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PHILIPPINE NURSES ASSOCIATION
90th Foundation Anniversary
55th Nurses Week Celebration
and National Annual Convention 2012
Plenary Session III:
Models of Health Care
Theme: Inspiring the Filipino Nursing Workforce towards Equity and Access to Health
Care
Josephine D. Lorica, RN, DPA
Faculty, School of Health Sciences
St. Paul University Phils.Tuguegarao City
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Session Objectives
1. Describe the four basic models of health care
system relating this to equity and access to health
2. Discuss the social model of health and its goal of
preventing and reducing illness and addressing
inequalitites and disadvantage that exist within
the community.
3. Discuss challenges and opportunities of nurses in
the present model of health care system in the
Philippines.
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Health is a basic human right!
The Universal Declaration of Human Rights
The General Assembly of the United Nations
adopted and proclaimed these principles in 1948
Article 25
Constitution of the Philippines
Article 2 Section 15
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Health Care System
Consist of
individuals and
organizations
designed to meetthe health needs of
target populations
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.. the measure of a responsive and effective
health system is its ability to contribute togood health. (WHO, 2000)
- main function of the national health care
system is to promote health among the
countrys citizens (McKinsey & Company,2006)
Health Care System
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Each nations health care system is a reflection
of its: History
Politics
Economy
National values
They all vary to some degree
However, they all share common principles
There are four basic health care models
around the world
Health Care System(Sibu Saha)
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Almost 200 countries in the world but only
about 40 of those are organized, rich andindustrialized enough to have a developed
health care system
Health Care System
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four basic models of health care
system (Reid, 2009)
1. The Beveridge Model
2. The Bismarck Model
3. The National Health Insurance
Model
4. The Out-of-the Pocket Model
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Named for William
Beveridge Social reformer who
designed Britains
National Health Service
(NHS)
The Beveridge Model
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The Beveridge Model
Health care provided and financed by
government through tax payments
Most hospitals and clinics are owned by the
government
Some doctors are government employees;
some private doctors collect their fees from
the government
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The Beveridge Model
British people never get a doctor bill
Medical treatment is public service
Beveridge systems tend to have low cost per
capita because government controls whatdoctors can charge
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The Beveridge Model Countries using Beveridge Plan or variations
from it: Great Britain, Spain, Scandinavia, New Zealand
a. Hongkong has its own Beveridge style system
since populace refused to give it up when Chinatook over in 1997
b. Cuba represents extreme application of
Beveridge probably worlds purest example oftotal government control
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The Bismarck Model
System named for
Prussian ChancellorOtto von Bismarck
Invented welfare state
as part of Germanys
unification during 19th
century
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The Bismarck Model
System uses insurance system
Insurers are called sickness funds
Private insurance system usually financed
jointly by employees and employees through
payroll deductions
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The Bismarck Model
Providers and payers are private
Health insurance plans have to cover
everybody
a. Multi-payer modelb. Does not make a profit
Tight regulation of medical services and fees(cost control)
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The Bismarck Model
Countries using it:
Germany, France, Belgium, The Netherlands,
Japan, Switzerland, and to a degree Latin America
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The National Health Insurance Model
Single payer system has elements of both
Beveridge and Bismarck
Single payer systems tend to have more
market power to negotiate lower health care
prices
Uses private sector providers, but payments
come from a government-run insuranceprogram that every citizen pays into
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The National Health Insurance Model
No need for marketing because there is no
financial motive to deny claims and profit
National insurance collects monthly premiums
and pays medical bills
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The National Health Insurance Model
NHI plans also control costs by:
1. limiting medical services they will pay
for or2. by making patients wait to be treated
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The National Health Insurance Model
Countries using it:
Canada, Taiwan, South Korea
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The Out-of-the-Pocket Model
plan used by most nations because they are
too poor and too disorganized to provide anymass medical care
no system countries
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Most medical care is paid for by the
patient, out-of-pocket
No insurance or government plan
The Out-of-the-Pocket Model
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In these poor countries, only rich can affordmedical care
a. Rural regions of Africa, India, China andSouth America, hundred of millions of peoplego their whole life without ever seeing adoctor
b. Tend to rely on village healers and home
remediesc. May pay a doctors bill with potatoes or
other produce
The Out-of-the Pocket Model
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COMMON PRINCIPLES OF ALL MODELS Coverage
Coverage for every resident (old or young, rich or
poor)
Moral principle of all developed countries
Every country rations care not everything is covered!
Quality
Other developed countries produce better quality
results.
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Cost
All other systems are cheaper except OOTP
Foreign employers pay far less for health coverage
Effect?
Choice
Many countries offer greater choice
COMMON PRINCIPLES OF ALL MODELS
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the health of individuals and communities is
seen as the result of complex and interactingsocial, economic, environmental and personal
factors
The SOCIAL MODEL of HEALTH
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The Social Model of Health
Carefully considers the wider determinantsof health i.e. the range of factor thatimpact on peoples health and well being.
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Social Model of Health
(Dahlgren & Whitehead, 1991)
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Dahlgren and Whitehead (1991) talk of thelayers of influence on health. They describe a
social ecological theory to health.
Social Model of Health
(Dahlgren & Whitehead, 1991)
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The first layer is a personal behavior and ways
of living that can promote or damage health.
eg. Choice to smoke or not individuals are
affected by friendship patterns and the norms
of their community.
Social Model of Health
(Dahlgren & Whitehead, 1991)
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The next layer is social and community inunfavorable conditions, but they can also
provide no support to have a negative effect.
Social Model of Health
(Dahlgren & Whitehead, 1991)
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The third layer includes structuralfactors: housing, working conditions,
access to services and provisions of
essential facilities
Social Model of Health
(Dahlgren & Whitehead, 1991)
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Individual and community
experience and knowledge becomes
relevant empowered
Health becomes a social
phenomenon
Social Model of Health
(Dahlgren & Whitehead, 1991)
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PHILIPPINE HEALTH CARE SYSTEM
Health development effort have aimed to
address the problem of inequity for almost 4decades
1979 Selective PHC implementation
1992 Devolution of health services
2000 health sector reforms
2005-2010 National objectives for health 2011-2016 Kalusugang Pangkalahatan
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Stated Objectives of our Health System
2005-2010 (National Objectives for Health
2010 Monograph)1. Better health outcomes
2. More equitable financing3. Increased responsiveness and client
satisfaction
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2011 2016 Kalusugang Pangkalahatan
Main Goal:
Achieving Universal Health Care
Stated Objectives of our Health System
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Goal of the Health System the main function of the national health care
system is to promote health among thecountrys citizens (McKinsey & Company,
2006),
this does not remain to be just health; it has
to put at the end view the equity, efficiency,
effectiveness of the chosen paths (WHO,
2007).
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Extent of the Goals being Achieved?
(WHO, 2011)
Improvement in the delivery of public
health services -> improved overallhealth outcomes
BUT PROGRESS towards the health MDGsappears to have slowed
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Regulations of goods and services hasbeen strengthened
BUT commercial interests continue todominate regulatory processes
Extent of the Goals being Achieved?
(WHO, 2011)
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Extent of the Goals being Achieved?
(WHO, 2011)
DESPITE strong efforts in the
implementation of Philippine HealthInsurance Law, OUT-OF-THE POCKET
costs have continued to increase
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Reforms in the governance continue to
be stymied by a flawed Local
Government Code -> increasedfragmentation in the management of
health services
Extent of the Goals being Achieved?
(WHO, 2011)
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Philippine Health Care SystemsEQUITY
ACCESS TO SERVICES is limited by
financial and social barriers
Low coverage rates found in poorestquintiles of the population, among rural
areas and among families with
uneducated mothers
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Disparities in the distribution of human
and physical resources
Utilization patterns are affected byfinancial barriers, negative perceptions
about quality of care and lack of
awareness of services
Philippine Health Care SystemsEQUITY
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Philippine Health Care SystemsCOST
Public financing levels have steadily increased,
however remain low in regional terms High and steadily increasing out of the pocket
spending exposes large financial risks from
illness
PhilHealth is only financing about a tenth of
the countrys total health expenditure
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Philippine Health Care SystemsALLOCATIVE AND TECHNICAL EFFICIENCY
More health resources are spent on personalcare than public health
Drug expenditure consume 70% of out-of the
pocket expenditures and are largely spent on
heavily marketed non-essential and mostlyineffective medicaions
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Health facilities and human resources areconcentrated relatively affluent areas
Devolution of health service widened the gap
in health resource allocation
Health workforce production is geared
towards a perceived lucrative international
market rather than national health needs
Philippine Health Care SystemsALLOCATIVE AND TECHNICAL EFFICIENCY
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National government facilities providing
expensive tertiary care have budgets that are
disproportionately high in relation to localprimary care programmes
NHIP also follows the trend by favoring
hospitalized care
Philippine Health Care SystemsALLOCATIVE AND TECHNICAL EFFICIENCY
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Philippine Health Care SystemQUALITY OF CARE
Efforts to improve quality are typically adhoc
and uncoordinated due to lack of data onquality and the lack of incentives for best
practice
Most hospitals and professional practitioners
meet the quality standards set by licensing
requirements and PhilHealth accreditation
standards
hili i l h
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Data on quality outcomes are few and
unreliable Primary care facilities and lower level hospitals are
bypassed perceptions of low quality
SOLUTION PERFORMANCE INCENTIVES INCREASING CLIENTS VOICE THROUGH
EFFECTIIVE CONSUMER PARTICIPATION
STRATEGIES
Philippine Health Care SystemQUALITY OF CARE
Phili i H l h C S
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Philippine Health Care System HEALTHIMPROVEMENTS
Noticeable health outcomes in communicable
disease control, and child health programsbecause of substantial participation of
national government and strong coordination
with LGUs while adverse health results wherenational policy is not directly supportive of
LGU action
Phili i H lth C S t
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Major weakness failure to address the
large disparities in health outcomesbetween the rich and the poor
Philippine Health Care System HEALTHIMPROVEMENTS
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The PHCS model is basically out of pocket for most
of the population except for theemployed which is similar to the
German(Bismarck) model.
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The coverage of Philippine HealthInsurance Corporation is too limited to
be considered as a national healthinsurance program as what exists in
Canada.
In the PHCS
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What nurses can do? - Opportunities
Personally, each registered nurse should workand save for his/her own health care needs
as one grows older, ones saving must also
grow.
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What nurses can do? - Opportunities
Call for A Nurse in every Barangay
- to implement primary health careconcepts and principles
Each registered nurse to implement and utilizethe social health model in their practice, make
each one or each family /community
empowered
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What nurses can do? - Opportunities
Empower the community through:
Community-based health care financing or comeup with a sustainable health care financing
health and wellness promotion action
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What nurses can do? - Opportunities
Conduct Researches consumer feedback of
stakeholders; quality data for utilization ofservices , evidence-based health promotion
strategies and or come up with a system that
is based on health needs of our country Participate in health systems analysis and
research
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What nurses can do? - Opportunities
All nurses need to do their social
responsibility from providing their basichealth skills to referral,to being actively
involved in the community (Barangay
Nutrition Committee, Community Health
Council etc.) , and to being advocates for
the community people
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Empower ourselves by:
Social marketing showing what we can do
Lobbying for a more innovative and
evidenced-based information models that
nurses can implement
Stronger nursing role in health policy
enter politics? Or become involved in policyand decision making
What nurses can do? - Opportunities
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So, CAN WE DO
SOMETHING FOR OURCOUNTRYS HEALTH CARE
EQUITY AND ACCESS?