Health Status Overview_October28 2014

8/18/2019 Health Status Overview_October28 2014

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Philippine Health Status

PIDS Team

Celia Reyes Oscar PicazoIda Marie Pantig Valerie UlepNina Ashley Dela Cruz Danica Ortiz

Kalusugang Pangkalahatan ProgramGeneral Health Status

Accessibility, Availability and Affordability of Health Services


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Philippine economy has been growing,but perennial poverty and incomeinequality remain as major challenges.

The upward trend in the economicgrowth has not translated to better andequitable social outcomes, particularly for

health status.


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Latest Poverty Trends(2006, 2009, 2012 and 2013 First Semester)

23.4 22.9 22.3

19.1

28.8 28.6 27.9

24.9

10.810.0 10.0

7.7

14.213.3 13.4

10.7

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

2006 2009 2012 2013

I n

P e r c e n t

Poverty incidence among families Poverty incidence among population

Subsistence incidence among families Subsistence incidence among population

Note: - The 2006, 2009 and 2012 estimates are based on the first visit of the Family Income and Expenditure

Survey (FIES), which used four replicates of the 2003 Master Sample or approximately 51,000 sample. These

estimates were released last 23 April 2013.

- The 2013 poverty estimates are based on the 2013 Annual Poverty Indicator Survey (APIS) conducted in July

2013, which adopted the income module of the FIES (with some modifications in the section containing the list of

wage and salary workers in the family), and used one replicate of the 2003 Master Sample or approximately

12,000 sample.

Source: Philippine Statistics Authority (PSA)


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Government Response:Kalusugang Pangkalahatan or Universal Healthcare

(2010)

UHC-KP

Financial RiskProtection

HealthFacilities

Improvement

Attainment ofHealth-

Related MDGs


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Improve financial risk protection

• Expand enrolment of the poor in the NHIP to improvepopulation coverage

•

Promote the availment of the quality outpatient and inpatientservices at accredited facilities through reformed capitation andno balance billing arrangements for sponsored members

• Increase the support value of health insurance for the poor


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Improve health facilities

• Targeted health facility enhancement program

• Fiscal autonomy and income retention schemes for government

hospitals and health facilities• Access to quality drugs, and deployment of health professionals


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Attain health-related MDGs

• Deploy Community Health Teams that shall actively assistfamilies in assessing and acting on their health needs

•

Utilize the life cycle approach in providing needed services,namely family planning, ante-natal care, delivery in healthfacilities, essential newborn and immediate postpartum care,and the Garantisadong Pambata package for children 0-14years old


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The country seemsto be on targettowards achieving

many of the health-related MillenniumDevelopment Goalsin 2015.

35.1

29

2523

19

0

5

10

15

20

25

30

35

40

1998 2003 2008 2013 2015

MDGtarget

Infant Mortality Rate

17.817

16

13

10

0

2

4

6

8

10

12

14

16

18

20

1998 2003 2008 2013 2015

MDGtarget

Neonatal Mortality Rate

48.4

40

3431

26.7

0

10

20

30

40

50

60

1998 2003 2008 2013 2015MDGtarget

Under Five Mortality Rate

25.5

20.7 20.719.9

13.6

0

5

10

15

20

25

30

1998 2003 2008 2013 2015MDGtarget

Malnutrition


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However, thegoal for MMR will

not likely beachieved by2015.

Sources: National Demographic Health Survey, National Statistical Coordination Board, Family HealthSurvey, Food and Nutrition Research Institute

128

182162

221

52

196

260

0

50

100

150

200

250

300

2006 2011 2015

Low Actual High


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Target 6.A: Have halted by 2015 and begun toreverse the spread of HIV/AIDS

Source: Philippine HIV Registry, National Epidemiology Center

"90 "91 "92 "93 "94 "95 "96 "97 "98 "99 "00 "01 "02 "03 "04 "05 "06 "07 "08 "09 "10 "11 "12 "13

Asymptomatic 48 68 51 64 61 65 104 94 144 80 83 118 140 140 162 171 273 311 505 804 156 223 315 447

AIDS 18 17 21 38 57 51 50 23 45 78 40 56 44 53 37 39 36 31 23 31 29 110 186 338

0

500

1000

1500

2000

2500

3000

3500

4000Total Reported Cases HIV/AIDS, 1990-2013

AIDS Asymptomatic


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Target 6.C: Have halted by 2015 and begun to reversethe incidence of malaria and other major diseases

Note: 2009-Partial Data

Source of basic data: DOH

123

86

72

55

41

2620

9.50

20

40

60

80

100

120

140Malaria morbidity rate (cases per 100,000 population), 1990-

2011


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Target 6.C: Have halted by 2015 and begun to reversethe incidence of malaria and other major diseases

393

360

329

301280

275

270

050

100

150

200

250

300

350

400

450Incidence of tuberculosis (per 100,000 population), 1990-2011

Source: Global Tuberculosis Report 2012, WHO


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The improved outcomes correspond tothe improved uptake of medical services

Source: National Demographic Health Survey, various rounds


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Compared toneighboringcountries,

Philippines isfaring well inimprovinghealthoutcomes.

54

41

34

26

23

18

11

0 20 40 60 80

Laos

Myanmar

Cambodia

Indonesia

PHILIPPINES

Vietnam

Thailand

Infant Mortality Rate

IMR2013

IMR2010

27

26

18

15

13

12

8

0 10 20 30 40

Laos

Myanmar

Cambodia

Indonesia

PHILIPPINES

Vietnam

Thailand

Neonatal Mortality Rate

NeonatalMR2013

NeonatalMR2010

72

52

40

31

31

23

13

0 20 40 60 80 100

Laos

Myanmar

Cambodia

Indonesia

PHILIPPINES

Vietnam

Thailand

Under Five Mortality Rate

U5MR2013

U5MR2010

220

200

190

170

221

49

26

0 50 100 150 200 250 300

Laos

Myanmar

Indonesia

Cambodia

PHILIPPINES

Vietnam

Thailand

Maternal Mortality Rate

MMR2013

MMR2010

Source: World DevelopmentIndicators


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However, regional disparities are stillevident.


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A t t l C I i ti (BCG) 2008 d 2013


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NCR

NCR

CAR

CAR

Reg I

Reg I

Reg II

Reg II

Reg III

Reg III

Reg IV-A

Reg IV-A

Reg IV-B

Reg IV-BReg V

Reg V

Reg VI

Reg VI

Reg VII

Reg VII

Reg VIII

Reg VIII

Reg IX

Reg IX

Reg X

Reg X

Reg XI

Reg XI

Reg XII

Reg XII

Reg XIIIReg XIII

ARMM

ARMM

40

50

60

70

80

90

100

110

Antenatal Care2008 and 2013

NCR NCR

CAR

CARReg I

Reg IReg II

Reg II

Reg III

Reg IIIReg IV-A

Reg IV-A

Reg IV-B Reg IV-B

Reg V

Reg V

Reg VI

Reg VI

Reg VIIReg VII

Reg VIII

Reg VIII

Reg IX

Reg IX

Reg X

Reg XReg XI

Reg XI

Reg XII

Reg XII

Reg XIII

Reg XIII

ARMM

ARMM

50

60

70

80

90

100

110

Immunization (BCG) 2008 and 2013

SBA 2008 and 2013 FBD 2008 and 2013


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NCR

NCR

CAR

CAR

Reg I

Reg I

Reg II

Reg II

Reg III

Reg III

Reg IV-A

Reg IV-A

Reg IV-B

Reg IV-B

Reg V

Reg V

Reg VI

Reg VIReg VII

Reg VII

Reg VIII

Reg VIII

Reg IX

Reg IX

Reg X

Reg X

Reg XI

Reg XI

Reg XII

Reg XII

Reg XIII

Reg XIII

ARMM ARMM

0

10

20

30

40

50

60

70

80

90

100

SBA 2008 and 2013

NCR

NCR

CAR

CAR

Reg I

Reg I

Reg II

Reg II

Reg III

Reg III

Reg IV-A

Reg IV-A

Reg IV-B

Reg IV-B

Reg V

Reg V

Reg VI

Reg VI

Reg VII

Reg VII

Reg VIII

Reg VIII

Reg IX

Reg IX

Reg X

Reg X

Reg XI

Reg XI

Reg XII

Reg XII

Reg XIII

Reg XIII

ARMM

ARMM

0

10

20

30

40

50

60

70

80

90

100

FBD 2008 and 2013

Source: National Demographic Health Survey


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The state of some regions in the countryare comparable to low-income countries

Skilled birth attendance and antenatal care, by region

Source: National Demographic and Health Survey, World Bank (for other countries)


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Despite this, there have been improvementsin regional health status from 2008 to 2013.


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Sources

National Demographic and Health Survey (NDHS), 2008 and Family Health Survey (FSH), 2011

14 – 18

19 – 2223 – 25

26. – 56

2011

PHILIPPINES 22

Ilocos 23

CAR 23

Cagayan Valley 20

Central Luzon 15

NCR 14

CALABARZON 21

Bicol 25

MIMAROPA 39

Eastern Visayas 40

Western Visayas 23

Central Visayas 23

Caraga 33

Northern Mindanao 31

Zamboanga Peninsula 25

Davao 27

SOCCSKSARGEN 19

ARMM 18

2008

PHILIPPINES 25

Ilocos 24

CAR 29

Cagayan Valley 38

Central Luzon 24

NCR 22

CALABARZON 20

Bicol 19

MIMAROPA 37

Eastern Visayas 45

Western Visayas 39

Central Visayas 31

Caraga 21



Davao 34

SOCCSKSARGEN 23

ARMM 56

Infant mortality rate


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Sources

National Demographic and Health Survey (NDHS), 2008 and Family Health Survey (FSH), 2011

20 – 28

29 – 3031 – 34

35 - 94

2011

PHILIPPINES 30

Ilocos 28

CAR 31

Cagayan Valley 28

Central Luzon 21

NCR 20

CALABARZON 29

Bicol 39

MIMAROPA 50

Eastern Visayas 53

Western Visayas 28

Central Visayas 34

Caraga 48



Davao 32

SOCCSKSARGEN 29

ARMM 32

2008

PHILIPPINES 34

Ilocos 26

CAR 31

Cagayan Valley 46

Central Luzon 29

NCR 24

CALABARZON 28

Bicol 34

MIMAROPA 49

Eastern Visayas 64

Western Visayas 43

Central Visayas 35

Caraga 30



Davao 44

SOCCSKSARGEN 34

ARMM 94

Under-five mortality rate


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Source

DOST-Food and Nutrition Research Institute (FNRI), using WHO-CGS

12.9 – 17.7

17.8 – 19.920.0 – 23.1

23.2 – 27.5

2013

PHILIPPINES 19.9

Ilocos 21.4

CAR 16.5

Cagayan Valley 20.6

Central Luzon 17.7

NCR 12.9

CALABARZON 18.1

Bicol 24.6

MIMAROPA 27.5

Eastern Visayas 21.7

Western Visayas 26.0

Central Visayas 23.1

Caraga 21.9

Northern Mindanao 17.7

Zamboanga Peninsula 24.5

Davao 18.8

SOCCSKSARGEN 23.8

ARMM 19.8

2008

PHILIPPINES 20.7

Ilocos 20.3

CAR 15.5

Cagayan Valley 20.5

Central Luzon 14.5

NCR 17.4

CALABARZON 16.5

Bicol 26.4

MIMAROPA 26.6




Caraga 22.7



Davao 22.0

SOCCSKSARGEN 24.7

ARMM 24.4

Prevalence of Underweight Children aged 0-5 Years Old


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Source

National Demographic and Health Survey (NDHS)

46.7 – 91.3

91.4 – 95.395.4 – 97.4

97.5 – 98.7

2013

PHILIPPINES 95.4

Ilocos 97.4

CAR 98.1

Cagayan Valley 97.2

Central Luzon 97.7

NCR 98.7

CALABARZON 97.1

Bicol 97.0

MIMAROPA 91.3




Caraga 97.0



Davao 97.6

SOCCSKSARGEN 91.6

ARMM 52.8

2008

PHILIPPINES 91.0

Ilocos 90.1

CAR 91.8

Cagayan Valley 94.8

Central Luzon 95.6

NCR 94.4

CALABARZON 95.4

Bicol 92.0

MIMAROPA 85.4




Caraga 96.6



Davao 93.6

SOCCSKSARGEN 86.1

ARMM 46.7

Antenatal care from health professional (%)


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Source

National Demographic and Health Survey (NDHS)

19.2 – 63.3

63.4 – 72.772.8 – 85.4

85.5 – 90.9

2013

PHILIPPINES 72.8

Ilocos 90.0

CAR 85.4

Cagayan Valley 64.4

Central Luzon 87.8

NCR 90.9

CALABARZON 84.6

Bicol 65.0

MIMAROPA 41.3




Caraga 63.2



Davao 67.7

SOCCSKSARGEN 55.7

ARMM 20.4

2008

PHILIPPINES 61.8

Ilocos 81.9

CAR 67.4

Cagayan Valley 59.2

Central Luzon 81.9

NCR 86.8

CALABARZON 74.5

Bicol 49.9

MIMAROPA 39.1




Caraga 49.9



Davao 51.4

SOCCSKSARGEN 35.6

ARMM 19.2

Delivered by a health professional (SBA)


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Source National Demographic and Health Survey (NDHS)

12.3 – 47.9

48.0 – 59.759.8 – 67.2

67.3 – 76.3

2013

PHILIPPINES 59.8

Ilocos 67.2

CAR 75.0

Cagayan Valley 50.6

Central Luzon 67.5

NCR 76.3

CALABARZON 64.5

Bicol 50.4

MIMAROPA 36.5




Caraga 55.0



Davao 60.4

SOCCSKSARGEN 47.9

ARMM 12.3

2008

PHILIPPINES 43.8

Ilocos 42.1

CAR 51.1

Cagayan Valley 28.9

Central Luzon 56.3

NCR 69.3

CALABARZON 53.2

Bicol 32.4

MIMAROPA 26.9




Caraga 30.1



Davao 42.4

SOCCSKSARGEN 23.5

ARMM 14.7

Facility-based delivery (FBD)


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57.1 – 87.6

87.7 – 94.794.8 – 97.4

97.5 – 100

2013

PHILIPPINES 94.8

Ilocos 98.0

CAR 96.4

Cagayan Valley 90.8

Central Luzon 95.0

NCR 97.5

CALABARZON 99.2

Bicol 97.3

MIMAROPA 87.6

Eastern Visayas 100



Caraga 95.1



Davao 97.4

SOCCSKSARGEN 89.6

ARMM 57.1

2008

PHILIPPINES 93.9

Ilocos 96.9

CAR 92.7

Cagayan Valley 97.0

Central Luzon 95.9

NCR 98.1

CALABARZON 95.7

Bicol 93.9

MIMAROPA 87.4




Caraga 100



Davao 95.2

SOCCSKSARGEN 94.6

ARMM 58.1

Immunization (BCG)


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Fertility Rate


2.3 – 2.9

2.9 – 3.23.2 – 3.8

3.8 – 4.3

2013

PHILIPPINES 3.0

Ilocos 2.8

CAR 2.9

Cagayan Valley 3.2

Central Luzon 2.8

NCR 2.3

CALABARZON 2.7

Bicol 4.1

MIMAROPA 3.7

Eastern Visayas 3.5

Western Visayas 3.8

Central Visayas 3.2

Caraga 3.6



Davao 2.9

SOCCSKSARGEN 3.2

ARMM 4.2

2008

PHILIPPINES 3.3

Ilocos 3.4

CAR 3.3

Cagayan Valley 4.1

Central Luzon 3.0

NCR 2.3

CALABARZON 3.0

Bicol 4.1

MIMAROPA 4.3

Eastern Visayas 4.3

Western Visayas 3.3

Central Visayas 3.2

Caraga 4.3



Davao 3.3

SOCCSKSARGEN 3.6

ARMM 4.3


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In the past decade, non-communicablediseases have become the leading causes

of mortality in the country

Causes of mortality Type of Disease 2000 2001 2002 2005 2006 2007 2008 2009

Diseases of the Heart

Non-

Communicable

79.1 80.8 88.2 90.4 95.5 99.7 101.9 109.4

Diseases of the VascularSystem 63.2 68.1 62.3 63.8 63.8 65.1 67.2 71.0

Malignant Neoplasms 47.7 48.5 48.8 48.9 49.5 50.1 51.1 51.8

Diabetes Mellitus 14.1 16.0 17.5 21.6 23.3 23.7 25.2 24.2

Nephritis, nephritic

syndrome and nephritis 10.4 13.0 14.2 13.8 13.9 15.0

Chronic lower respiratory

diseasesInfectious

20.8 21.8 24.3 24.6 24.4 23.9 24.2 24.7

Pneumonia 42.7 43.6 43.0 42.8 41.6 40.1 43.9 46.2

Tuberculosis, all forms 36.1 35.1 35.9 31.2 29.7 27.1 27.2 27.6

Certain conditions

originating in the perinatal

period MCH-related 19.8 21.8 17.9 14.5 13.8 14.1 13.9 12.5

Accidents 42.4 42.2 42.3 39.1 40.2 38.4 39.3 39

Leading Causes of Mortality, 2000-2009*Number of Deaths per 100,000 population

Source: Analysis of data from DOH


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What are the drivers of the current healthstatus of our country?


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Only a third of all provinces meets the bed-to-population ratio

0.00 – 0.49

0.50 – 0.99

1.00–

1.50

1.51 – 5.00

Source: Bureau of Health Facilities and Services, 2011


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Health labor force is maldistributed

Source: PhilHealth list of accredited physicians 2011


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Not all hospitals have X-Ray andUltrasound Machines

43%

48%

59%

61%

61%

62%

62%

63%

66%

67%

75%

75%78%

79%

85%

88%

92%

0% 20% 40% 60% 80% 100%

CARAGA

ARMM

REGION VIII

REGION V

REGION II

CAR

REGION XII

REGION IVB

REGION X

REGION XI

REGION VII

REGION IXREGION VI

REGION I

REGION IVA

REGION III

NCR

Percent of Hospitals with X-Ray

24%

27%

29%

30%

35%

38%

39%

42%

45%

47%

47%

47%57%

60%

63%

66%

87%

0% 20% 40% 60% 80% 100%

CARAGA

REGION V

REGION VIII

ARMM

CAR

REGION XII

REGION II

REGION IVB

REGION IX

REGION VI

REGION VII

REGION XREGION I

REGION XI

REGION IVA

REGION III

NCR

Percent of Hospitals with Ultrasound

Source: Estimates were generated using 2011 services and equipment census from DOH


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Also, not all hospitals have completebasic emergency equipment

7%

13%

15%

19%

19%

19%

19%

25%

26%

28%

29%

31%

32%

38%

38%

40%

41%

56%

0% 10% 20% 30% 40% 50% 60%

CARAGA

REGION IVB

ARMM

REGION VIII

REGION V

CAR

REGION II

REGION IX

REGION XII

REGION VII

REGION I

REGION VI

PHILIPPINES

REGION X

REGION XI

REGION III

REGION IVA

NCR

Percent of hospitals with complete basic emergency equipment

Source: Estimates were generated using 2011 services and equipment census from DOH


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Looking at prices, the increase in the costof medical care is still at par with theoverall increase in good and services.

0%

5%

10%

15%

20%

25%

1 9 9 5

1 9 9 6

1 9 9 7

1 9 9 8

1 9 9 9

2 0 0 0

2 0 0 1

2 0 0 2

2 0 0 3

2 0 0 4

2 0 0 5

2 0 0 6

2 0 0 7

2 0 0 8

2 0 0 9

2 0 1 0

2 0 1 1

2 0 1 2

2 0 1 3

Year on year growth of CPI for health and totalgoods and services, Philippines, 1995 to 2013

CPI-Health CPI-All

Source:Calculation of data from NSO; baseline: 2006

P i C i f S l D


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Price Comparison of Select Drugs

Source: MIMS Online (accessed August 4, 2014); MIMS 2008

Generic Name Dosage, Strength and Form

MDRP

2009

(PHP)

Branded

Equivalent

2008

(PHP)

2014

(PHP)

The

Generics

Pharmacy

2014 (PHP)

Amlodipine 5 mg tablet 22.85 Norvasc 42.24 21.70 2.75

10 mg tablet 38.50 Vasalat 20.00 20.00 3.25

Atorvastatin 10 mg film-coated tablet 34.45 Lipitor 58.62 32.72 4.5

20 mg film-coated tablet 39.13 Lipitor 71.97 37.17 16.00



Azithromycin 500 mg tablet 151.43 Zithromax 280.01 143.86 60.00

500 mg tablet 151.43 Azyth 152.3 130.78 115.00

200 mg /5mL (15mL) 427.5 Zithromax 746.91 406.13 270.00

Cytarabine 100 mg/ mL ampul/vial

(IV/SC) 240 Cytosar-U 524.67 540.41

100 mg/mL ampul/vial (5mL) 900 Leucyt 1,500.00 100 mg/mL ampul/vial (10mL) 1,800 Leucyt 3,000.00

Doxorubicin 50 mg powder vial for injection 2,265.74 Adriblastina

RD 3,878.00 2,152.45

10 mg/ 5mL 1,465.75 Adriblastina

RD 969.04 998.11


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Prices of select drugs and medicines (PH peso) in thePhilippines are relatively higher compared to othercountries

Philippines Indonesia IndiaPonstan tab 500 mg 30.93 10.31 2.24

Plendil ER XR tab 5 mg 44.82 28.68 6.27

Diamicron tab 80 mg 9.41 19.72 5.83

Isordil sublingual tab 5 mg 19.27 2.24 0.13

Norvasc tab 10 mg 37.65 24.20 8.52

Lipitor tab 20 mg 38.10 56.02 -

Source: MIMS Online (accessed August 4, 2014)


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PhilHealthcoverage stands

at 75%* andvaries acrossregions.

However, there isno clear pattern ofbenefit utilizationand coverage.

Reg X and ARMM:high coverage, lowutilization

94%

89%

84%

83%

82%

80%

78%

77%

76%

75%

74%

74%

73%

70%

70%

68%

68%3.3%

0.0%

1.0%

1.2%

4.8%

3.4%

2.4%

4.0%

3.4%

1.5%

7.4%

1.3%

2.1%

2.2%

2.6%

2.2%

0.5%

0% 1% 2% 3% 4% 5% 6% 7% 8%

0% 20% 40% 60% 80% 100%

NCR

ARMM

Reg IV

Reg XI

Reg X

CAR

Reg VIII

Reg XIII

Reg I

PHILIPPINES

Reg XII

Reg VI

Reg V

Reg VII

Reg IX

Reg III

Reg II

Estimated Benefit Utilization

Coverage Rate

Coverage Rate Estimated Benefit utilization

*Coverage Rate: total number of members and dependents for 2012/total projected population: Source: PhilHealth and projected population from NSO

**Number of population who utilized PHIC benefits. Source: Analysis of APIS 2011 data

Estimated Support Value*


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0.0% 50.0% 100.0%

PHILIPPINES

NCR

CAR

Reg I

Reg II

Reg III

Reg IV-A

Reg IV-B

Reg V

Reg VI

Reg VII

Reg VIII

Reg IX

Reg X

Reg XI

Reg XII

Reg XIII

ARMM

Estimated Support Value

*Analysis of APIS 2011

Survey data

shows that on

average,PhilHealth

support value is

at 41.4%.*


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SUMMARY

•

The Philippines is on track in achieving many of thehealth-related MDGs.

• Regional disparities are evident in health outcomes.

• Inequities in accessibility, availability and affordability ofhealth services need to be addressed to

• continue the gains that have been achieved.


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Thank you

Documents

Health Status Overview_October28 2014