Healthcare Innovation Forum: Philippine Healthcare

Teodoro J. Herbosa MD FPCS College of Medicine, University of the Philippines, Manila Undersecretary, DOH (2010-2014)

ObjectivesHistory of the Philippine Health care system

Health Reforms: Universal Health Care

Health Financing

Health Systems Strengthening

Health Partnerships

Intended Health Outcomes

Philippine Health CarePrehispanic era

Spanish Era

American Era

Golden Era 50’s

Diaspora

Two Systems: Public vs Private

Health ReformsGovernment owned Corporate Hospitals

Local Government Code/decentralization/devolution

Reforms from private healthcare vs social protection scheme

National Health Insurance Act 1994 Philippine Health Insurance Corporation

Universal Health Care funded through Sin Tax

Governance Reform for Public Hospitals

Background

3

Universal Health Care Building Blocks

Governance

Financing

Health Goods and Materials

Health Services

Information System

Health Workforce

THE AQUINO HEALTH AGENDAUniversal Health Care or Kalusugan Pangkalahatan, has three

strategic thrusts:

Universal Health Care / Kalusugan Pangkalahatan

Improved Health especially for the

Poor and Vulnerable

Secure access to quality

care at facilities

Achieve the public health

MDGs

Provide financial risk

protection

INTERVENTIONS OF CARE

Prim

ary

Prev

entio

n an

d

Health

Pro

mot

ion Curative

Health Care

Secondary Prevention and Primary Care

Universal Health CareKalusugan Pangkalatan

Health Risk Financing and Payment schemes reforms

Access to quality and affordable health care - modernization

Improved Public Health Outcomes focused on Maternal and Child Health

eHealth National eHealth Strategic Plan and Framework

Health FinancingPremium based health insurance system

Targetting the poorest

Using Sin Tax revenues for sustainable financing

Increased Health expenditure by government

Catastrophic Illness packages

Primary Care Benefit

Case Payment scheme/Capitation payments

SUBSTANTIAL INCREASE IN THE DEPARTMENT OF HEALTH BUDGET

Budget (in billion pesos)

Billi

on P

esos

0

22.5

45

67.5

90

Year2008 2009 2010 2011 2012 2013 2014

Budget (in billion pesos)

18.91 23.67 24.65 31.83 42.08 50.44 89.7

23 Case Rates (No balance billing for Sponsored Program beneficiaries in

government hospitals)

Health Systems Strengthening

Health Leaders Program ZFF

MMCF Strategic Thinking for Hospital Directors

Hospital governance reform; ISO Certification

Hospital Accreditation Commission

Health Systems Strengthening

Focus on GIDA

Preventive Health approach expanding EPI, rotavirus, Pneumococcal vaccines

NCDs

Local health systems/Interlocal health zones

IMPROVED ACCESS TO QUALITY HOSPITALS AND FACILITIES

3,576:Total health facilities upgraded and rehabilitated as of Feb 2013

1,049 hospitals

Another 2,487 health facilities will be upgraded this 2013.2,751 (91%) came from the 609 priority municipalities listed by the National Anti-Poverty Commission

Result: Increase in deliveries of mothers in hospitals. 719,552 mothers (38.8%) (2009) vs 1,014,613 mothers (57.1%) (2011)

Health Partnerships

Public Private Partnerships PPPs

Social Marketing and buy in

Name calling by certain sectors

Success in Emergencies and Disasters

Protracted planning and feasibility studies

Performance Comparison: Existing & MPOC

EXISTING POC

MODERNIZED POC

534 beds utilized out of 700 sanctioned beds, sub capacity operation at 55%

-60% levels

Ideal Staff to Bed Ratio not being

effectively achieved

Lower than average period of Avg. Length

of Stay (ALOS) & discharge times for admitted patients

Only primary and secondary medical

services, Limited allied services, medical tourism & private patients due to

poor competitive advantage

Private sector efficiency in operations to

ensure atleast 70% capacity utilization

Expected Ideal Staff to Bed Ratio of 2.25 persons/

bed

Possible reduction in ALOS, discharge period to reduce from 22 days to 8

days

Super specialty tertiary care with increased private

patients, medical tourists, allied medicine due to

internationally competitive services & facilities

Criteria For Selection Of Pilot Hospitals

22

Health OutcomesLonger Life Span

Increase in Average height

Lower Maternal and Child Mortality

Correcting undernutrition

Decerease childhood obesity

Decrease smoking related mortalities NCDs

OUTCOMES

3

ATTAINMENT OF THE HEALTH-RELATED MILLENNIUM DEVELOPMENT GOALS

Disaster Risk Reduction

Capacity and Capability

Incident Command Systems

Emergency Operations Center

Communications and Coordination

Logistics management system

eHealthEnterprise architecture/Common platform

Standards and Nomeclature

Security and Privacy

Risk management

Health Information Exchange

Analytics and Big Data

eHealth Component Map (Based on the DOH Philippine eHealth Framework and

Development Plan 2013-2016)

Health Information ExchangeOPENHIE

Private Sector Health systems development: Corporate networks

Procure and Improve Model

Ambulatory services to a greater number

Market segment capture

HMO and Health Insurance

Health Industry; Pharma, Equipment, Supplies, Design and construction

Threats to UHC Sec. AG Romualdez

•Emphasis on profit in the private health sector •Health goods and services as commodities •*Globalization – ASEAN Harmonization of

Health Services •*Public-Private Partnerships •Medical Tourism •Two-tiered health care system

– Dr. S.T.Han, WHO Regional Director for the Western Pacific: Hiscock Memorial Lecture, University of Hawaii, 1991

““You may have the best infrastructures, the most modern and up to date technology, and the best management and finance systems, but without a

well-motivated and skilled workforce none of these will have beneficial impacts on the health of

people.””

–Randy Pausch, The Last Lecture

“The brick walls are there for a reason. The brick walls are not there to keep us out. The brick walls

are there to give us a chance to show how badly we want something. Because the brick walls are there to stop the people who don't want it badly enough.

They’re there to stop the other people.”