of birth attended by skilled health personnel 6/

Prevalence of underweight children under 5 years of

age4/

Number of Botika ng Barangay established 5/

Number of PhilHealth accredited hospitals 9/

1/ Revised

Proportion of tuberculosis cases cured under directly

observed treatment short course (DOTS)7/

Proportion of families with access to safe water supply 8/

Proportion of urban population with access to improved

sanitation8/

Morbidity Rates (per 100,000 population) for the leading causes of morbidity 6/

2/ National Statistics Office, 2000 Census-Based National, Regional and Provincial Population Projections

Number of accredited health professionals 9/

Number of accredited rural health units (RHUs) 9/

2.15 HEALTH EXPENDITURE AND HEALTH STATUS, 2005-2011

Crude Birth Rate (births per 1,000 population) 2/

STATISTICS

Proportion of tuberculosis cases detected under directly

observed treatment short course (DOTS)7/

Proportion of 1 year-old children immunized against

measles 6/

Infant Mortality Rate (per 1,000 livebirths)3/

Maternal Mortality Ratio (per 1,000 livebirths)3/

66.1

71.6

25.7

Total Fertility Rate (no. of children per woman)2/

4/ Food and Nutrition Research Institute, 2008 National Nutrition Survey; 2005 and 2011 Updating of Nutritional Statuts of Filipino Children and Selected Population Groups

5/ Department of Health, National Drug Policy-Pharmaceutical Management Unit (NDP-PMU 50)

6/ Department of Health, 2005, 2006, 2007, 2008, 2009, 2010, and 2011 Field Health Service Information System

7/ Department of Health, National Center for Disease Prevention and Control

8/ National Statistics Office, Annual Poverty Indicators Survey

9/ PhilHealth, 2005, 2006, 2007, 2008, 2009, 2010 and 2011 Annual Report

3. 2005-2011PNHA MATRIX

2005 Matrix

Loans

GOP

counterpart

funding

PERSONAL HEALTH CARE 12,024,360 6,172,018 755,812 - 8,242,932 17,511,411 79,100 115,393,479 2,184,548 7,167 6,666,901 5,411,280 2,138,047 1,293,401

Government Hospital12,024,360 4,709,647 755,812 - 7,800,334 4,903,195 1,293,401

Private Hospital- 535,950 - - - 12,608,216

Non-Hospital MD Facilities- 878,144 - - 442,598 -

Other Professional Facilities- 48,278 - - - -

Dental Facilities- - - - - -

Traditional Health Care- - - - - -

Retail Outlets: Drugs and

Other Non-Durable

Purchases (self care) - - - - - -

Retail Outlets: Vision

Products and Other Medical

Durables (self care)- - - - - -

PUBLIC HEALTH CARE 2,302,259 1,080,688 6,114,687 324,459 13,996,894 - - - - - - - - 977,298 24,796,285

OTHERS 2,626,981 510,596 193,537 33,684 9,250,315 1,758,102 11,239 - 1,919,176 1,106 3,237,615 - - 93 19,542,445

General Administration and

Operating Costs 2,466,367 433,272 - - 9,250,315 1,758,102 11,239 - 1,919,176 1,106 3,237,615 - - - 19,077,193

Bio-Medical Research160,286 34,332 - - - - - - - - - - - - 194,618

Operations/Policy Research- 23,018 193,537 33,684 - - - - - - - - - - 250,239

Survey and Monitoring- 19,974 - - - - - - - - - - - - 19,974

Manpower Training

Activities 328 - - - - - - - - - - - - 93 421

16,953,601 7,763,303 7,064,036 358,143 31,490,141 19,269,513 90,339 115,393,479 4,103,724 8,273 9,904,516 5,411,280 2,138,047 2,270,792 222,219,186

28

Private

Schools

REST OF

THE

WORLD

USE OF FUNDS

1/ - DOH includes the following agencies: DOH, PHC, NKTI, LCP, PCMC, NNC, PopCom, and PITAHC.

2,184,548 7,167

3.1 PHILIPPINE NATIONAL HEALTH ACCOUNTS, 2005 (in thousand pesos)

TOTAL BY

USE

GOVERNMENT SOCIAL INSURANCE PRIVATE SECTOR

DOH 1/

SOURCE OF FUNDS

National

Health

Insurance

Program

Other

Private

Insurance

Employees'

Compensation

2/ - Others include DDB, VMMC-PVAO, FNRI, NMIS, AFP-Medical Center, PCHRD, NCDA, AFP-PN, AFP-PA, AFP-PAF, BFP, BCOR, DepEd, PAGCOR, PCSO, OSHC, UP System, DOLE, PNP, DSWD, and NAPOLCOM.

177,880,456 79,100 115,393,479 5,411,280 6,666,901

TOTAL BY SOURCE

Local

Government

National Government

Private

Establishments

2,138,047

Other

National

Government

Agencies 2/

HMOsLife & Non-

life

Insurance

Companies

Foreign-Assisted Projects Private Out-

of-Pocket

Private Insurance

2006 Matrix

Loans

GOP

counterpart

funding

PERSONAL HEALTH CARE 10,436,649 8,202,735 572,464 90 9,446,302 17,104,881 68,816 133,711,051 1,863,158 1,462 8,009,721 5,520,351 2,401,038 -

Government Hospital10,436,649 5,585,698 572,464 90 8,774,126 4,789,367

Private Hospital- 734,645 - - - 12,315,514

Non-Hospital MD Facilities- 1,814,082 - - 672,176 -

Other Professional Facilities- 68,310 - - - -

Dental Facilities- - - - - -

Traditional Health Care- - - - - -


Other Non-Durable

Purchases (self care) - - - - - -



Durables (self care)- - - - - -

PUBLIC HEALTH CARE 2,005,326 1,597,920 4,363,128 278,637 15,676,768 - - - - - - - - 4,463,266 28,385,046

OTHERS 3,333,207 2,816,692 80,563 - 8,698,157 1,899,712 24,532 - 2,058,855 1,240 3,178,556 - - - 22,091,514


Operating Costs 3,047,423 2,745,636 - - 8,698,157 1,899,712 24,532 - 2,058,855 1,240 3,178,556 - - - 21,654,111


Operations/Policy Research- 18,552 80,563 - - - - - - - - - - - 99,116


Manpower Training

Activities 92 - - - - - - - - - - - - - 92

15,775,183 12,617,347 5,016,155 278,727 33,821,227 19,004,593 93,348 133,711,051 3,922,013 2,701 11,188,277 5,520,351 2,401,038 4,463,266 247,815,278

29

Private Out-

of-Pocket

Private Insurance

National

Health

Insurance

Program

Other

National

Government

Agencies 2/

Foreign-Assisted Projects Life & Non-

life

Insurance

Companies

Other

Private

Insurance

1,462 8,009,721


5,520,351

2,401,038

TOTAL BY SOURCE

Private

Schools DOH 1/

National Government

Local

Government

Private

Establishments


197,338,718 68,816 133,711,051 1,863,158


USE OF FUNDS

SOURCE OF FUNDS

TOTAL BY

USE


Employees'

Compensation

PRIVATE SECTOR

REST OF

THE

WORLDHMOs

2007 Matrix

Loans

GOP

counterpart

funding

PERSONAL HEALTH CARE 10,518,078 7,039,113 101,934 90 11,434,127 17,447,808 64,789 147,872,855 1,863,640 4,020 9,262,506 5,995,580 2,819,670 38,765

Government Hospital10,518,078 4,951,623 101,934 90 10,373,003 5,059,864 - -

Private Hospital- 377,578 - - - 12,387,944 - -

Non-Hospital MD Facilities- 1,650,218 - - 1,061,124 - 38,765

Other Professional Facilities- 59,694 - - - - -

Dental Facilities- - - - - - -

Traditional Health Care- - - - - - - -


Other Non-Durable

Purchases (self care) - - - - - - - -



Durables (self care)- - - - - - - -

PUBLIC HEALTH CARE 2,459,608 1,794,955 4,181,926 380,220 18,540,290 - - - - - - - - 893,895 28,250,893

OTHERS 4,075,683 2,135,015 61,968 - 11,313,101 2,390,497 69,377 - 2,306,894 714 3,860,401 - - - 26,213,650


Operating Costs 3,865,764 2,022,338 - - 11,313,101 2,390,497 69,377 - 2,306,894 714 3,860,401 - - - 25,829,085


Operations/Policy Research- 21,372 61,968 - - - - - - - - - - - 83,340


Manpower Training

Activities 17 - - - - - - - - - - - - - 17

17,053,369 10,969,083 4,345,828 380,310 41,287,518 19,838,305 134,165 147,872,855 4,170,534 4,734 13,122,907 5,995,580 2,819,670 932,659 268,927,518

30

Private Out-

of-Pocket

Private Insurance

National

Health

Insurance

Program

Other

National

Government

Agencies 2/

Foreign-Assisted Projects Life & Non-

life

Insurance

Companies

Other

Private

Insurance

4,020 9,262,506


5,995,580

2,819,670

TOTAL BY SOURCE

Private

Schools DOH 1/

National Government

Local

Government

Private

Establishments


214,462,975 64,789 147,872,855 1,863,640


USE OF FUNDS

SOURCE OF FUNDS

TOTAL BY

USE


Employees'

Compensation

PRIVATE SECTOR

REST OF

THE

WORLDHMOs

2008 Matrix

Loans

GOP

counterpart

funding

PERSONAL HEALTH CARE 11,026,964 10,105,455 27,754 12,898 10,480,527 18,136,063 49,989 171,115,766 2,229,496 2,784 11,560,284 7,043,355 3,147,878 242,494

Government Hospital11,026,964 8,315,663 27,754 12,898 9,677,960 5,078,098 - 206,373


Non-Hospital MD Facilities- 1,386,213 - - 802,567 - 36,122





Other Non-Durable





PUBLIC HEALTH CARE 3,854,637 3,688,379 918,563 290,027 17,273,567 - - - - - - - - 3,439,049 29,464,221

OTHERS 4,095,462 2,534,280 - - 10,566,007 3,209,014 38,445 - 2,875,986 123 4,077,931 - - - 27,397,248


Operating Costs 3,844,907 2,402,667 - - 10,566,007 3,209,014 38,445 - 2,875,986 123 4,077,931 - - - 27,015,080


Operations/Policy Research- 25,235 - - - - - - - - - - - - 25,235


Manpower Training

Activities 776 - - - - - - - - - - - - - 776

18,977,062 16,328,114 946,317 302,925 38,320,101 21,345,077 88,434 171,115,766 5,105,482 2,906 15,638,215 7,043,355 3,147,878 3,681,543 302,043,175

31

Private Out-

of-Pocket

Private Insurance

National

Health

Insurance

Program

Other

National

Government

Agencies 2/

Foreign-Assisted

ProjectsLife & Non-

life

Insurance

Companies

Other

Private

Insurance

2,784 11,560,284


7,043,355

3,147,878

TOTAL BY SOURCE

Private

Schools DOH 1/

National Government

Local

Government

Private

Establishments


245,181,706 49,989 171,115,766 2,229,496


USE OF FUNDS

SOURCE OF FUNDS

TOTAL BY

USE


Employees'

Compensation

PRIVATE SECTOR

REST OF

THE

WORLDHMOs

2009 Matrix

Loans

GOP

counterpart

funding




Non-Hospital MD Facilities- 950,588 - - 1,201,117 - -





Other Non-Durable

Purchases (self care) 0 - - - - - - -





OTHERS 3,429,853 4,306,840 - - 13,937,033 3,579,444 52,113 - 3,117,003 78 4,778,165 - - 46,500 33,247,031


Operating Costs 3,140,666 4,208,996 - - 13,937,033 3,579,444 52,113 - 3,117,003 78 4,778,165 - - - 32,813,499




Manpower Training

Activities 941 - - - - - - - - - - - - 46,500 47,441

20,926,190 15,402,791 504,767 115,023 51,772,996 27,790,656 106,511 182,369,924 6,080,970 1,736 18,198,960 7,809,123 3,403,928 7,680,524 342,164,096

32

Private Out-

of-Pocket

Private Insurance

National

Health

Insurance

Program

Other

National

Government

Agencies 2/

Foreign-Assisted

ProjectsLife & Non-

life

Insurance

Companies

Other

Private

Insurance

1,658 13,420,794


7,809,123

3,403,928

TOTAL BY SOURCE

Private

Schools DOH 1/

National Government

Local

Government

Private

Establishments


265,633,276 54,397 182,369,924 2,963,966


USE OF FUNDS

SOURCE OF FUNDS

TOTAL BY

USE


Employees'

Compensation

PRIVATE SECTOR

REST OF

THE

WORLDHMOs

2010 Matrix

Loans

GOP

counterpart

funding




Non-Hospital MD Facilities- 1,672,694 - - 1,392,400 - 16,203

Other Professional

Facilities - 178,077 - - - - -




Other Non-Durable






OTHERS 5,376,056 6,533,774 - - 15,856,895 3,784,761 78,180 - 3,459,364 143 5,623,495 - - 12,848 40,725,516


Operating Costs 5,066,104 6,407,934 - - 15,856,895 3,784,761 78,180 - 3,459,364 143 5,623,495 - - - 40,276,876




Manpower Training

Activities 420 - - - - - - - - - - - - 12,848 13,268

24,208,466 18,441,924 578,126 146,803 58,002,522 33,798,967 125,548 199,982,739 6,399,728 1,543 21,169,816 7,936,838 3,648,768 6,383,947 380,825,733

33

Private Out-

of-Pocket

Private Insurance

National

Health

Insurance

Program

Other

National

Government

Agencies 2/

Foreign-Assisted

ProjectsLife & Non-

life

Insurance

Companies

Other

Private

Insurance

1,400 15,546,321


7,936,838

3,648,768

TOTAL BY SOURCE

Private

Schools DOH 1/

National Government

Local

Government

Private

Establishments


299,463,278 47,368 199,982,739 2,940,364


USE OF FUNDS

SOURCE OF FUNDS

TOTAL BY USE


Employees'

Compensation

PRIVATE SECTOR

REST OF

THE

WORLDHMOs

2011 Matrix

Loans

GOP

counterpart

funding

PERSONAL HEALTH CARE 14,164,219 9,908,527 132,968 - 17,487,345 34,884,817 51,690 227,214,628 3,231,435 295 18,324,967 9,296,907 3,705,637 517,964

Government Hospital14,164,219 8,628,029 132,968 - 16,035,460 10,814,293 - 517,964


Non-Hospital MD Facilities- 131,558 - - 1,451,885 - -





Other Non-Durable






OTHERS 3,768,566 3,555,953 - - 17,290,073 4,137,523 52,428 - 3,989,916 33 6,245,151 - - 24,948 39,064,591


Operating Costs 3,475,047 3,380,907 - - 17,290,073 4,137,523 52,428 - 3,989,916 33 6,245,151 - - - 38,571,079




Manpower Training

Activities 90 - - - - - - - - - - - - 24,948 25,039

29,815,873 22,359,805 760,987 132,629 63,363,630 39,022,341 104,118 227,214,628 7,221,351 328 24,570,118 9,296,907 3,705,637 3,478,219 431,046,571

34

TOTAL BY SOURCE



Private Out-

of-Pocket

Private Insurance

338,921,399 51,690 227,214,628 3,231,435 295


USE OF FUNDS

SOURCE OF FUNDS

TOTAL BY

USE


REST OF

THE

WORLDDOH 1/

National Government

Local

Government

18,324,967 9,296,907

3,705,637

PRIVATE SECTOR

Private

Schools HMOs

Private

Establishments

Other

National

Government

Agencies 2/

Foreign-Assisted

ProjectsLife & Non-

life

Insurance

Companies

Other

Private

Insurance

National

Health

Insurance

Program

Employees'

Compensation

2011 Matrix

TOTAL PS MOOE CO TOTAL PS MOOE CO TOTAL PS MOOE CO

13,462,099,397 10,193,983,970 2,562,143,268 705,972,159 3,180,454,533 1,913,073,716 672,573,973 594,806,844 8,157,012,559 5,265,999,948 2,730,699,013 160,313,598

Government Hospital 13,462,099,397 10,193,983,970 2,562,143,268 705,972,159 3,060,336,995 1,809,319,177 656,210,974 594,806,844 7,549,118,787 5,260,707,263 2,132,410,633 156,000,891

Private Hospital - - - - - - - - - - - -

Non-Hospital MD

Facilities- - - - 120,117,538 103,754,539 16,362,999 - 607,893,772 5,292,685 598,288,380 4,312,707

Other Professional

Facilities- - - - - - - - - - - -

Dental Facilities - - - - - - - - - - - -

Traditional Health Care - - - - - - - - - - - -


Other Non-Durable - - - - - - - - - - - -


Products and Other - - - - - - - - - - - -

PUBLIC HEALTH CARE 1,978,828,558 483,035,892 1,435,713,444 60,079,222 763,420,865 77,379,994 677,799,593 8,241,278 13,717,784,341 9,806,048,341 3,631,778,599 279,957,402

OTHERS 4,871,612,025 3,123,751,750 1,193,966,216 553,894,060 359,228,658 250,675,164 72,119,316 36,434,177 9,191,363,162 6,976,919,727 2,123,272,397 91,171,039

General Administration

and Operating Costs4,699,230,830 3,013,672,977 1,131,663,794 553,894,060 290,402,141 201,381,294 57,730,396 31,290,451 9,191,363,162 6,976,919,727 2,123,272,397 91,171,039

Bio-Medical Research 172,369,323 110,078,772 62,290,550 - 34,129,404 28,491,772 3,946,313 1,691,320 - - - -

Operations/Policy

Research- - - - 15,288,358 5,210,596 9,457,763 620,000 - - - -

Survey and Monitoring - - - - 19,408,755 15,591,503 984,845 2,832,406 - - - -

Manpower Training

Activities11,872 - 11,872 - - - - - - - - -

Net Income - - - - - - - - - - - -

Additions to Reserves - - - - - - - - - - - -

20,312,539,980 13,800,771,611 5,191,822,928 1,319,945,441 4,303,104,056 2,241,128,875 1,422,492,883 639,482,299 31,066,160,063 22,048,968,016 8,485,750,009 531,442,039

35

3.8 GOVERNMENT HEALTH EXPENDITURES BY TYPE, 2011

TOTAL BY SOURCE

USES OF FUNDS

SOURCES OF FINANCING/TYPE OF EXPENDITURE

NationalLocal

DOH Others

PERSONAL HEALTH

CARE

4. THE PNHA FRAMEWORK

The PNHA Framework

36

4. The PNHA Framework

4.1 Concepts and Definitions

4.1.1 Health Care Expenditure

The PNHA covers total health care expenditures in a given year for the country as a whole. As defined in the PNHA, health care expenditures refer to expenditures on goods and services for the preventive, curative, therapeutic and rehabilitative care of the human population for the primary purpose of improving health. These include

(a) health care goods and services provided by

• government hospitals and medical clinics • private for profit hospitals and medical clinics • private non-profit hospitals and medical clinics • school-based and business establishment-based hospitals

and medical clinics • own-account physicians • dentists • non-MD health practitioners • traditional health attendants

(b) health care goods prescribed or consumed for home or self-care;

(c) government expenditure on: • various programs such as the immunization, nutrition, disease

control, vector control and health information and education • construction of government hospitals and facilities for use in

public health programs1 • health policy-formulation and program planning activities,

biomedical and operations research and non-degree training of health manpower2

• overall administration of public health programs

(d) administration expenditure of public and private health insurance operations and other health care financing schemes

1 Cost of private sector capital investments are assumed to be recovered through revenues obtained from

products sold and is therefore not reported in the PNHA under a separate category. 2 Cost of private sector research and training are assumed to be recovered through revenues obtained from

products sold and is therefore not reported in the PNHA under a separate category.

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37

Excluded are large programs which have health effects, but whose primary goal is not health improvement. Examples are: general food subsidies, pollution abatement, sewerage and water supply projects. However, targeted supplemental feeding, water quality testing and water treatment projects are included in the PNHA when the primary purpose for the activities is to improve health.

4.1.2 Health Care Goods and Services

For both goods and services, the type of product consumed and/or the type of establishment providing the product determine the product's inclusion or exclusion in the PNHA. For both goods and services, one taxonomy used is the Philippine Standard Industrial Classification (PSIC). The PSIC is a scheme that groups together businesses producing like products.

4.1.2.1 Health Care Goods

Using the commodity groupings of the Philippine Central Product Classification (PCPCI, health care goods include the following:

PCPC Code Commodity Description

352 Pharmaceutical Products

3529

Other Pharmaceutical Products or Articles for Medical or Surgical Purposes

PSIC Code Industry Description

21001

21002

26701

Manufacture of drugs and medicines including

biological products such as bacterial and virus vaccines, sera and plasma

Manufacture of surgical dressings, medicated wadding, fracture bandages, catgut and other prepared sutures

Manufacture of optical instruments and lenses

.

The PNHA Framework

38

4.1.2.2 Health Care Activities (Provider-Based)

Health care activities include the following:

PSIC Code Industry Description

86111 86121

Public Hospital services Private Hospital services

86212 86222

Public Dental and Laboratory Activities Private Dental and Laboratory Activities

86211 86221

Public Medical Activities Private Medical Activities

Using the PSIC, provider-based health care services are identified as those produced by the following establishments:

PSIC Codes Industry Description

8621 Public medical, dental and other health activities

8622 Private medical, dental and other health

activities

8519 Other hospital activities and medical and dental practices

Direct purchases by household and other final consumers of services provided by establishments listed above are included in the PNHA.

4.1.2.3 Other Health Services (Non-Provider Based)

Services provided by the DOH (other than those by DOH health care facilities) are all classified as health care service. Services provided by non-DOH government agencies (over and above those provided by agency-based health care facilities) such as nutrition programs, health information campaigns and drinking water testing are also classified as health care services.

The PNHA Framework

39

4.2 Design/Matrix The PNHA framework consists of a matrix of operational categories classifying

and defining the sources and uses of funds for health care goods and services. It is similar to that of the U.S. in that it is two-dimensional where the columns are the sources of funds and the rows are the uses (types of providers and services) of funds. The entries along each of the dimension of the PNHA matrix reflect characteristics of the system of health care delivery and financing in the Philippines

The PNHA tells: (a) how much was spent for health care in the country; (b) who

paid for health care (sources of funds); and (c) what was paid for (uses of funds). An illustration of the matrix is shown in Figure 13 below: Figure 13. Conceptual PNHA Framework

USE OF FUNDS

SOURCE OF FUNDS

TOTAL Government Social

Insurance Private Rest of the world National Local

Personal Public Other

TOTAL

4.2.1 Uses of Funds In principle, all health care goods and services can be classified by who

receives the benefits of their provision. At one extreme end of the continuum are purely private goods and services for which all benefits are captured by the person who receives the health care (e.g., a cast for a broken bone). At the other extreme are pure public goods and services, for which the benefit are equally received by everyone in the community (e.g., spraying for malaria control). Many health care goods and services are mixed public/private goods that fall somewhere in the middle of the continuum. A vaccination for polio, for example, provides a private immunization benefit to the individual who receives it, and many others receive benefit because they are less likely to be exposed to polio from the person who was immunized. Mixed public/private goods have effects that are external to the individual, and are simply referred to as goods with externalities.

For purpose of the PNHA, health care goods/services or uses of health funds

are classified into three main types: personal health care, public health care and others.

Personal health care includes pure private health goods and services. Public health care includes both pure public health goods and services and goods/services with externalities (e.g., information/education campaigns or IEC, safety and standards regulation, spraying for malaria control and other vector control activities, immunization, programs providing personal care services combined with information and education services like primary health care, maternal and child health care, control of diarrheal diseases and control of acute respiratory infections).

The PNHA Framework

40

“Others” include all health-related uses of funds that are not direct health care provision but which support, enhance and facilitate the production, provision, delivery, payment and consumption of the two main categories of health care goods and services. Thus, it can be described as the indirect cost of providing health goods and services. Included under this third category are: (1) central administration by government of health activities, by PhilHealth, ECC, SSS and GSIS of social insurance operations and by private insurance companies for private health insurance operations; and (2) health-related research and training.5

4.2.2 Sources of Funds

The payors identified in the Philippines and adopted as PNHA sources of funds categories are the government, social insurance, private sources and other sources.

The categories along the “sources” dimension of the PNHA matrix answer the

questions: who and how health services are financed. Thus, the sources of health expenditures refer to the person or institution that directly pays the health care providers. Payors are not necessarily the consumer of the goods or services. For example, medical services provided by an NGO to a group of people (i.e., consumers) for free are, under the PNHA, paid for by the NGO entity (i.e., the payor), even if NGO funds originally came from community donations, international donors and other various sources. Thus the NGO is the ultimate financing unit rather than the household or the rest of the world. Payor for health care received by persons fully covered by medical insurance is the insurer. Payor for health care received by persons for free from public facilities is the government.

4.3 The PNHA Operational Framework

4.3.1 Uses of Funds

Existing data sources do not allow perfect classification of health care expenditures according to the two main categories (personal vs. public health care) defined above. As proxy measure for source (row) categories, a “facility-based” definition is adopted. A “facility” is defined as any establishment or institution that provides health care goods or services or undertakes activities that support and enhance health care service provision.

Because nearly all health care facilities provide a mix of personal and public

health care, as well, as support/enhancement services, the row assignment is dictated by the primary (majority) activity provided by the facility. Thus, services received from hospitals and dental clinics are classified as personal health service. Goods and services provided by Rural Health Units (RHU), Barangay Health Stations (BHS), puericulture centers and other government clinics such as social hygiene clinics, chest clinics, and floating clinics are classified as public health care because these are, in general, characterized to have positive economic externalities. For example, vaccinations provided by these facilities protect immunized individuals and, at the same time, also prevent the spread of disease to the community. Purely

5 Earlier versions of the PNHA included net income and additions to reserves for insurance operations.

The PNHA Framework

41

personal health care services, however, are also provided by these facilities but current data sources do not provide sufficient information to allow the separation of expenditures for purely personal services from those for services with externalities.

4.3.1.1 Categories of Uses of Fund

The sub-categories for each category of uses of funds are given below: Uses Categories (Rows)

1. Personal Health care

1.1 Government Hospitals 1.2 Private Hospitals 1.3 Non-hospital Medical Care Facilities 1.4 Dental Care Facilities 1.5 Other Professional Care facilities 1.6 Traditional Health Care 1.7 Retail Outlets: Drugs and Other Non-Durables (self-care) 1.8 Retail Outlets: Vision Products and Other Medical Durables (self-

care) 2. Public Health Care 3. Others

3.1 General Administration and Operating Cost 3.2 Research and Training

4.3.1.2 Operational Definition for Uses of Fund

4.3.1.2.a Personal Health Care

Government Hospitals. In general, hospital expenditures are measured by total revenue from all sources including government budgetary allocation – but because government hospitals do not retain insurance payments and patient fees (except for payments for drugs which go into a hospital revolving fund), total expenditures included in the PNHA are basically paid out of and limited to the amount of revenues net of Medicare benefit payments, EC payments, private insurance payments, household out-of-pocket expenditures and any non-retained fees from other sources. Revenues of government hospital from sources other than the government budget are generally small. Private Hospitals. Total expenditures at private hospitals, including profit, non-profit and charitable (philanthropic) hospitals, are measured by public and private health insurance benefit payments, patient fees, subsidies by government and any other non-patient revenues, including gifts and donations. Non-hospital MD facilities. Includes expenditures for all goods obtained from and all services rendered in non-hospital facilities operated by medical

The PNHA Framework

42

doctors. Included are expenditures at offices and clinics of private physicians, dermatologists, psychiatrists, opthalmologists. Dental care facilities. Includes expenditures for all goods obtained from and all services rendered in dental facilities, including separate private dental X-ray facilities. Also included in this category are expenditures for activities under the DOH special program for dental care. (Note that dental surgery, if conducted in a hospital is included under hospital health care). Additionally, purchases of health care goods from sources outside of dental facilities but bought as prescribed or as advised during a dental visit are included here.

Other professional care facilities. Includes expenditures for goods obtained from services rendered in establishments of health professionals not already captured by the above categories such as services of private-duty nurses, midwives (i.e., lying-in clinics), medical officers, chiropractors, podiatrists, physical therapists (i.e., rehabilitation centers), optometrists, clinical psychologists and laboratory/medical technicians (i.e., diagnostic laboratories and x-ray facilities). Traditional Health Care. Includes payments made to “hilots”, “herbolarios” and other traditional practitioners for in-home or office facility health care goods and services plus payments for prescribed health care supplies. Also includes the expenditures for DOH programs on traditional medicine. Retail Outlets: Drugs and Other Non-Durables (Self Care). Expenditures in this category are limited to spending for products purchased from retail outlets by consumers of health care goods which were not prescribed or advised by any of the health care providers above. These include expenditures for drugs, medicines, herbal preparations and medical sundries such as bandages, absorbent cotton, mouthwash, medicated strip, betadyne, rubbing alcohol and dextrose. Retail Outlets: Vision Products and Other Medical-Durables (Self Care). Expenditures in this category are limited to expenditures made by consumers for health care goods that were not prescribed or advised by any of the health care providers above. Included are expenditures for such items as eyeglasses, hearing aids, thermometer, sphygmomanometer, bulk and cylinder oxygen, wheelchairs, and equipment rental at retail outlets.

4.3.1.2.b Public Health Care

Covers expenditures by institutions, including DOH, non-DOH central government agencies, LGUs, donor agencies and NGOs, for the production and/or provision of health care goods and services with economic externalities or which are characterized as public goods. Specific programs and activities that are classified as public health care (and with "public goods" characteristics) include vector control activities like mosquito spraying, information and education campaigns (e.g. DOH Anti-Smoking Program) and safety/standards regulation activities. Goods and services provided by Rural Health Units (RHUs), Barangay Health Stations (BHS’), puericulture centers, and other government clinics such as social hygiene

The PNHA Framework

43

clinics, chest clinics, and floating clinics are also classified as public health care because these are, in general, characterized to have positive economic externalities. For example, vaccinations provided by these facilities protect immunized individuals and, at the same time, also prevent the spread of disease to the community. Purely personal health care services, however; are also provided by these facilities, but current data sources do not provide sufficient information to allow the separation of expenditures for purely personal services from those for services with externalities. When, and if such data become available, expenditures should be distributed by type of service, and these government facilities should then also be included among those providing personal care.

4.3.1.2.c Others

This category is defined to include expenditures for health-related activities that are not direct health care provision but which support, enhance and facilitate the provision delivery, payment and consumption of the two main categories of health care goods and services. The institution that undertakes these types of activities include the DOH, non-DOH central government agencies, PhilHealth, SSS, GSIS, private health insurance companies, HMO's, companies with employer-based plans and NGO's with community-based health programs.

General Administration and Operating Cost. In general, administration cost is defined as an overhead expense of operating an institution, i.e. over and above the total expenditures for goods and/or services provision. Included under administrative expenditures or operating costs are costs of management, finance, accounting, procurement and other such services. Expenditures for general administration of national government included in the PNHA are expenditures for the overall management of central government health care activities more specifically by the DOH’s Office of the Secretary and by other non-DOH government agencies undertaking health care activities. Expenditures for the general administration of government health care facilities such as public hospitals and RHUs, however, are considered part of service provision costs and thus, excluded from this category. As a rule, all administrative costs of health care service providers (public or private) are considered part of service provision and counted in the appropriate rows of the PNHA matrix. Health insurance activities of PhilHealth, SSS, GSIS, private insurance companies and HMO's enhance and facilitate the payment and consumption of health care goods and services by allowing risk-pooling. Thus, all costs of insurers other than health benefit payments, which are for the administration and continuing operation of health insurance activities are included in this category. These costs include payments for management, finance and other such services; payments for other underwriting costs; payments for premium and income taxes; payments for utilities, transport, supplies and materials. Administration costs of philanthropic organizations and NGO's for health-related but not direct service provision activities are included. Note again that administration costs of the health care providers are considered part of service provision costs and are, thus, excluded here.

The PNHA Framework

44

Research and Training. Expenditures for research and training that would lead to improved medical treatment, efficient service delivery and/or effective planning and management of health care activities are classified under the "other" uses category. The institutions covered are government agencies and non-profit entities that undertake health research and training activities. Expenditures for research and training conducted by private, for-profit organizations are excluded because these expenditures are treated as intermediate consumption and are recovered through company sales. Expenditures for the following types of research by government and non-profit institutions are included: (1) bio-medical research; (2) research to improve the efficiency and effectiveness of the health care delivery system; (3) research to improve logistics systems and to improve the effectiveness of the management of health care resources; and (4) survey, monitoring and evaluation - surveys of disease incidence and immunization coverage; monitoring effectiveness of projects or programs; and evaluating alternative interventions. Only expenditures for special non-degree training of workers who are already in the health care industry are included (e.g., special training for physicians, BHWS and “hilots”). Excluded are schooling expenditures of individuals attending medical and nursing schools. Also excluded are schooling expenditures of health workers who have gone back to school to formally earn a higher degree.

4.3.2 Sources of Funds

4.3.2.1 Categories of Sources of Fund

The PNHA sources of financing for health care goods and services include expenditures made by the following four main groups: (1) the government; (2) social insurance; (3) private sources; and (4) other sources. The subcategories within each category are shown below:

Sources Categories (Columns)

1. Government 1.1 National 1.2 Local

2. Social Insurance6 2.1 National Health Insurance Program 2.2 Employees’ Compensation

3. Private 3.1 Out-of-pocket 3.2 Private Insurance 3.3 Health Maintenance Organizations 3.4 Private Establishments 3.5 Private Schools

4. Rest of the world

6 Earlier versions of the PNHA included Hospitalization Insurance Plan (HIP) of the GSIS under social

insurance. HIP was later transferred to private insurance since it is a benefit under the Optional Life Insurance, in which membership is purely on a voluntary basis.

The PNHA Framework

45

The categories adopted for sources of funds make the PNHA useful for providing information on various dimensions: (a) public versus private roles in health care provisions; (b) the entities/organizations which manage the financing scheme and determine the level of health expenditures; (c) type of financing for health services, i.e., whether from taxation, contributions to insurance funds, household out of-pocket or foreign assistance; and (d) modes of compensating health care providers, i.e., whether fee for service (as in the case of out-of-pocket payments to provider), fixed budget for operations (funding for DOH programs and health care facilities) or cost-reimbursement (payments by health insurance companies to health care providers).

4.3.2.2 Operational Definition for Sources of Fund

4.3.2.2.a Government

National Government. Expenditures for health care consist of non-foreign-funded spending and GOP counterpart funding by the DOH and by other national government agencies undertaking health care activities, as well as spending out of health-related foreign-assisted projects implemented by national government agencies. Local Government. Covers expenditures made by provincial, municipal and city governments for clinics, regional/provincial hospitals devolved from the DOH, Regional Health Units (RHUs), Barangay Health Stations (BHS) and various public health programs. Administration and other support service expenditures due to the provision of health care services by the local government are also included. For both national and local government, health-related activities whose main purpose is for the provision of food, shelter and other infrastructure (e.g., building of water systems, regular water treatment, flood control, construction of toilets, construction of sewerage system, setting up of dump site, garbage collection, incremental food production, pollution control) are excluded.

4.3.2.2.b Social Insurance Covers health benefit payments out of the National Health Insurance Program (NHIP) and Employees’ Compensation (EC) Funds of PHIC, SSS, and GSIS, plus administration costs and research and training expenses for these three funds. NHIP covers only inpatient care. EC, on the other hand, also cover certain non-hospital services costs and other health professional fees.

4.3.2.2.c Private Sources

Out-of-Pocket. Amounts paid directly by households from out of-pocket for health care good and services net of amounts eventually reimbursed by insurance, by employer-provided benefits and by other sources of funds.

The PNHA Framework

46

Value of health care goods and services paid for or provided by government for free are excluded from this category. Premium payments for health insurance are also not included. Private Insurance. Private insurance companies can be identified as establishments assigned by the National Statistics Office (NSO) with Philippine Standard Industrial Classification (PSIC) codes 6701 for life and 6703 for non-life. Included are expenditures for benefit payments on health/accident, administrative costs from health/accident insurance activities. Insurance schemes operated by business firms for the sole benefit of its employees are not included here and are classified as employer-based sources of health funds. Only private insurance companies that operate commercially are included here. Also included are benefit payments out of the Hospitalization Insurance Plan (HIP) under the Optional Life Insurance program of the GSIS plus administration costs of managing HIP7. Health Maintenance Organizations (HMOs). HMO's distinguish themselves from pure insurers in that they provide managed health care; that is, besides paying for services covered by insurance, they also pursue preventive and promotive health care programs such as reminding women to undergo regular gynecological examinations and sending regular newsletters on health-related topics. A further distinction is that, HMO's unlike pure insurers, may operate their own health care facility. HMOs operated by business firms for the sole benefit of its employees are classified as employer-based sources of health funds. HMOs are registered at the DOH-Bureau of Licensing and Regulations (DOH-BLR) as a form of health care provider. Only HMOs that operate commercially are included in this category. Private Establishments. Private establishment sources column in the PNHA include total expenditures by establishments for the health care of its employees but excluding NHIP/EC premium payments and premium payments made to third-party commercial insurers on behalf of employees. Included are payments for: (1) health expenditure allowance; (2) reimbursement of employees' health care expenditures; (3) drugs and other medical goods supplied by the company for free or at subsidized cost in the workplace; (4) prepaid arrangements with retained health care facilities; (5) operating costs of company-owned and operated health care facilities; (6) operating costs of company-owned and operated HMO and health insurance scheme; and (7) administration costs of providing health benefits. Private Schools. Private schools column in the PNHA includes total expenditure by private schools for the health care of its students. Included are payments for: (1) wages of health manpower; (2) medical supplies and materials; (3) use of clinic space; and (4) administrative costs of providing health care. Rest of the World. The column on Rest of the World includes grants from other countries for health-related projects.

7 Ibid.

The PNHA Framework

47

4.3.3 Full Operational Matrix Figure 14 shows the full PNHA operational matrix showing the subcategories

for each main category of both sources and uses of funds.

5. TECHNICAL NOTES

Technical Notes

49

5. Technical Notes - Data Sources and Estimation Procedures This section describes data sources and estimation procedures used in the compilation of the 2005 to 2011 Philippine National Health Accounts (PNHA) matrices. It also discusses the significant revisions/changes made since the first uploaded webpage covering the 2005 to 2007 PNHA. 5.1 Government 5.1.1 DOH and Other National Government Agencies Data Sources 5.1.1.1 The following documents/data were used, namely: (a) COA’s 2005-2011 Annual

Financial Report of the National Government which reports total actual expenditure per department/office; (b) COA’s 2005-2011 Annual Financial Report of the Government Owned and/or Controlled Corporations; (c) DBM’s Budget of Expenditure and Sources of Financing; (d) DBM’s 2007-2013 National Expenditure Program (NEP) files containing obligations incurred per PPA per agency; (e) PITAHC and OSHC’s Annual statement of income and expenses; (f) Annual data on the distribution of expenditures for the PCSO Individual Medical Assistance Program and the PCSO charity clinic; and (g) Annual distribution of the health-related expenditures of PAGCOR.

5.1.1.2 For PCSO, data on health expenditures were directly obtained from the Fund

Allocation Department specifically from the Individual Medical Assistance Program’s approved cases from the central office and records of the Charity Clinic. Health related data were obtained from the Accounting Division

Coverage and Estimation 5.1.1.2 The expenditures included in the PNHA are those for national government

agencies with health-related activities. For PNHA purposes, national government agencies were broadly classified into two, namely: (a) agencies whose mandates are all health-related (i.e., “health-related” agencies); and (b) agencies also providing non-health services (i.e., “partial budget” agencies).

The entire budget/expenditures of “health-related” agencies are included in the PNHA. These are as follows: DOH, DDB, PHC, LCP, NKTI, PCMC, VMMC, FNRI, NMIC, AFP-Medical Center, NNC, PopCom, PCHRD, NCDA, PITAHC. For the four specialized hospitals (LCP, NKTI, PCMC, PHC), all expenditures are included, except those charged to their income from hospital fees as these are already accounted for under the private household out-of-pocket health expenditures. “Partial-budget” agencies, on the other hand, are those agencies, which have a portion only of their expenditures for health care. These are: AFP-GHQ, AFP-PN, AFP-PA, AFP-PAF, BFP, BCOR, DepED, OP-Proper, UP System, DOLE, PNP, NBI, NAPOLCOM, PCSO, PAGCOR, OSHC and DSWD.

5.1.1.3 Since COA does not report expenditures with the required PNHA breakdown (i.e.

by agency and by PPA), expenditures per agency and PPA were estimated.

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5.1.1.4 For the 2005 to 2011 series, the estimates were based on: (a) the obligations incurred by and PPA by agency as obtained from the NEP files of the DBM and (b) the agency actual expenditure-to-obligations incurred ratios or “utilization rates” computed from agency level data reported in the 2007-2013 and 2005-2011 Annual Financial Report of the National Government from COA.

5.1.1.5 The 2002-2005 Annual Financial Report (AFR) of the National Government from

COA is the first report based on the New Government Accounting System (NGAS). The NGAS is a simplified set of accounting concepts, guidelines and procedures adopted by COA to ensure correct, complete and timely recording of government financial transactions and production of accurate and relevant financial reports. One implication of the new accounting system is the non-comparability of data on expenses by object, that is, by Personal Services (PS), Maintenance and Other Operating Expenses (MOOE) and Capital Outlay (CO). In the new summary reports from COA, the expense categories are PS, MOOE, Financial Expenses and Subsidy; thus, there is no expense category for CO. In the 2005 PNHA, expenses for CO were estimated by computing the proportion of CO to total 2004 expenditure for each agency, then applying the ratio to the total 2005 expenditure of the agency. In the 2004 PNHA, the CO estimates were computed as the net increase or decrease in the amounts of capital assets. For the 2005-2011 PNHA, this methodology yielded unrealistic estimates, hence, was revised by assuming the CO value from the NEP as the final expenditure level for CO. This methodology is still subject to further improvement.

5.1.1.6 Expenditures of GOCCs like the National Kidney and Transplant Institute,

Philippine Heart Center, Philippine Children's Medical Center and Lung Center are funded by budgetary support coming from the national government as well as by revenues from agency operations and other sources of corporate funds.

5.1.1.7 In the case of the Bureau of Corrections, health expenditures are measured only in

terms of the salaries of its medical officers and chiefs of hospitals. Other operating costs of its facilities could not be estimated from the current format of expenditure reporting.

5.1.1.8 Administration cost of health services in agencies also providing non-health

services (i.e. "partial budget" agencies) are estimated by multiplying (a) total general administration and support services expenditures with (b) the percentage share of health-related expenses to total expenses of the agency net of general administration expense.

5.1.1.9 Data on health expenditures were directly obtained from the Fund Allocation

Department specifically from the Individual Medical Assistance Program’s (IMAP) approved cases and expenses on medical, dental, medicines for the PCSO charity clinic as culled from the accounting systems. Health related expenditure for IMAP are reflective only of those processed in the PCSO Central Office. Data of approved cases for individual medical assistance program for the government hospitals, private hospital and other professional facilities were included under the personal healthcare. Data from the charity clinic on medical/dental care, supplies and materials were included under public healthcare.

5.1.1.10 Data were obtained from the accounting record systems which include the health-

related expenditures and contributions/ hospitalization, wheelchair, laboratory/medical equipment, medicines, drugs and dental supplies for employees, other medicines, supplies and materials for medical missions/medicine kits, and for NGOs, and foundations. Data on drugs, medicines, medical and dental supplies provided to employees, contributions for health, hospitalization directly paid to hospitals, wheelchairs, laboratory and medical equipment, are included under personal healthcare. On the other hand, medicines/medical supplies for medical missions/kits, and contributions for health for foundations and NGOs are included under public healthcare. Data on health care benefits on

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healthcare plan for PAGCOR employees and contributions directly paid to individuals were not included in the health care expenditures in the PNHA since these were already included in the HMO and out- of- pocket expenses. Data on administration costs incurred for the provision of the health services were not included due to difficulty of allocating expenditure expenditure items to those for provision of health services from the total operating expenditures for PCSO and PAGCOR. Direct estimation of the health expenditures for personal and public healthcare as obtained from the accounting report systems both for PCSO and PAGCOR.

Classification by PNHA Use 5.1.1.11 Expenditures for mixed services/facilities (e.g., payment for hospital, medical and

other professional health care by NAPOLCOM) which could not be disaggregated by component are classified according to the most expensive component or that which is expected to account for most of the total. In the example cited, the mixed-uses expenditures of NAPOLCOM are classified under government hospital care. This general rule on classification is applied repeatedly on various types of expenditure mixes as described in some of the succeeding items below.

5.1.1.12 Expenditures of DOH's Dental Services are classified under personal health care

since most of its budget are for dental commodities provided to RHUs through the Community Health Care Agreement (CHCA).

5.1.1.13 RHU expenditures for dental services are included under public health care

because no detail on RHU/BHS budget is available. Based on service statistics reports for RHUs and BHS, however, dental cases account for about 2.14 percent of all cases seen at RHUs and BHSs. For a rough estimate of dental cost, the percentage may be applied to total DOH budget for Field Health Services, for pre-devolution years, or to total LGU budget for Health Services, for post-devolution years.

5.1.1.14 Due to data limitations, expenditures for dental clinic services of the following

agencies are lumped under either the government hospital health care or clinic care categories: AFP/General Headquarters, AFP-PAF, AFP-PA, AFP-PN, DepED-OSEC and OP-Proper.

5.1.1.15 Expenditures of the DOH for its Traditional Medicine Program and Herbal

Processing Plants are classified under (personal) traditional health care. 5.1.1.16 All activities of government hospitals including those for general administration and

support services are classified under government hospital care. 5.1.1.17 Terminal Leave Benefits, Personnel Economic Relief Allowance and other similar

(non-salary or non-wage) personnel compensation/benefits, which were reported lump-sum under General Administration and Support from 1992-1993, were all assigned under the PNHA uses category Other-General Administration. This rule must particularly be taken into account when comparing levels of central government administration expenditures to expenditures for other PNHA uses. It should be noted that these benefits are paid not only to personnel performing administrative functions but also to those performing health care provision functions.

5.1.1.18 Starting 1994, with the reclassification of national government expenditure items,

only Medicare, EC and PAGIBIG premium payments were retained lump-sum under General Administration. All other types of personnel benefits or non-salary compensation (90 percent of all benefits) were already reported as part of Personal Services for each program or activity of the agencies, i.e. transferred out of General Administration. With this new way of reporting, majority of personnel

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benefits have then been classified according to the program or activity to which they have been transferred, i.e. no longer General Administration. This change should be taken into account when comparing General Administration cost between the years 1993 and 1994.

5.1.2 Foreign-Assisted Projects

Data Sources 5.1.2.1 Data on health expenditures by foreign-assisted projects (FAPs) came from four

basic sources (listed in the order of preference): (a) DBM's BESF; (b) DOH-Foreign Assistance Coordination Service (FACS) reports and DOH Annual Reports; (c) NEDA Project Management Staff reports; and, (d) DSWD’s List of Kalahi-CIDSS Community Sub-Projects. BESF is preferred because it is the source that provides actual fund utilization by projects. The other two sources, however, are also necessary because not all FAPs are reported in the BESF.

Coverage and Estimation 5.1.2.2 All FAPs undertaken by the DOH (or those in which DOH is one of the

implementors) are included in the PNHA. Similarly, all FAPs of other national government agencies whose mandates are entirely health-related (e.g., National Nutrition Council, Food and Nutrition Research Institute, Philippine Council for Health Research and Development, etc.) are also included.

5.1.2.3 Actual availment for the year are reported only for projects listed in the BESF and,

when available, availment figures are used directly in the PNHA. For projects with multiple implementing agencies, only the availment of the DOH and the health-related agencies are included in the PNHA.

5.1.2.4 When actual availment data are not available, as in the case for FAPS reported

only in DOH-FACS or NEDA-PMS documents, an alternative estimation method is used. Three pieces of information are required: (a) total project cost, (b) project duration and (c) number/types of implementing agencies. Annual availment is then estimated as follows: divide total project cost by the duration of the project and then calculate for the share of the health agencies out of the total estimated availment assuming that each implementing agency is assumed to take equal share out of total availment. If even one piece of information is missing, annual availment was not estimated.

5.1.2.5 Only the health-related sub-projects of Department of Social Welfare and

Development’s Kalahi-CIDSS is accounted for FAPs. These sub-projects include those of construction of health stations, and sanitation/solid waste management facilities. Total project cost of each sub-project completed in the reference year is then including in the estimation of the expenditure related to health.

Classification by PNHA Use 5.1.2.5 Expenditures by FAPS for mixed services/facilities (e.g., Philippine Health

Development Project's [PHDP] payments for hospital equipment, vector control, training of public health personnel, improvement of provincial health office planning and programming and more) which could not easily be disaggregated by component are classified according to the most expensive component or that which is expected to account for most of the total. In the case of the PHDP, most of the expenditures are for providing public health care.

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5.1.3 Local Government Data Sources 5.1.3.1 Health care expenditures of the Provincial, Municipal and City Governments are

reported, along with all other local government expenditures, in the Commission on Audit's (COA) Annual Financial Reports (AFR) of the Local Government Units. However, with the implementation of NGAs, some expenditure details have been omitted in the reports. To bridge these losses, BLGF’s Annual Statement of Income and Expenditure is also used.

Coverage and Estimation 5.1.3.2 Health expenditures of LGUs are reported under three (COA-defined) expense

categories: Health, Family Planning Services1 (under Social Welfare Services) and Education Subsidiary Services (a subcategory under Education Services).

5.1.3.3 General administration cost for health services provision was estimated by

applying (a) the proportion accounted for by health services out of total cost for all LGU services (i.e., total includes health, education, labor and employment, housing, economic and others) to (b) total general administration cost of LGUs. Administration cost includes those for the following: Executive, Accounting, Auditing, Treasury, Budgeting, Administrative and General Services.

5.1.3.4 The data for education subsidiary services (under item on Non-Hospital MD

Facilities) is not available from the 2002 COA AFR. Data for 2002 were therefore estimated using regression of the proportion to total local government health expenditure.

5.1.3.5 The data on the breakdown of each expenditure by item was not published in the

2004 and 2005 AFR. Data is available for all expenditure items by PS, MOOE, CO. The 2004 breakdown by item was derived by applying the corresponding 2003 percent share by item to total for all expenditure items to the total 2004 for PS, MOOE and CO. From 2005 onwards, the breakdown was derived by applying the average growth rates for the past three years of each expenditure item.

5.1.3.6 With the shift to the NGAS in 2004, the table (Status of Appropriations, Allotments

and Obligations) that provided the detailed expenditure of LGUs on health was no longer included in the COA Annual Financial Report. To bridge this loss, BLGF’s SRE is used to compute for the health expenditure. Health care expenditure includes the following three categories: 1) Health, Nutrition & Population Control (HNPC), 2) General Public Services (GPS), and 3) Total Capital/Investment Expenditures. The proportion of health-incurred expenses out of the total expenses is applied to GPS and CO to estimate Administrative and Capital Outlay costs, respectively, then added to HNPC to estimate health-care expenses as reported by the BLGF. Using COA data as parameter, the proportion of BLGF health-related expenditure out of its total expenditure is then applied to COA Total Expenditure to estimate health care financing.

5.1.3.7 To breakdown the expenditures by use of funds (personal, public, and others) and

by expenditure item (PS, MOOE, and CO), the average shares of the detailed LGU expenditures to the total expenditures are computed for the past three years and applied to the total expenditure for the reference year to get the breakdown of expenditures by use of funds (personal, public, and others) and by expenditure item (PS, MOOE, and CO).

1 Population Control was reported together with health services in 1991. Starting 1992, the program

was renamed Family Planning Service and assigned under Social Welfare Services.

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Classification by PNHA Use 5.1.3.6 LGU health expenditures were generally classified under four uses: Hospital

Services under personal (hospital) care; Education Subsidiary Services under personal (non-hospital) care; Health Services, Chest Clinic, Population Control, Development Funds and Miscellaneous Health Services under public health care; and Administration Expenditures under "others".

5.2 Social Insurance Data Sources 5.2.1 Expenditures and the general administrative expenses from the National Health

Insurance Program (NHIP) are obtained from PhilHealth’s Statement of Revenues and Applications. Starting 2005, the Overseas Workers Welfare Administration (OWWA) medicare program was already combined with PhilHealth, since the former is now under PhilHealth.

5.2.2 Data on employees’ compensation (EC) benefit payments by type (to be able to

segregate medical benefits) are obtained from the reports of the Government Service Insurance System (GSIS) and the Social Security System (SSS).

5.2.3.1 Data used on the computation of the general administrative costs of EC are taken

from the Statement of Revenues and Expenditures of the Employees’ Compensation Insurance Fund (ECIF) of the GSIS and the Statement of Comprehensive Income of the SSS.

Coverage and Estimation 5.2.4 Included are benefit payments from the NHIP, EC Fund of SSS and GSIS (medical

components only) plus operating expenses of these institutions attributable to the management of the respective funds.

5.2.4 General administration cost for the medical component of EC are estimated by

applying the proportion accounted for by EC medical benefit payments (out of the total benefit payments for EC) to the total general administration cost of EC.

5.2.5 Insurance expenditures of the GSIS are excluded to avoid double counting.

Payments by re-insurers are accounted for in the "private insurance" column of the PNHA.

5.2.6 No breakdown by type of hospital is provided in the NHIP benefit payments.

Starting 1999, however, PhilHealth was able to provide such breakdown in terms of percentage shares.

Classification by PNHA Use 5.2.7 For NHIP, benefit payments cover only hospitalization cost and are therefore

classified under the PNHA use category personal (hospital) care. 5.2.8 EC medical benefits cover medical and rehabilitative services and should therefore

be classified under the four subcategories of personal care; that is, government hospital, private hospital, non-hospital medical clinics and other professional care, if data are available.

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5.3 Private Sources

5.3.1 Out-of-Pocket Data Sources 5.3.1.1 Data on household expenditure for health are taken from the National Statistics

Office's (NSO) Family Income and Expenditure Survey (FIES) conducted every three years. The FIES results are used directly in the PNHA estimation.

5.3.1.2 Other data/parameters used include: (a) 2000-2010 Household Final Consumption

Expenditures (or HFCE, as estimated in the National Income Accounts); (b) proportion of the HFCE spent by non-household entities (1990 Social Accounting Matrix of NSCB); and (c) proportion of household health care expenditures truly paid for by household funds (PNHA Rider to the 1994 FIES).

Coverage and Estimation 5.3.1.3 The household out-of-pocket health expenditures are not independently estimated

and instead were lumped in the miscellaneous expenditures in the HFCE. The data provided in the FIES are then used for the estimation of the household out-of-pocket health expenditures.

5.3.1.4 The proportion of spending by non-profit institutions serving households (NPISH)

was netted out of HFCE to reflect only the final consumption expenditure of households. The 1990 SAM indicates that around 0.35 percent of the total HFCE constitutes the final consumption of the NPISH.

5.3.1.5 For the FIES percentage shares to be consistent with the HFCE, adjustments are

also made for the FIES percentage shares by netting out the proportion of spending for taxes, gifts and donations, and other miscellaneous expenditures. Furthermore, FIES also reports as household health expenditures the value of free medical goods and services, medical goods and services paid for by employers, medicare, health insurance, charitable organizations, relatives and friends. The PNHA rider to the 1994 provides an estimate of the percentage of health care expenditures truly paid by household funds, which is 98.9 percent of the health care expenditure.

5.3.1.6 The method of double moving averages was applied to the adjusted FIES medical

shares for the years from 2000, 2003, 2006, and 2009. With this, the final medical shares for the years 2003 and 2006 were derived. For the year 2009, the average of the adjusted medical shares for 2006 and 2009 was considered. Consequently, the corresponding medical shares for the non-FIES years were derived using linear interpolation. The method of double moving average was used to reduce the effect of the sudden fluctuations on the adjusted FIES medical shares.

5.3.1.7 The out-of-pocket health expenditures for each year are then estimated by

multiplying the final medical shares derived after applying the double moving average method to the adjusted HFCE.

Classification by PNHA Use 5.3.1.8 Except for 1994 for which the PNHA Rider to that year's FIES provides household

health expenditure breakdown by NHA use categories, no such breakdown are available for the other years.

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5.3.2 Private Insurance Data Sources 5.3.2.1 Data on health benefit payments and administrative plus other costs of private

insurance companies were taken from the 2005-2011 Annual Reports of the Insurance Commission (IC).

5.3.2.2 GSIS provides the data on benefit payments under the Hospitalization Insurance

Plan (HIP) component of the Optional Life Insurance Fund (OLIF) and the Family Hospitalization Plus Plan (FHPP) under the Pre-Need Fund (PNF). These data were culled from the 2005-2011 Consolidated Statement of Claims and Benefits Paid of the GSIS. The administrative and operating expenses of the OLIF and PNF were directly lifted from their respective Statement of Revenues and Expenditures.

Coverage and Estimation 5.3.2.3 Included are health benefit payments by both life and non-life insurance

companies and the administrative costs attributable to the health insurance activities. Health benefit payments are reported in the IC Annual Report and these are used directly in the PNHA.

5.3.2.4 Included also are benefit payments from the Hospitalization Insurance Plan (HIP)

under the Optional Life Insurance program and Family Hospitalization Plus Plan (FHPP) under the Pre-Need program of the GSIS.

5.3.2.5 General administrative expenses and other costs of health and accident insurance

activities are estimated by multiplying the proportion of health and accident premiums (to total premiums of a company) with the total general and other operating expenditures of the same company.

5.3.2.6 General administration cost for the HIP component of the Optional Life Insurance

of GSIS are estimated by applying the proportion accounted for by HIP benefit payments (out of the total benefit payments for Optional Life Insurance) to the total general administration cost of Optional Life Insurance. The general administration cost for the FHPP under the Pre-Need Insurance is computed using the similar method applied for HIP.

Classification by PNHA Use 5.3.2.7 All health and accident benefit payments are classified under personal health care.

Expenditures cannot further be classified according to the specific type of facility due to lack of data.

5.3.2.8 All other expenses are classified under the PNHA uses category "others" (i.e.,

general administration, additions to reserves, and net income). 5.3.3 Health Maintenance Organizations (HMOs) Data Sources 5.3.3.1 Data on health benefit payments and general administration and operating costs of

HMOs are taken from Financial Statements (FS) submitted to the Association of Health Maintenance Organizations of the Philippines, Inc. (AHMOPI), Bureau of Health Facilities and Services (BHFS) of the Department of Health (DOH).

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5.3.3.2 The annual list of HMOs issued clearance to operate by the DOH is used for validation purposes. Additional listing of HMOs is obtained from the accredited HMOs from websites of leading hospitals/clinic.

5.3.3.3 The Securities and Exchange Commission (SEC) was one of the data sources

before, but questions have been raised on the agency’s policy of charging fees for their data, even for government agencies like the NSCB.

Coverage and Estimation 5.3.3.4 Included in the PNHA are expenditures on health benefit payments and general

administration and operating costs of entities that have been confirmed to be HMOs. The total health expenditure of all HMOs is estimated using the growth rate method; that is, an overall growth rate is applied to the previous year’s estimate to get the current year’s estimate. The overall growth rate is computed based on the top 95 percent of HMOs in terms of health expenditure using matched data.

5.3.3.5 For HMOs belonging to the top 95 percent with missing AFRs, expenditure for a

specific reference year is estimated using the growth rate for the immediately preceding years with data.

5.3.3.6 The percentage shares of health benefit payments and operating expenses are

computed based on the data for all HMOs. The annual figures of individual HMOs are sometimes revised based on the restated/revised AFRs (if there are any).

5.3.3.7 Limitations of the estimates include dwindling number of FS obtained from existing

data sources and the difficulty of establishing the actual number of existing HMOs

Classification by PNHA Use 5.3.3.7 All HMO benefit payments are classified under personal health care. Expenditures

cannot further be classified according to the specific type of facility due to lack of data.

5.3.3.8 All other expenses are classified under the PNHA uses category "others" (i.e.,

commission expense, general operating expense, and taxes paid). 5.3.4 Private Schools Data Sources 5.3.5.1 The average expenditure (1991-1993) for the health care of students per private

school, by enrollment size, were estimated using results from the PNHA Survey conducted by the Commission on Higher Education (CHED) in 1995.

5.3.5.2 The total number of private schools by year was obtained from the Department of

Education (DepED) and CHED. The distribution of private schools by enrollment size were obtained from: (a) PNHA Survey by CHED (for higher education institutions 1991-1993), from (b) DepED (for pre-elementary, elementary and secondary schools ; and (c) CHED (for higher education institutions.

5.3.5.3 The consumer price index for medical goods and services for the years 1991 to

2005 were obtained from the NSO.

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Coverage and Estimation 5.3.5.4 Included in the PNHA are expenditures by private schools for providing medical

and dental care to students. Expenditures are basically for salaries and wages of health personnel, drugs and medical supplies, and other school health programs.

5.3.5.5 Total health care expenditures for all private schools from 1991-1993 were

estimated by multiplying: (a) 1991-1993 average health care expenditure per school by size of enrollment (PNHA Survey by CHED) with (b) number of schools for each enrollment size for the years 1991-1993. For other years, the 1993 average costs were similarly multiplied by the number of schools for the current year. The health care expenditure estimates are summed up across all enrollment sizes and levels of education and then the total expenditure obtained was adjusted for inflation using the CPI for medical goods and services.

5.3.5.6 The administration cost of providing health care was not estimated due to lack of

data. Classification by PNHA Use 5.3.5.9 All expenditures for establishments (as estimated above) are classified under

personal health care. No breakdowns by PNHA use categories are available. 5.4 Rest of the World

Data Sources 5.4.1. The data sources are the same as those used for FAPs funded through loans

included under national government. Coverage and Estimation 5.4.2. Rest of the world includes the expenses for foreign-assisted projects of PNHA

health-related agencies funded through grants. 5.4.3 The estimation methodology is the same as those used for FAPs funded through

loans included under national government. Classification by PNHA Use 5.3.6.6 Medical expenses; laboratory exams; medical assistance; medical equipment;

doctor’s fee; hospitalization and medication are classified under personal health care.

5.3.6.7 All expenditure like Immunization; Pulmonary Tuberculosis (PTB) Treatment;

Psychological Testing; Counseling Session: Blood Program; Free Consultation/Distribution of Medicines; Nutritional Assistance; Outside Medical Help Program; Hygiene Kit; Annual Medical Check-up; Special Medical Assistance; Community Health and Nursing Department; Health and Sanitation; Hepatitis Vaccination; Therapy Counseling; Safety Services; Medical and Health Mission; Health Program; Medical/Dental/Psychiatric and Social Hygiene; Rehabilitation Services for Person with Disabilities (PWD); Health and Physical Development; and Psychological Testing are classified under public health care.

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5.3.6.8 Research activities; Health and Hygiene Education; Promotion and Health Issue; Health and Physical Development; Training of Health Workers; and Advancement and Promotion are classified under Others.

Technical Staff

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Social Sectors A Division Social Statistics Office

National Statistical Coordination Board

JOSE RAMON G. ALBERT Secretary General

LINA V. CASTRO

Asst. Secretary General

JESSAMYN O. ENCARNACION Director, Social Statistics Office

ESTRELLA R. TURINGAN Chief, Social Sectors A Division

RACQUEL DOLORES V. SABEÑANO

PNHA Coordinator, Social Sectors A Division

Sector Specialists/Staff CARMELITA H. DESTREZA

GERALD JUNNE L. CLARIÑO

WHO NHA Research Assistants AIZA C. VILLAMOR

EBONY R. KANGLEON

Special thanks to MA. VIDA A. GOMEZ

NATIONAL STATISTICAL COORDINATION BOARDNATIONAL STATISTICAL INFORMATION CENTERGround Floor Midland Buendia Building403 Sen. Gil J. Puyat Avenue, Makati CityPhilippines 1200

Tel. Nos. +63(2) 8952767 +63(2) 8909405Telefax No. +63(2) 8908456

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1 front cover.ppt - National Statistics Office of the ... 2005-2011_0.pdf · method Resolu Compil further change ... Consolidated and Income and ... 1.3.1 DOH agencies continue to