Universal Health Care: the Philippine experience
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Transcript of Universal Health Care: the Philippine experience
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)
13
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