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Dr. Eduardo P. Banzon is a Senior Health Specialist in the World Bank since December 2006. Prior to the World Bank, he was the Vice-President and Head of the Health Finance Policy Sector of the Philippine Health Insurance Corporation. In 2005, he was concurrently tasked to help in the strengthening of the Bureau of Food and Drugs.He is a former Research Associate Professor in the University of the Philippines (UP) -National Institutes of Health. He was a Clinical Associate Professor in the Department of Clinical Epidemiology and the Department of Family and Community Medicine of the UP College of Medicine and a faculty member of the Ateneo Graduate School of Business-Health Unit. He has worked and assisted national and international agencies and has been published locally and internationally.
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Health Financing Summit
04.14.10
How the Philippines compare How the Philippines compare in health system performance in health system performance
with other Asian and middle-income countries with other Asian and middle-income countries
World Bank Sector Assessment Team (Sarbani Chakraborty, George Scheiber, Ajay Tandon, Oscar
Picazo, Eduardo Banzon et al)
Presented by: Dr. Eduardo BanzonSenior Health Specialist
World Bank
Methodology
• Trends over time on readily measurable performance indicators and health systems inputs against other comparable income and health spending countries
• Assessing the country against global averages– Nothing right or wrong about a global average– But large deviations indicate areas that may require changes in health
policies.
Three areas• HEALTH SPENDING
– total, public or government , private, and out-of-pocket (OOP) health spending
• HEALTH OUTCOMES– Life expectancy, IMR and MMR
• HEALTH INPUTS– Health workers and Hospital beds
HEALTH FINANCING
HEALTH FINANCINGTOTAL HEALTH SPENDING PER CAPITA
100
200
300
400
500
600H
ealth
exp
endi
ture
per
cap
ita(c
onst
ant P
esos
)
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008Year
total public
private out-of-pocket
Composition of total health expenditure
Sources: WDI; WHO
Composition of Total Health Spending per Capita in Constant Pesos (1995-2007)Total spending for health per capita in constant pesos (1995-2007)
3.9% growth
0
20
40
60
80
100S
hare
of t
otal
hea
lth e
xpen
ditu
re (%
)
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008Year
private public
external resources out-of-pocket
Composition of total health expenditure
Sources: WDI; WHO
Composition of Total Health Spending as Share of Total Health Expenditure (1995-2007)Composition of total spending for health (1995-2007)
Total spending for health per capita in US$ PPP in selected comparators (1995-2007)
Korea
Indonesia
Philippines
Sri Lanka
Thailand
Malaysia
China
Vietnam
25
100
200
300
500
1250
Tota
l hea
lth s
pend
ing
per c
apita
(Int
erna
tiona
l$)
1994 1996 1998 2000 2002 2004 2006 2008Year
Source: WDINote: y-axis log scale
Total Health Spending per Capita (International$) in Selected Comparators (1995-2007)
HEALTH FINANCINGHEALTH SPENDING AS SHARE of GDP
Total
Public
Private
Out-of-Pocket
1
1.5
2
2.5
3
3.5
4H
ealth
spe
ndin
g co
mpo
nent
sha
res
of G
DP
(%)
1994 1996 1998 2000 2002 2004 2006 2008Year
Source: WDINote: y-axis log scale
Health Spending Component Shares of GDP (%)Health spending component share of GDP (1995-2007)
3.4%
3.9%
Malaysia
Indonesia
Philippines
Sri Lanka
Thailand
Korea
China
Vietnam
1
3
5
7
9
Tota
l hea
lth s
pend
ing
per c
apita
sha
re o
f GD
P (%
)
1994 1996 1998 2000 2002 2004 2006 2008Year
Source: WDINote: y-axis log scale
Total Health Spending Share of GDP (%) in Selected Comparators (1995-2007)Total spending for health as share of GDP in selected comparators (1995-2007)
HEALTH FINANCINGGOVERNMENT HEALTH SPENDING
Department of Health budget (2005-2010)
Source: General Appropriations Acts 2005 to 2010
MalaysiaIndonesiaPhilippines
Sri Lanka
Thailand
Korea
China
Vietnam
.75
1.25
1.75
2.25
2.75
3.25
3.75
Pub
lic h
ealth
spe
ndin
g pe
r cap
ita s
hare
of G
DP
(%)
1993 1995 1997 1999 2001 2003 2005 2007Year
Source: WDI (updated as of October 8, 2009)Note: y-axis log scale
Public Health Spending Share of GDP (%) in Selected Comparators (1995-2007)Government spending for health as share of GDP (1995-2007)
Real Per Capita Government Health Expenditures (1997-2008)
-
50
100
150
200
250
300
350
400
450
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
In 2
000
Pric
es
Consolidated Public Health Spending NG Health Spending LGU Health spending
Source: Sicat et al 2010
HEALTH FINANCINGSOCIAL HEALTH INSURANCE
% of uninsured Filipinos (based on PhilHealth reports 2000-2008)
Source: PhilHealth annual reports
China
Indonesia KoreaMalaysia
CambodiaLao PDR
Sri Lanka
Thailand
VietnamPhilippines
0
20
40
60
80
Out
-of-p
ocke
t hea
lth s
pend
ing
(% to
tal h
ealth
spe
ndin
g)
100 250 1000 10000 25000GDP per capita (current US$)
Sources: WDI; WHONote: x-axis log scale
Out-of-Pocket Spending as Share of Total Health Spending versus Income per Capita (2007)Out of pocket spending for health as share of total health spending vs. GDP per capita (1995-2007)
> 50%
China
IndonesiaKorea
MalaysiaSri Lanka
Cambodia
Lao PDR
Thailand
Vietnam
Philippines
0
20
40
60
80
Priv
ate
heal
th s
pend
ing
(% to
tal h
ealth
spe
ndin
g)
100 250 1000 10000 25000GDP per capita (current US$)
Sources: WDI; WHONote: x-axis log scale
Private Spending as Share of Total Health Spending versus Income per Capita (2007)Private spending for health as share of total health spending vs. income per capita (1995-2007)
65%
Catastrophic Health Expenditure Headcounts, by Various Thresholds
Source: Lavado et al 2010
HEALTH OUTCOMES
Under-five mortality
Infant mortality
Life expectancy
2040
6080
100
Und
er-f
ive/
infa
nt m
orta
lity
rate
5560
6570
75Li
fe e
xpec
tanc
y
1960 1970 1980 1990 2000 2007Year
Source: WDI
Population health indicators in the Philippines, 1960-2007POPULATION HEALTH INDICATORS, 1960-2007
HEALTH OUTCOMESINFANT MORTALITY RATE
Indonesia
Thailand
MalaysiaSri Lanka
Vietnam
Lao PDR
PhilippinesChina
Below averagePerformance
Above averagePerformance
Bel
ow a
vera
geP
erfo
rman
ceA
bove
ave
rage
Per
form
ance
IMR
rela
tive
to in
com
e pe
r cap
ita
IMR relative to total health spending per capita
Sources: WDI;WHONote: Both axes current US$
Global Comaprisons of Infant Mortality versus Income and Total Health Spending (2007)INFANT MORTALITY RATE as to INCOME and TOTAL HEALTH SPENDING, 2007
Cambodia
MalaysiaThailand
China
Lao PDR
Sri LankaIndonesia
Philippines
0
20
40
60
80
100
Fem
ale
liter
acy
rate
(%)
100 250 1000 2500 10000 25000GDP per capita (current US$)
Sources: WDI; WHONote: x-axis log scaleFemale literacy rate and GDP per capita data are for latest available year
Female Literacy versus Income (2000-2007)FEMALE LITERACY versus INCOME, 2000-2007
China
Korea
Sri Lanka
Malaysia
Thailand
Indonesia
Papua New Guinea
Philippines
510
25
50
100
250
Infa
nt m
ort
ality
rate
1 3 5 7 9 11Average years of schooling among females
Infant mortality, 2007
China
Indonesia
Korea
Sri Lanka
Thailand
Malaysia
Papua New Guinea
Philippines
525
100
250500
1500
Mate
rnal m
ort
ality
rate
1 3 5 7 9 11Average years of schooling among females
Maternal mortality, 2005
Source: WDI; Barro-LeeNote: Education attainment data are for 2000
Attainment relative to female educationIMR (2007) as to YEARS of FEMALE EDUCATION
Philippines
Malaysia
Sri Lanka
Korea
Indonesia
Thailand
2.5
525
5010
025
0In
fant
mor
talit
y
1955 1965 1975 1985 1995 2005Year
Source: WDINote: y-scale logged
Infant mortality rate, 1960-2007INFANT MORTALITY RATE, 1960-2007
Tawi-Tawi
Ifugao
Romblon
Catanduanes
North Cotabato
Sorsogon
La Union
Apayao
Aklan
Abra
Nueva Ecija
Cagayan
Mozambique
South Africa
Cambodia
Guyana
Georgia
Armenia
Uruguay
United Arab Emirates
ItalyJapan
Nigeria
Tanzania
Turkmenistan
Fiji
Brazil
Mexico
CubaNetherlands
Philippines
50
60
70
80
Life e
xpecta
ncy
Philippines Other countries
Source: WDI;UNDP
Life expectancy, 2006Philippines provinces vs global comparators
Region IX
Region XCARAGARegion III
Region VII
Region II
ARMM
Region IVARegion XII
CAR
Region IVB
Region VIII
Iceland
Spain
Slovak Republic
Bosnia and Herzegovina
Tonga
Suriname
Nepal
Zimbabwe
Gambia, The
Equatorial Guinea
Afghanistan
Norway
Korea, Rep.
Antigua and Barbuda
Moldova
Belize
Dominican Republic
Marshall Islands
Malawi
Nigeria
Philippines
15
25
50
100
200
Infa
nt m
orta
lity
Philippines Other countries
Source: WDI;NDHS
Infant mortality, 2007Philippines regions vs global comparatorsINFANT MORTALITY RATE (2007)
HEALTH OUTCOMESLIFE EXPECTANCY
Indonesia
Malaysia Philippines
China
Thailand
Vietnam
Korea
Sri Lanka
30
40
50
60
70
80
Life
exp
ecta
ncy
(yea
rs)
1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010Year
Source: WDINote: y-axis log scale
Life Expectancy in Selected Comparators (1960-2008)LIFE EXPECTANCY at birth in selected Asian countries (1960-2008)
53 years
72 years
CambodiaThailand Malaysia
Philippines
Indonesia
Vietnam
Lao PDRSri Lanka
China
Below averagePerformance
Above averagePerformance
Bel
ow a
vera
geP
erfo
rman
ceA
bove
ave
rage
P
erfo
rman
ce
Life
exp
ecta
ncy
rela
tive
to in
com
e pe
r cap
ita
Life expectancy relative to total health spending per capita
Sources: WDI;WHONote: Both axis current US$
Global Comparisons of Life Expectancy versus Income and Total Health Spending (2007)LIFE EXPECTANCY versus INCOME and TOTAL HEALTH SPENDING, 2007
Tawi-Tawi
Ifugao
Romblon
Catanduanes
North Cotabato
Sorsogon
La Union
Apayao
Aklan
Abra
Nueva Ecija
Cagayan
Mozambique
South Africa
Cambodia
Guyana
Georgia
Armenia
Uruguay
United Arab Emirates
ItalyJapan
Nigeria
Tanzania
Turkmenistan
Fiji
Brazil
Mexico
CubaNetherlands
Philippines
50
60
70
80
Life e
xpecta
ncy
Philippines Other countries
Source: WDI;UNDP
Life expectancy, 2006Philippines provinces vs global comparators
Region IX
Region XCARAGARegion III
Region VII
Region II
ARMM
Region IVARegion XII
CAR
Region IVB
Region VIII
Iceland
Spain
Slovak Republic
Bosnia and Herzegovina
Tonga
Suriname
Nepal
Zimbabwe
Gambia, The
Equatorial Guinea
Afghanistan
Norway
Korea, Rep.
Antigua and Barbuda
Moldova
Belize
Dominican Republic
Marshall Islands
Malawi
Nigeria
Philippines
15
25
50
100
200
Infa
nt m
ort
ality
Philippines Other countries
Source: WDI;NDHS
Infant mortality, 2007Philippines regions vs global comparatorsLIFE EXPECTANCY (2006)
HEALTH OUTCOMESMATERNAL MORTALITY
China
Indonesia
MalaysiaLao PDR
Sri Lanka
Thailand
Vietnam
PhilippinesCambodia
Below averagePerformance
Above averagePerformance
Belo
w a
vera
gePe
rform
ance
Abov
e av
erag
ePe
rform
ance
MM
R re
lativ
e to
inco
me
per c
apita
MMR relative to total health spending per capita
Sources: WDI;WHONote: Both axis current US$
Global Comparisons of Maternal Mortality versus Income and Total Health Spending (2005)MATERNAL MORTALITY versus INCOME and TOTAL HEALTH SPENDING, 2005
China
Korea
Sri Lanka
Malaysia
Thailand
Indonesia
Papua New Guinea
Philippines
510
25
50
100
250
Infa
nt m
ort
ality
rate
1 3 5 7 9 11Average years of schooling among females
Infant mortality, 2007
China
Indonesia
Korea
Sri Lanka
Thailand
Malaysia
Papua New Guinea
Philippines
525
100
250500
1500
Mate
rnal m
ort
ality
rate
1 3 5 7 9 11Average years of schooling among females
Maternal mortality, 2005
Source: WDI; Barro-LeeNote: Education attainment data are for 2000
Attainment relative to female educationMMR (2005) as to YEARS of FEMALE EDUCATION
Source: WDI; Barro-Lee
Cambodia
ThailandVietnam
Philippines
ChinaIndonesia
Korea, Rep.Korea, Rep.
Malaysia
Sri Lanka
Wor
se th
anav
erag
eBe
tter t
han
aver
age
Better than averageWorse than average
Perfo
rman
ce re
lativ
e to
hea
lth s
pend
ing
Performance relative to incomeSource: WDI;WHOData are latest available year 2003-2007
Skilled Birth Attendance Relative to Income and Spending, 2003-2007Skilled birth attendance relative to income and spending, 2003-2007
Caraga
Zamboanga PeninsulaSOCCSKSARGEN
ARMM
Davao PeninsulaCagayan Valley
Central VisayasCalabarzon
Central Luzon
Mimaropa
Eastern VisayasNorthern MindanaoBicol Region
Cordillera Admin Region
Ilocos Region
National Capital Region
Bangladesh
Cambodia
China
Indonesia
BhutanMyanmar
Nepal
Turkey
United States
Philippines
0
20
40
60
80
100P
erce
nt (%
)
Philippines Other countries
Source: WHO; NDHS 2008Note: A skilled birth attendant is an accredited health professionalincluding midwife, doctor, and nurse
Attainment of Skilled Birth Attendants:Comparisons of Selected Countries and Regions of Philippines% of Births attended by health professionals (comparison across countries and Philippine regions), 2008
HEALTH INPUTS
Indonesia
Philippines
China
Thailand
Vietnam
Korea
Malaysia
Sri Lanka
.02
.05
.1
.5
1
1.5
2P
hysi
cian
s pe
r 1,0
00
1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010Year
Source: WDINote: y-axis log scale. Philippines data are from 1960 to 2002
Physician to Population Ratio in Selected Comparators (1960-Most Recent Available Year)Physician to Population ratio in selected Asian countries (1960- available current year)
Malaysia
Vietnam Lao PDR
Philippines
China
Indonesia
Cambodia
SamoaThailand
Below averagePerformance
Above averagePerformance
Bel
ow a
vera
geP
erfo
rman
ceA
bove
ave
rage
Per
form
ance
Tota
l hea
lth w
orke
rs p
er 1
,000
rela
tive
to in
com
e pe
r cap
ita
Total health workers per 1,000relative to total health spending per capita
Sources: WDI;WHONote: Total health expenditure and GDP per capita data are for 2007.Number of total health workers is estimated by using the most recent available year from 2000 to 2007.Total health workers(a) include physicians,nurses, and midwives.
Total Health Workers(a) to Population Ratio Relative to Total Health Spending and IncomeTotal Health Worker to Population ratio Relative to Total Health Spending and Income
Malaysia
Indonesia
PhilippinesChina
Thailand
Vietnam
Korea
Sri Lanka
0
2
4
6
8
Hos
pita
l bed
s pe
r 1,0
00
1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010Year
Source: WDINote: Philippines data are from 1960 to 2006
Hospital beds to Population Ratio in Selected Comparators (1960-Most Recent Available Year)Hospital Beds to Population ratio in selected Asian countries (1960- available current year)
Cambodia
Malaysia
Thailand
Vietnam
China
Indonesia
Philippines
Lao PDRSri Lanka
Below averagePerformance
Above averagePerformance
Bel
ow a
vera
geP
erfo
rman
ceA
bove
ave
rage
Per
form
ance
Hos
pita
l bed
s pe
r 1,0
00re
lativ
e to
inco
me
per c
apita
Hospital beds per 1,000relative to total health spending per capita
Sources: WDI;WHONote: Beds and GDP per capita data are for the latest available year.Philippines is for 2002.
Hospital Beds to Population Ratio Relative to Total Health Spending and IncomeTotal Hospital Bed to Population ratio Relative to Total Health Spending and Income
Hospital/inpatient facility as Place of Death for Filipinos
Source: National Statistics Office
IMPLEMENT A-B-C TOWARDS MORE VALUE FOR MONEY:
IMPLEMENT:
• A-O 29 series of 2008 or the Rapid Reduction of Maternal and Neonatal Mortality particularly promotion of facility-based deliveries
• B-enefits Reforms in PhilHealth– Converting PhilHealth into an Active Purchaser of health services
(thru contracts and case payments)– Expansion of primary care benefits to the entire enrolled population – PhilHealth coverage of P100 drugs
• C-overage for all Filipinos in the PhilHealth Sponsored Program with National Government financing using the DSWD’s proxy means test from its National Household Targeting System for Poverty Reduction or the NHTS-PR PMT– TEACH the member of the poor (SP members) utilize their benefits
IMPLEMENT:
• D- ata dictionaries (for health) towards a national health IT system/ improved PhilHealth IT system
• E- xpansion of Results-based Financing – Needs-based facilities and health personnel master plan to
guide future investments in the health sector by expanding capacity in underserved areas of the country
– Performance –based budgets/grants– Hold LGUs, hospitals and PhilHealth accountable for
services and outputs
• F-acility autonomy reforms
• G-ame plan against Non-Communicable Diseases
Health Financing Summit
04.14.10
