Universal Health Care: the Philippine experience


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Presntation by Zorayda E. Leopando, MD, MPH
Professor of Family and Community Medicine University of the Philippines Manila at the WHO/TNO/Dutchgovernment Congres 'Connecting Health and Labour' 29 - 1 December 2012

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Universal Health Care: the Philippine experience

  1. 1. Universal Health Care: The Philippine Experience Zorayda E. Leopando, MD, MPHProfessor of Family and Community Medicine University of the Philippines Manila
  2. 2. • “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
  3. 3. Universal Health CareDeliberate attention to theneeds of millions of poorFilipino families whichcomprise the majority ofour population
  4. 4. Comprehensive Reform Agenda Reforms FocusHealth Sector Reform public health, hospital,Agenda, 1999-2004 health care financing, governance, and regulations.Fourmula One For financing, serviceHealth, 2005-2010 delivery, regulation, governanceUniversal Health Care, to improve, streamline,2011-2016 and scale up above reforms
  5. 5. Filipino Income Quintiles Monthly income Families per quintileQ1 3,460 5,218,267Q2 6,073 4,094,164Q3 9,309 3,912,443Q4 15,064 3,707,494Q5 38,065 3,485,067Exchange rate US$ 1.00= Php 43.00 Source: National Health and Demographic Survey, 2008
  6. 6. 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
  7. 7. Office of Secretary of Health Attached Agencies Regional hospital Medical Centers Regional Offices Sanitaria City Health Offices Provincial Health Offices Provincial (Chartered Cities) Hospitals Inter-local Health Zones City Health Hospitals Centers City Health Offices Municipal health District offices/ Rural hospitals Barangay (Component Cities)Level of Health Unit HealthSupervision Health Stations City Barangay Health Centers DOH Hospitals Stations Province Barangay City government Health Municipal gov’t Stations
  8. 8. Utilization of Health Facilities % HEALTH FACILITY TYPE Government 50 % Private 42 % Traditional healer 7%Common reasons for seeking health care: illness or injury ---------------------- 68 % medical check-up --------------- 28 % dental care --------------- 2 % medical requirement ---------- 1 % Source: NDHS, 2008
  9. 9. • 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
  10. 10. 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
  11. 11. Distribution of HealthExpenditure by Source of Funds Total health expenditure is P234.3 B (3.2 percent of GDP) Source: Philippine National Health Account, 2007
  12. 12. Distribution of Health Expenditure by Use of FundsPublic Health Others Total health expenditure is P234.3 B Care 10% (3.2 percent of GDP) 9% P 23.3 billionP 21.2 billion Personal Health Care 81% P 189.7 billion Source: Philippine National Health Account, 2007
  13. 13. National Health Insurance Program and the Philippine Health Insurance CorporationPres. 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
  14. 14. Given priority poorest of the poor families
  15. 15. DOH, 2010 GOALS Better health Responsive health Equitable health outcomes system financing Objectives Instruments utlized Health Service Policy, standards Health Health GovernanceFinancing Delivery and regulation Human Information for Health Resource
  16. 16. 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 facilitiesPlus: 1. Attain efficiency by using information technology 2. More aggressive promotion of healthy lifestyle DONH, 2010
  17. 17. STRATEGY # 1 Ensure that each family has an assigned competent primary health care provider STRATEGY # 2 Produce health professionals that areresponsive to the current needs of the health sector STRATEGY # 3 Manage the exit or re-entry
  18. 18. 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
  19. 19. 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.
  20. 20. Universal Health Care or “Kalusugan Pangkalahatan” (KP) Access to KP as an Operational Solution Quality IP and OP Care NHIP PublicBenefit HealthDelivery Services Poorest Families • Convergence of three strategic thrusts to serve poor families
  21. 21. Access to Quality IP Kalusugan Pangkalahatan (KP) and OP CareNHIP Benefit Public Health Delivery Services Poorest Families 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 DOH, 2011
  22. 22. The goals set by the DOHFinancial 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
  23. 23. The goals set by the DOHHealth 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
  24. 24. The goals set by DOHAttaining Health-related MDGs • Procure and distribute health commodities to RHUs serving 4Ps beneficiaries ONGOING • Deploy Community Health Teams ONGOING DOH, 2011
  25. 25. What Phil Health Says:Moving forward with KP
  26. 26. 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
  27. 27. 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
  28. 28. Benefits for members• 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
  29. 29. 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
  30. 30. Thank you very much