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LOCAL HEALTH ACCOUNTS IN THE LOCAL HEALTH ACCOUNTS IN THE PHILIPPINES PHILIPPINES Understanding the Sources and Uses of Funds in Understanding the Sources and Uses of Funds in a Decentralized Health Systema Decentralized Health System
Philippine National Health Philippine National Health AccountsAccounts Developed in 1991 to provide basis
for health reforms
Provides information for evidence-based decision-making
- setting targets and goals - monitoring the progress and outcomes
of policy interventions
Office of Secretary of Health
Executive Committee for National Field Operations
Regional Offices
Provincial Health Offices
City Health Offices District Health Offices
City Hospitals Rural Health Units
Barangay Health Stations
District Hospitals Municipal Health Offices
Barangay Health Stations
Provincial Hospitals
Regional Hospitals Medical Centers
Sanitaria
• Devolved to provincial government• Devolved to city government • Devolved to municipal government
Health Reform in the Health Reform in the PhilippinesPhilippines
National Health Insurance Program Law 1995
Local Government Code 1991
Despite these reform initiatives..
Questions remain unanswered
how much is being spent on health carewho pays for health carewhat health care services are being spent on
Lack of sector-specific expenditure data at the local level made it difficult to analyze local spending for health
Local Health AccountsLocal Health Accounts
• Mid 1990s: LHAs in selected provinces not sustained
• Lack of capacity to do estimation• Inadequate appreciation and use of LHA
information in local policy-making
• 2008: - Local purpose felt with the PIPH
Data needed for use for setting targets and goals, monitoring progress, and evidence-based decision-making
- DOH spearheading building capacities and institutionalization
INSTITUTIONALIZING LHA ESTIMATION
• National LHA team/TWG overseeing the institutionalization of LHA estimation in the provinces
• LHA estimation methodology developed, based on international methods of estimating health accounts. Manuals and other guide materials developed.
- Methodology is simple, doable
- Uses secondary data
Local Health Accounts: Local UseLocal Health Accounts: Local Use
Province of CapizKnown for successful health reforms: e.g. implementation of pooled procurement and revolving drug funds
2006 LHA became the basis to triple enrollment of indigent population in the National Health Insurance Program
Source: Province of Capiz, 2010
Capiz Budget for PhilHealth Enrollment of Indigent Families
Source: Preliminary Capiz Local Health Accounts, 2006-2010
Capiz Health Expenditures by Financing Agent, 2006-2010
Local Health Accounts: Local UseLocal Health Accounts: Local Use
Province of Bukidnon
All indigents enrolled by Province in PhilHealth. Facilities are equipped to deliver curative services.
Province to use LHA results to discuss and leverage with municipalities the delivery and financing of preventive and public health services.
Source: Preliminary Results of Bukidnon Local Health Accounts, 2006-2010
Health Expenditures by Financing Agent, Bukidnon, 2006 -2010 (in Percentage)
Source: Preliminary Results of Bukidnon Local Health Accounts, 2006-2010
Health Expenditures by Health Care Function, Bukidnon, 2006 -2010 (in PhP)
Source: Annual Health Report, Bukidnon, 2010
Local Health Accounts: Local UseLocal Health Accounts: Local UseMakati City• Makati Health Program (MHP)/Yellow Card
Program: City subsidizes hospitalization expenses of constituents in the
city hospital
• LHA results flag areas to make the MHP more sustainable by minimizing unnecessary subsidies: - need to properly identify services due for reimbursement from the National Health Insurance Program - need to cost hospital service properly, to be able to charge the paying patients correctly
Source: Preliminary Results of Makati City Local Health Accounts, 2006-2010
PhilHealth Claims in Makati City and in Ospital ng Makati, 2006 -2010 (in PhP)
CHALLENGESCHALLENGES
Data Collection
Mainstreaming in the functions of the local personnel: planning, budgeting
LHA: WAY FORWARDLHA: WAY FORWARDAt the local level Mainstreaming in the planning and budgeting
processes PIPH and LGU Scorecard
At the national level Mainstreaming in the monitoring systems - LGU Scorecard
More responsive financing support to LGUs
Partnering with a training institution to offer LHA training courses