The Philippine Health Care Delivery System

Service Delivery

Government

Classification According to Ownership

Private

General Facilities/ Hospitals

Examples:

• Philippine General Hospital (PGH)
• Jose Reyes Memorial Medical Center (JRMMC)

Forms of Health Service Delivery in the Philippines

Classification of Health Facilities

Key Elements in Health Service Delivery

Classification

According to Scope

of Services

1) According to ownership

2) According to scope of services

3) According to functional capacity

• Organizing health services as networks of primary care backed up by hospitals and specialized care
• Providing package of health benefits with clinical and public health interventions
• Ensuring access and quality of services
• Holding providers accountable for access and quality and ensuring consumer voice

Specialty Centers/ Hospitals

Private Sector

Public Sector

Source: DOH AO 2012-0012:Rules and Regulations Governing the New Classification of Hospitals and Other Health Facilities in the Philippines

Examples:

• Philippine Heart Center
• National Kidney and Transplant Institute (NKTI)

• Financed through taxes
• Budgeting system is done at the local and national level
• Health care service is "free" at the point of care

• Profit and non-profit health providers
• Usually market-driven
• Services are not free
• out-of-pocket schemes
• insurance
• external funding

Public Health

• LGU - direct delivery of public health services
• DOH - technical assistance
• capacity building
• advisory services for disease prevention and control
• provides free medicines and vaccines

Classification According to Functional Capacity

The Philippine

Health Care

Delivery

System

Human

Resources

Health

Information

Career Choices (MDs)

Health Workforce Distribution

Trends in Health Personnel

Health Providers in the Philippines

Key Elements in Human Resources for Health

• More hospital-based doctors, nurses, PTs and OTs are in the private sector than in government.
• NCR, Regions III and IV-A have a higher proportion of government health workers than other regions in PH

• Largest category of health workers in the Philippines: nurses and midwives.
• Many newly graduated or licensed nurses are unable to find employment.
• There is an underproduction in other categories such as doctors and dentists.

• There are 22 categories of health workers trained in the Philippines.
• Though some categories do not correspond to international classifications.

• Achieving sufficient numbers of the right mix of staff
• Ensuring system wide deployment and distribution
• Establishing job related norms and enabling work environments
• Establishing payment systems that produce the right kind of incentives

• Government-based positions - not attractive among newly-trained MDs
• isolation from other colleagues
• perceived lack of incentives
• As of 2008 (DOLE):
• Specialists - 68%
• Generalists - 32%
• 52% are clustered in Metro Manila

National Telehealth Service Program (NTSP)

Key Elements in Health Information

"Aims to improve communication capabilities and provide better access to up-to-date information, consultations with clinical specialists and other forms of support for health professionalsin remote communities or those providing health care to marginalized and vulnerable groups separated from the mainstream of socio-economic activities."

Health Information in the Philippines

• Provide timely and quality evidence to inform policy development and planning, health advocacy and education ("feedback")
• Make information accessible to all stakeholders
• Maximize the use of information technology for better health services

• National and local health information systems are poorly integrated and are weakly governed (Marcelo, 2005)
• Telecom infrastructures are mostly concentrated in the cities
• Unclear considerations for the role of IT in primary health care in the Philippines
• Lack of IT governance structures (explicit standards, etc.)

eMedicine

eSurveillance

eRecords

• Electronic monitoring of health indicators and performance
• Also for epidemiologic use

• Telereferrals
• RxBox - a biomedical device designed to provide better access to life-saving health care services in geographically isolated and disadvantaged areas (GIDAs). Can function as:
• ECG
• Blood pressure apparatus
• Pulse oxymeter
• Tocometer
• Fetal heart monitor

• Storage of patient's records online
• Computerized retrieval of patients' records

Leadership and Governance

RA 7160

Devolution

Context of Devolution in the ARMM

Inter-Local Health Zones

Refers to the act by which the National Government confers power and authority upon the various Local Government Units (LGUs) to perform specific functions and responsibilities.

• Local Government Code of 1991
• Legal basis of devolution
• It devolved the following basic services:
• agriculture
• forest management
• health services
• social welfare
• barangay level roads
• LGUs were given increased powers to mobilize their resources

• It has retained the centralized character of its health system
• DOH ARMM directly runs the provincial hospitals and the municipal health centers

• Inspired by the District Health System (DHS) model of the WHO
• An integrated health management and delivery system based on defined administrative and geographical area.
• Composed of clusters of adjacent municipalities, usually with similar health needs, plus other stakeholders.

Health Care Delivery System - the network of health facilities and personnel which carries out the task of rendering health care to the people

References:

Health

Financing

Medicine and Technologies

National Health Insurance Program

Philippine Health Insurance Corporation (PHIC)

(More commonly known as PhilHealth)

Lifetime Member Program

Employed Sector Program

free for members that have already completed their

120 monthly contributions

compulsory coverage of all employees in government and the private sector

Sponsored Programs

covers the "poorest of the poor" segment of the population (quintiles 1 and 2)

Individually Paying Program

Overseas Filipino Workers (OFWs)

voluntary coverage of the self-employed and

others not covered by the rest of the programs

RA 7875

Key Elements in Health Financing

3 Major Groups of Payers of Healthcare in PH

Health Financing in the Philippines

• National Health Insurance Act of 1995

• 4.6% of GDP (World Bank, 2012); Global average, meanwhile, is 10.2%
• Low public budget share of health spending (only 7.6% of the total)
• Has a high proportion of out-of-pocket spending
• Currently fragmented and inequitable

• Raising sufficient funds for health
• Pooling financial resources across population groups and sharing financial risks
• Using funds for health efficiently and equitably

1) Government

2) Social health insurance

3) private sources.

Source: WHO, 2011

Pharmaceutical Care

Medical Technologies and Devices

Constraints in Accessing Essential Drugs

Distribution of Medical Devices

1) Limited availability

2) Irrational use

3) High costs

Bureau of Health Devices and Technologies of the DOH (BHDT) - Develops plans, policies, programs and strategies for regulating health and health-related devices and technology.

• Pharmaceuticals reach consumers via a supply-driven distribution scheme (PHAP,2008)
• drugstores - 80.1%
• hospitals - 9.7%
• Others - 10.2% (PHAP, 2008).
• Monopolistic pricing exists in hospital drug sales, especially in private hospitals where outside purchases are discouraged.
• Drug prices in hospitals are reported to be double those of prices in retail outlets (DOH, 2008).

• General radiography represents the most basic equipment available across the country
• As of 2009, these devices totaled to 3860 with 31% found in the NCR.

Source: DOH, 2008

• World Health Organization (2011). The Philippine Health Systems Review.
• Cetrangolo, et al (2013). Health Care in the Philippines: Challenges and Ways Forward.
• Villaverde, M. (2012). Objectives, Functions and Components of Health Systems (powerpoint slides).
• The Local Government Code of 1991 (Republic Act 7160).
• Department of Health (2012). Rules and Regulations Governing the New Classification of Hospitals and Other Health Facilities in the Philippines (Adiministrative Order 2012-0012).

WHO 6 Building Blocks of Health Systems

THANK YOU!