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Health Policy and Kalusugan Pangkalahatan
 

Health Policy and Kalusugan Pangkalahatan

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Slide presentation used at one of the breakout/parallel sessions of the 4th National Medical Students' Conference (NMSC). On health policy in the Philippines and the country's Kalusugan Pangkalahatan ...

Slide presentation used at one of the breakout/parallel sessions of the 4th National Medical Students' Conference (NMSC). On health policy in the Philippines and the country's Kalusugan Pangkalahatan (Universal Health Care) program.

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  • http://AlbertDomingo.comfacebook.com/aedomingotwitter.com/AlbertDomingo
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  • It will be necessary to draw evidence from a wide variety of disciplines if public health professionals are to continue to identify the causes of ill-health and to prevent disease and promote health through the organized efforts of society.
  • Although the idea underpinning the introduction of any organizational change may reflect the ideology of the political party in power, or that of an individual, pressure group or think tank, the decision taken can be based on evidence.The nature of the evidence may be: (1) the experience of what happened since the last change in service financing and organization; or (2) derived from research findings.However, the amount of research evidence available on which to base healthcare policy is often limited, and politicians may argue that the introduction of a particular policy is supported by common sense.Reference: Gray, 2004 (p. 291)
  • 1990s: disjoint split of service delivery and financing2000s onwards: “making devolution work” (attempts)Kalusugan Pangkalahatan care builds on gains on the reform initiatives of the last decade. Health Sector Reform Agenda (HSRA) – identified the reform pillars of public health, hospital, health care financing, governance, and regulations Fourmula One for Health – provided for an implementation framework: financing, service delivery, regulation, governanceAHA-UHC/Kalusugan Pangkalahatan – an operational focus that improves, streamlines, and scales up reform interventions
  • Mortality Trends of Communicable Diseases, Malignant Neoplasms, and Diseases of the Heart, per 100,000 Population, 1954-2008
  • Question:Does illness result in poverty,or does poverty result in illness?UHC is defined as achieving the best health status for a given population while providing them protection from the financial risks of utilizing care.The gains brought about by inclusive growthcan be easily wiped out by loss of productivity owing to illness and premature deathand the financial burdenof paying for health careThe push towards UHC varies in approach across countries, depending on their respective economic status, cultural context, political environment, and other operational considerations.
  • Explain broken loop -> cases not detected most likely to go untreated -> MDR -> infective, increases incidence; or, they die (TB mortality) / naturally get well (small percentage) Sure, there may be a natural rate of decline, due to:1. Geographical isolation2. Relative temporal improvements in social determinants (housing, hygiene, etc)3. Pockets of infection due to social stigma4. Self-medication (which may lead to MDR)
  • Mall vs. Main Street
  • This is the mandated goal. But HOW?
  • Skills – from WHO/Geneva (http://www.who.int/hrh/en/HRDJ_1_1_02.pdf)Roles – from Silliman University (http://su.edu.ph/article/396-5Star-Roles)
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Health Policy and Kalusugan Pangkalahatan Health Policy and Kalusugan Pangkalahatan Presentation Transcript

  • Health Policy and Kalusugan Pangkalahatan
  • What is Health Policy?
  • 0 10025 x 1,000 km 75 Parameter 25 75 100 Life Event Manufacture to Prime Middle Age Resale / Trade-in / Scrap Care Provider “Casa” “Talyer” / Self-repair ? Dx, Tx, Rx Preventive Maintenance (e.g., Oil Changes) Brake Pad Replacements, Recalibrations Overhauls Costs of Care + +++ +++++ Financing Co-pay Co-pay, Insurance Co-pay, Insurance Catastrophe MV “Crash” (Damage) Regulation LTO, LTFRDB, MMDA, etc.
  • 0 10025 x 1 year 75 Parameter 25 75 100 Life Event Birth to Early Adulthood Middle to Old Age (Very) Old Age Care Provider Clinics (OB, Pedia, Surg) Clinics / Hospitals (IM, Surg) Hospitals (IM, Surg, Patho) Dx, Tx, Rx Outpatient > Inpatient (Vaccines, Vitamins, etc) Outpatient = Inpatient (“Maintenance” Meds, etc) Outpatient << Inpatient (ACLS, Critical Care, etc) Costs of Care + +++ +++++ Financing OOP vs. Insurance OOP vs. Insurance OOP vs. Insurance Catastrophe MV “Crash” (Trauma) Regulation PRC – Board of Medicine, DOH (incl. FDA), PHIC, etc.
  • Demystifying and De-medicalizing  The allocation of resources must be explicit  Decision-making at all levels must be open  Medicine must be de-mystified and health de- medicalized, for professionals, patients, the general public and politicians alike  Public health / health policy is thus multi-disciplinary, and multi-stakeholder Reference: Gray, 2004 (pp. 317-318), modified
  • “Pharmacology” of Health Policy  DYNAMICS and the mechanism of action:  Will an intervention reduce the risk?  KINETICS and the response of the system:  Will the intervention for the main concern increase other risks? (i.e., adverse effects)  THERAPEUTICS and delivery:  Is it operationally possible to introduce the intervention? Reference: Gray, 2004 (p. 296), with modification
  • Health Policy: Scope, Scale, and Stakeholders
  • Factors in Health Policy Change OLD POLICY NEW POLICY Ideological inspirations Change in circumstances Evidence Common sense From research From experience Reference: Gray, 2004 (Fig 7.8, p. 291; p. 292) NOTE: Policy makers operate on a timescale that does not generally admit of delays that research will take.
  • How has health policy developed over time in the Philippines?
  • Historiography of PH Public Health  Spanish era: reordering of Philippine society  American era: a civilizing mission to prepare Filipinos for independence; governance through sanitation, health, hygiene, medical and scientific institutions, medical and health professions  Public schools and school children as agents for public health work  Educational, medical, and scientific research institutions as training and preparation “laboratories”  Leading to “Filipinization” of the bureaucracy Reference: Planta, 2008
  • History of Philippine Health Reform  1960s: Medicare  1970s: Population Policy  1980s: Generics Act of 1988  1990s:  Local Government Code of 1991  National Health Insurance Act of 1995  2000-present:  HSRA  F1  KP Reference: Romualdez, 2011 FINANCING SERVICE DELIVERY
  • Epidemiological Transition 0 10 20 30 40 50 60 70 80 90 100 110 0 100 200 300 400 500 600 1954 '57 '60 '63 '66 '69 '72 '75 '78 '81 '84 '87 '90 '93 '96 '99 '02 '05 2008 Deathsper100,000population (non-communicablediseases) Deathsper100,000population (communicablediseases) Year Communicable Diseases Malignant Neoplasm Diseases of the Heart Source: Philippine Health Statistics, various years
  • Is Universal Health Care more fun in the Philippines?
  • Areyougettingwell? Can you pay for the services?Reference: Berman, 2012
  • Improved Health Outcomes and Minimal Financial Risk Use of Quality Services Reduction of Exposure to Health Risks
  • Start with the Poor and Vulnerable Q1 Poorest Q2 Poor Q3 Middle Income Q4 Rich Q5 Richest 16 Note: Population counts projected for FY 2013 (except for DSWD numbers); rounded off to the nearest million. • Poverty incidence by NEDA/NSO is only a statistical estimate • DSWD’s NHTS-PR and 4Ps/CCT, while with data on names, faces, and places, may not have enlisted all the “real poor” • The DOH thus uses Q1 + Q2 for planning estimates, with reliance on the DSWD’s NHTS-PR and 4Ps/CCT for targeting/identification Identified by DSWD
  • 1.0 Public Health MDGs Achieved 1.1 - Reduce Maternal and Child Mortality 1.2 - Control and Eliminate Infectious Diseases 1.3 - Promote a Healthy Lifestyle and Prevent NCDs 2.0 Financial Risk Protection Improved 2.1 - Expand PhilHealth Coverage 2.2 - Improve PhilHealth Benefit Package 3.0 Quality Care Delivery System Accessible 3.1 - Upgrade and Improve Health Units and Hospitals 3.2 - Deploy Human Resources for Health 4.0 Health Governance Improved 4.1 – Improve/ Reform Health Systems 4.2 – Maintain an Effective Health Regulatory System Outcomes and Strategies
  • How will we achieve public health MDGs?
  • 1.0 Public Health MDGs Achieved 1.1 - Reduce Maternal and Child Mortality 1.2 - Control and Eliminate Infectious Diseases 1.3 - Promote a Healthy Lifestyle and Prevent NCDs Package of actions and population coverage: • Increase facility-based deliveries and family planning services, commodities and counseling for Q1 and Q2 mothers & women of reproductive age • Immunize all infants according to the Expanded Program on Immunization (EPI) & provide pneumococcal and rotavirus vaccines among susceptible communities • Immunize poor senior citizens (influenza and pneumococcal vaccines) • Provide vitamins & minerals to all children (<5 y/o)
  • Carpi o RPRH Law? April 8, 2014 (Tuesday)
  • 1.0 Public Health MDGs Achieved 1.1 - Reduce Maternal and Child Mortality 1.2 - Control and Eliminate Infectious Diseases 1.3 - Promote a Healthy Lifestyle and Prevent NCDs Package of actions and population coverage: • Treat all diagnosed TB cases • Eliminate malaria in endemic provinces • Improve HIV/AIDS prevention, screening, diagnosis, and treatment • Provide rabies vaccine for dog bite victims and coordinate with DA for dog vaccination • Eliminate filaria and other intestinal parasites
  • Susceptible Population Not detected or false negatives on screening, hence not treated; Or self-medicated MDR TB Mortality Treatment Success Rate (TSR) Case Detection Rate (CDR) Prevalence RateIncidence Rate TB Infection Cycle Failed treatment Spontaneous remission Case Notification Rate (CNR) Cure Rate (CR)
  • 1.0 Public Health MDGs Achieved 1.1 - Reduce Maternal and Child Mortality 1.2 - Control and Eliminate Infectious Diseases 1.3 - Promote a Healthy Lifestyle and Prevent NCDs Package of actions and population coverage: • Promote key health messages (on Healthy Lifestyle, preventing disease and injury, available health services) • Establish, link, and maintain non- communicable disease registries in provinces • Provide access to screening services for NCDs for the poor through PhilHealth Primary Care Benefit package
  • How will we improve Financial RisK Protection?
  • Who pays for the cost of health care? National Government 12% Local Government 15% Social Health Insurance (PhilHealth) 9%Private OOP 53% Others 11% Source: 2011 Philippine National Health Accounts
  • 2.0 Financial Risk Protection Improved 2.1 - Expand PhilHealth Coverage 2.2 - Improve PhilHealth Benefit Package Package of actions and population coverage: • Expand coverage of all Filipinos, especially the poor and near-poor (14.7M) • Inform and guide all members on PhilHealth availment procedures and benefits • Improve access to primary care benefit package for the poor (drugs & diagnostics) • Increase PhilHealth share in total health care costs, to minimize out-of-pocket payments Increased Fiscal Space:  “Tuwid na Daan”  Sin Tax Reform of 2012  National Health Insurance Act of 2013
  • How do we make a Quality Care Delivery System Accessible?
  • 3.0 Quality Care Delivery System Accessible 3.1 - Upgrade and Improve Health Units and Hospitals 3.2 - Deploy Human Resources for Health Package of actions and population coverage: • Upgrade, build, and enhance: • Barangay health stations as well as rural and city health units to deliver preventive health services • LGU district and provincial hospitals for quality outpatient and inpatient care • DOH regional hospitals and medical centers to make specialized care more affordable • Distribute complete treatment packs (for common diseases like infections, diabetes, hypertension, heart diseases, etc) to poor patients
  • 3.0 Quality Care Delivery System Accessible 3.1 - Upgrade and Improve Health Units and Hospitals 3.2 - Deploy Human Resources for Health Package of actions and population coverage: • Deploy human resources for health (Physicians, Nurses, and Midwives) nationwide, properly distributed with priority to NHTS and other priority areas • Train and deploy Community Health Teams (CHTs) to reach families with key messages and basic preventive care
  • Public/Gov’t Health Facilities
  • Office of Secretary of Health Attached Agencies Regional Offices Provincial Health Offices 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 Provincial Hospitals Regional hospital Medical Centers Sanitaria City Health Offices (Chartered Cities) City Hospitals Health Centers Barangay Health Stations References: Kelekar and Llanto, 2013; Khemani, 2010
  • The Five-Star Doctor Roles  Health Care Provider  Teacher  Researcher  Social Mobilizer  Manager / Policy Maker Examples of Leaders  Expert Clinicians  Deans and Professors  Principal Investigators  Health Advocates  DOH Officials / Staff
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