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Philippine
Health Agenda:
Universal Health Care
Enrique T. Ona, MD, FPCS, FACS
Secretary of Health
“Thirty percent of our countrymen
who succumb to sickness die
without seeing a doctor.” without seeing a doctor.”
- President Aquino’s Challenge
July 2010
Universal Health Care
Deliberate attention to the
needs of millions of poor
Filipino families which
comprise 40% of the comprise 40% of the
Philippine population
Filipino Income Quintiles
Monthly income Families per quintile
Q1 $76.89 5.2M Q1 $76.89 5.2M
Q2 $134.96 4.1M
Q3 $206.87 3.9M
Q4 $334.76 3.7M
Q5 $845.89 3.5M
Source: National Health and Demographic Survey, 2008P1 = $0.02
Comprehensive Reforms in Health
Universal Health Care
(2010 -2016)
Fourmula One for Health Fourmula One for Health
(2005 – 2010)
Health Sector Reform Agenda
(1999- 2004)
Comprehensive Reforms in Health
• Health Sector Reform Agenda (HSRA) – focused on public health, hospitals, health care financing, health regulations, and good governance.
• Fourmula One for Health (F1) – implementation • Fourmula One for Health (F1) – implementation blueprint with four pillars: health financing, service delivery, health regulation, and good governance
• Universal Health Care – focus on the very poor Filipinos to ensure equity given disparities in health outcomes, financing, and service delivery interventions for the poor
Office of Secretary of Health
Attached Agencies
Regional Offices
Provincial Health Offices Provincial Hospitals
Regional hospital Medical Centers
Sanitaria
City Health Offices(Chartered Cities)
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
City Hospitals
Health Centers
Barangay Health
Stations
CURRENT STATUS
Health Outcomes
Demographic Characteristics
Population, total (millions) 94,013,200 (projected, NSO 2007)
Population < 25 years
(% of total population)
52.8 % (projected, NSO 2007)
49,617,400 M Filipinos
Population > 60 years
(% of total population)
6.7% (projected, NSO 2007)
6,637,100 M Filipinos
Birth rate
(births per 1,000 population)
23.4 (NDHS 2008)
2,162,303 live births per year
Death rate
(deaths per 1,000 population)
5.48 (NSO 2007)
515,192.34 deaths / year
Top Ten Causes of MortalityCause Total Rate
1. Diseases of the heart 70, 861 84.8
2. Diseases of the vascular system 51,680 61.8
3. Malignant Neoplasms 40,524 48.9
4. Accidents 34,483 41.3
5. Pneumonia 32,098 38.4
6. Tuberculosis 26,770 31.0
7. Unclassified 21,278 25.5
8. Chronic lower respiratory diseases 18,975 22.7
9. Diabetes mellitus 16,552 19.8
10. Conditions originating from the
perinatal period
13,180 15.8
Philippine Statistical Yearbook, 2009
Towards the attainment of MDGs ….
Indicators 2015 Target Accomplishment
MDG 4:
Under 5 mortality rate(per 1,000 live births)
26.7 34 (2008 NDHS)
Infant mortality rate 19.0 25 (per 1,000 live births) (2008 NDHS)
MDG 5:
Maternal mortality ratio(per 100,000 live births)
52 162 (2006 FPS)
Proportion of births attended by skilled health professional
70%(2010 NOH)
62 %(2008 NDHS)
Contraceptive Prevalence Rate (modern methods)
70%(2010 NOH)
34% (NDHS, 2008)
INDICATORS 2015 Target ACCOMPLISHMENT
MDG 6
Prevalence of HIV/AIDS among high risk groups
<1%5,364 cases (1984-2010)
<1%
Malaria morbidity rate 62/100,000 pop 38,135 cases(based from 1990
baseline)
21.6/100,000 pop19,555 cases
(2009)
Malaria mortality rate 0.75456 deaths
0.02624 deaths
13
456 deaths(based from 1990
baseline)
24 deaths(2009)
TB morbidity rate 137/100,000128,798 cases
(2010 NOH)
129 (2008)121,277 cases
TB mortality rate <44/100,00041,366 deaths
(PhilPACT)
41.0 (2007)
TB case detection rate 70 % 75 % (NTP, 2007)
TB cure rate 85 % 83 % (NTP, 2007)
Mortality Trend: Communicable Diseases, Malignant Neoplasms & Diseases of the Heart
Rate/100,000 PopulationPhilippines, 1953-2005
400
500
600
700
Communicable Diseases
60
70
80
90
100
Malignant Neoplasms & Diseases of the Heart
Communicable Diseases
Malignant Neoplasms
Diseases of the Heart
0
100
200
300
1953 '54
'55
'56
'57
'58
'59
'60
'61
'62
'63
'64
'65
'66
'67
'68
'69
'70
'71
'72
'73
'74
'75
'76
'77
'78
'79
'80
'81
'82
'83
'84
'85
'86
'87
'88
'89
'90
'91
'92
'93
'94
'95
'96
'97
'98
'99
2000 '01
'02
'03
'05
Year
0
10
20
30
40
50
Source: Philippine Health Statistics, 2005
CURRENT STATUS
HEALTH FINANCING
Share of health expenditure per GDP
2
2.5
3
3.5
4
Per
cent
0
0.5
1
1.5
2
Per
cent
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
YearTotal health expenditure = P234.3 B ( $5.2B) or 3.2 percent of GDP
Source: Philippine National Health Accounts
Total expenditure on health as a Percentage
of GDP
Source: World Health Statistics 2010
Distribution of Health Expenditure by
Use of FundsPublic
Health Care9%
P 21.2 billion
Others10%P 23.3 billion
Total health expenditure is P234.3 B
($ 5.2B) or 3.2 percent of GDP
Personal Health Care
81%P 189.7 billion
Source: Philippine National Health Account, 2007
Distribution of Health Expenditure by
Source of Funds
Source: Philippine National Health Account, 2007
Total health expenditure is P234.3 B or $5.2B (3.2 percent of GDP)
National Health Insurance Program
• A compulsory health insurance program of
government as established under Republic Act 7875
which shall provide universal health insurance
coverage and ensure
• affordable, acceptable, available and accessible
health care services for all Filipinos.
• Managed by Philippine Health Insurance
Corporation (PhilHealth), an attached agency of the
Department of Health
Membership (as of 2009)
• Employed Sector (46%)– covers all employed in the government and in the private sector
• Overseas Filipino Workers (11%) - PhilHealth took over the Medicare functions for OFWs on March 1, 2005
• Lifetime Program (1%) - Covers all retirees and pensioners 60 years old and above and with at least pensioners 60 years old and above and with at least 120 monthly contributions
• Individually Paying (15%)- Covers all self-employed and the informal economy workers
• Sponsored Program (24%) - Covers the poor families as identified through community surveys and enrolled by the Local Government Unit with National Government counterpart
3
4
5
6
7
Mil
lio
ne
n
Enrollment of the Poor
0
1
2
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 As of
Aug.
2010
• Enrollment of poor families by the LGUs increased from
0.087 in 1999 to 6.1M in August 2010
Health Insurance coverage by
wealth quintile, 2008
50
60
70
80
90
PhilHealth
0
10
20
30
40
50
Philippines Lowest Second Middle Fourth Highest
No Insurance
National Health and Demographic Survey 2008
1,566
0,009
1,752
0,010
MIDDLE INCOME
HIGH INCOME P194,965
P30,622
Ave.
Monthly
Income
19.1%
0.1%
The informal sector and self-employed
2,208
4,431
2,470
4,957
5 4 3 2 1 0 1 2 3 4 5
LOW INCOMEPOOR
LOW INCOMENON POOR
Number of Families(in Millions)
Non Wage/Salaries Wage/Salaries
>P7,513
Source: NSCB (FIES 2006)
80.8%
Total: 17.4 Million families
Health Insurance coverage by region,
2008
VII- Central Visayas
VIII- Eastern Visayas
IX- Zamboanga Peninsula
X- Northern Mindanao
XI-Davao
XII-SOCCSKSARGEN
XIII-Caraga
ARMM
0 20 40 60 80 100
Philippines
NCR
CAR
I- Ilocos
II-Cagayan Valley
III- Central Luzon
IVA- CALABARZON
IVB- MIMAROPA
V- Bicol
VI- Western Visayas
VII- Central Visayas
No Insurance
PhilHealth
PhilHealth
“The President was dismayed at the benefit
delivery rate of the National Health Insurance
Program in the country”
26
Coverage rate Availment rate Support value
53% 42% 34%
CURRENT STATUS
HEALTH FACILITIES
Hospitals
Hospitals
Priority Health Policy Directions of
the DOH1. A roadmap towards universal health care through a
refocused PhilHealth;
2. Particular attention to the construction, rehabilitation, and support of health facilities:
– LGU/regional hospitals, – LGU/regional hospitals,
– rural health units
– barangay health stations
3. Attainment of Millennium Development Goals 4, 5, and 6– Reduction of maternal, neonatal, and infant mortality
– Support to contain/eliminate age old pubic health diseases (malaria, dengue, TB)
Every Link in PhilHealth Value
Chain must work to achieve
financial risk protection
FINANCIAL
PROTECTION
PROVIDED TO THE
POPULATION
AccreditationEnrollmentClaims
Availment and
Processing
Insurance
Payments
Source: Joint DOH-PhilHealth Benefit Delivery Review (2010)
Redirecting PhilHealth: Enrollment
• Enforce mandatory PhilHealth coverage for all Filipinos:– Autonomic enrollment of indigents identified by the
DSWD (lowest quintile)
– Compulsory enrollment of members of the informal sector, especially those who can afford to pay the
– Compulsory enrollment of members of the informal sector, especially those who can afford to pay the premium
• National government to pay for the entire premiums of the poorest quintile
• National government – local government sharing for the second poorest quintile
Redirecting PhilHealth: Enrollment
• Work with other government agencies to enforce mandatory PhilHealth membership for all Filipinos:
– School enrollment
– Licensing of business– Licensing of business
– Renewal of driver’s license
– Other government transactions
• Work with the private sector to launch innovative schemes in paying premiums (e.g. payment premium through SMS)
Redirecting PhilHealth: Accreditation
• Licensing and accreditation shall be unified to
fast track accreditation of more health
facilities in the country
• Provisional accreditation for all government • Provisional accreditation for all government
health facilities to ensure access of PhilHealth
members to health services
• Monitoring teams to check on needs of health
facilities for improvement
Redirecting PhilHealth:
Claims Availment and Processing
PhilHealth Information Technology upgrade to
accelerate processing of claims accelerate processing of claims
Redirecting PhilHealth:
Insurance Payments
• Improve significantly support value from 20% to 70% for all illnesses
• Increase significantly the support value for catastrophic illnesses
• Zero balance billing in all government hospitals • Zero balance billing in all government hospitals for the Sponsored Program
• Promote cost effectiveness: – case-payment
– registration of the indigents under one GP
– National standard treatment guidelines in all levels of health care
KaSAPI Program Kalusugang Sigurado at Abot-kaya sa
Philhealth Insurance
Objectives:
• Increase enrollment and sustain membership
Implement an alternative premium payment • Implement an alternative premium payment
scheme through Organized Groups (OG)
• Identify and develop innovative approaches
of marketing SHI
• Strengthen solidarity and risk sharing
Mechanics to enroll the Informal
Sector through KaSAPI
• Focuses on group enrollment scheme through
organized groups (OG) with minimum membership
size of 1000
• OGs are assessed based on organizational stability
and financial performance
• Once the OG passes the evaluation, a Memorandum
of Agreement is signed with PhilHealth
• Provides incentives to partner-OGs through premium
discounts based on group size, and flexible mode of
payment (e.g. weekly premium payment through OG)
Health Facilities Enhancement
• Upgrading of health facilities: rural health
units, district hospitals, provinicial hospitals,
DOH Retained hospital
Strategies for Health Facilities
Enhancement• Public-Private Partnership
• Regional Clustering
• Fiscal autonomy and income retention for
government health facilitiesgovernment health facilities
• Streamlining of licensing and regulation for
improved accreditation
Thank you!
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