Universal Health Care: The Philippine Experience

Zorayda E. Leopando, MD, MPH

Professor of Family and Community Medicine University of the Philippines Manila

• “Health is a right of every Filipino citizen and the State is duty-bound to ensure that all Filipinos have equitable access to effective health care services”

Philippine 1987 Constitution

Universal Health Care

Deliberate attention to the needs of millions of poor Filipino families which comprise the majority of our population

Comprehensive Reform Agenda

Reforms Focus

Health Sector Reform Agenda, 1999-2004

public health, hospital,

health care financing,

governance, and

regulations.

Fourmula One For Health, 2005-2010

financing, service

delivery, regulation, governance

Universal Health Care, 2011-2016

to improve, streamline,

and scale up above

reforms

Filipino Income Quintiles

Monthly income Families per quintile

Q1 3,460 5,218,267

Q2 6,073 4,094,164

Q3 9,309 3,912,443

Q4 15,064 3,707,494

Q5 38,065 3,485,067

Source: National Health and Demographic Survey, 2008

Exchange rate US$ 1.00= Php 43.00

The Philippine Health Care System

• Public Sector:

– Services devolved to local government units

• Private sector

– More doctors are in the private sector

– Almost the same number of hospitals and hospital beds between public and private sectors

Office of Secretary of Health

Attached Agencies

Regional Offices

Provincial Health Offices

City Health Offices

(Component Cities)

Inter-local Health Zones

City

Hospitals

Health

Centers

Barangay

Health

Stations

District

hospitals

Municipal health

offices/ Rural

Health Unit

Barangay Health

Stations

Provincial

Hospitals

Regional hospital

Medical Centers

Sanitaria

City Health Offices

(Chartered Cities)

City

Hospitals

Health

Centers

Barangay

Health

Stations

DOH

Province

City government Municipal gov’t

Level of

Supervision

Utilization of Health Facilities

Common reasons for seeking health care:

illness or injury ---------------------- 68 %

medical check-up --------------- 28 %

dental care --------------- 2 %

medical requirement ---------- 1 %

Source: NDHS, 2008

HEALTH FACILITY TYPE %

Government 50 %

Private 42 %

Traditional healer 7 %

• Improved public health services such as PhilHealth for all within three years

– President Aquino’s Inaugural Speech

• to enroll the poorest 5,000,000 Filipino families with PhilHealth

– President Aquino’s State of the Nation Address

Health Coverage in the Philippines

• 1960’s- Medical Care Commission, implemented for the employed and their families, hospitalization benefits only

• 1995: National Health Insurance Program with Philippine Health Insurance Corporation as implementing agency, Phase 1 for the employed and their dependent, Hospitalization initially, then with selective outpatient package; plus sponsored members

Distribution of Health Expenditure by Source of Funds

Source: Philippine National Health Account, 2007

Total health expenditure is P234.3 B (3.2 percent of GDP)

Distribution of Health Expenditure by Use of Funds

Personal

Health Care

81%

P 189.7 billion

Public Health

Care

9%

P 21.2 billion

Others

10%

P 23.3 billion

Source: Philippine National Health Account, 2007

Total health expenditure is P234.3 B (3.2 percent of GDP)

National Health Insurance Program and the Philippine Health Insurance Corporation

Pres. Aquino, on PhilHealth Enrolment: According to the National Statistics Office, 38% of Filipinos Have PhilHealth coverage.

(Pnoy’s SONA – July 26, 2010; emphasis supplied)

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Given priority poorest of the poor families

Better health

outcomes Responsive health

system Equitable health

financing

Health Financing

Service Delivery

Policy, standards and regulation

Health Human Resource

Health Information

Governance for Health

Instruments utlized

GOALS

Objectives

DOH, 2010

Three Strategic Thrusts Improve financial risk protection through improvements in NHIP benefit delivery

Achieve health-related Millennium Development Goal -Max (MDGmax) targets

Improve access to quality health care facilities

Plus: 1. Attain efficiency by using information technology

2. More aggressive promotion of healthy lifestyle

DONH, 2010

STRATEGY # 1 Ensure that each family has an assigned competent primary health care provider

STRATEGY # 2 Produce health professionals that are

responsive to the current needs of the health sector

STRATEGY # 3 Manage the exit or re-entry

Best Practices for Health Human Resource Development Initiatives

• University of the Philippines Manila School of Health Sciences (1976) – Ladderized curriculum- student can become

midwife, nurse, doctor with service leave in between

– Students nominated by communities – Do not pay tuition fees, given allowance – To serve for 2 years for every year of education – Retention rate of 85-90 %Now with 3 campuses

Best Practices for Health Human Resource Development Initiatives

• Department of Health – Doctors to the Barrios program (1995)- doctors recruited

for underserved, doctorless communities, serve for 2 years, with financial incentives and CME activities

– Pinoy MD- scholarship for doctors who are required to serve fort two years for every year of education

– Midwifery Students Scholarship Program - midwives to serve for two years for every year of education

– RNHeals – 10000 nurses to be fielded to train community health teams.

Universal Health Care or “Kalusugan Pangkalahatan” (KP)

KP as an Operational Solution

Poorest

Families

NHIP Benefit Delivery

Access to Quality IP

and OP Care Public Health

Services

• Convergence of three strategic thrusts to serve poor families

Kalusugan Pangkalahatan (KP)

Analysis of the Problem

• Neither Government subsidy nor the NHIP have adequately protected the poor from financial risk

• The poor have limited access to quality outpatient (RHUs)

or inpatient (hospital) facilities

• Current public health effort may not meet MDG commitments by 2015, specially those related to maternal and child health

Poorest

Families

NHIP Benefit Delivery

Access to Quality IP

and OP Care

Public Health Services

DOH, 2011

The goals set by the DOH

Financial Risk Protection

• Enroll 5.2 million families (Q1) identified by NHTS-PR under the PhilHealth Sponsored Program__> DONE

• Train and deploy 10,000 RNHeals nurses as trainers and

supervisors to capacitate community-level health workers ongoing

• Secure drugs, medicines and supplies for DOH-retained

hospitals serving NHTS-PR families for implementation of NBB policy ONGOING

DOH, 2011

The goals set by the DOH

Health Facilities Enhancement

• Upgrade DOH-retained hospitals, provincial hospitals, district hospitals and RHUs to ensure access to better-quality inpatient and outpatient care for NHTS-PR families ONGOING, WITHIN TARGET

• Procure and distribute treatment packs for hypertension and diabetes to RHUs for the use of 4Ps beneficiaries

DOH, 2011

The goals set by DOH

Attaining Health-related MDGs

• Procure and distribute health commodities to RHUs serving 4Ps beneficiaries ONGOING

• Deploy Community Health Teams ONGOING

DOH, 2011

What Phil Health Says: Moving forward with KP

Phil Health Membership • Aim for 100 % coverage

• Sponsored Program Coverage to be sustained

• Coverage of the Rest of the Informal Sector

– Revive organized group enrollment

• Educating the Sponsored and Informal Sector Members

– RN Heals

– Family Development seminars with DSWD

•

E. P. Banzon, PHIC, 2011

Health care providers

• Facilitate accreditation of Autonomous Region of Muslim

Mindanao facilities and MDG benefit providers • Incentive package for healt5h providers • Facilitate investments in innovative health care providers

such as specialty surgical hospitals

• Maximize use of information technology with POLICIES on Health data dictionaries, AND security and privacy of health data disseminated

E. P. Banzon, PHIC, 2011

• Total shift to case payment

• CONSIDER Differential case payments based on facility type, remoteness, incentive for quality

• Intensify implementation of No Balance Billing for the SPONSORED PROGRAM in GOVERNMENT HOSPITALS

• Improved OPB now to be called the PRIMARY CARE BENEFIT – Gate-keeping ! – Continued support for innovative models like the Bukidnon model – Open to all types of health care providers complying with accreditation

requirements

Benefits for members

• Supplemental health insurance benefits for government employees

• Catastrophic fund in collaboration with President’s social fund, PCSO, PAGCOR, etc.

• Closer collaboration with HMOs to simplify PhilHealth availment of PhilHealth members who are also HMO members

Benefits for members

Thank you very much