This document provides an overview of the Philippine health care system. It begins by defining key terms like health care system, health care delivery, and Philippine health care system. It then discusses the WHO health systems framework and describes the four essential functions of a health system: service provision, resource generation, financing, and stewardship. The document outlines different health care system models and describes the main components of the Philippine system, including its national health insurance program, PhilHealth. It discusses factors like leadership and governance, health care financing, the health workforce, access to medicines and technologies, health information and research, and health service delivery. Overall, the document comprehensively summarizes the organization and structure of the Philippine health care system.

1. Health Care System
REFERENCES:
HTTPS://WWW.SLIDESHARE.NET/LOPAOMD/AN -INTRODUCTION-TO-HEALTH-SYSTEMS-AN-OVERVIEW-
OF-THE-PHILIPPINE-HEALTH-CARE-SYSTEM-AND-HEALTH-SYSTEMS-THINKING
HTTPS://WWW.SLIDESHARE.NET/SHARINA11/HEALTH -CARE-DELIVERY-SYSTEM-IN-THE-PHILIPPINES

2. Objectives:
• Define Health Care System
• Discuss factors affecting Health Care System
• Provide overview of Philippine Health Care Delivery System

3. THE WHO HEALTH SYSTEMS FRAMEWORK

4. Definition of Terms
HEALTH CARE SYSTEM - an organized plan of health services
(Miller-Keane, 1987)
HEALTH CARE DELIVERY -rendering health care services to
the people (Williams-Tungpalan, 1981).

5. HEALTH CARE DELIVERY SYSTEM (Williams-Tungpalan, 1981)
-the network of health facilities and personnel which carries
out the task of rendering health care to the people.
PHILIPPINE HEALTH CARE SYSTEM - is a complex set of
organizations interacting to provide an array of health
services (Dizon, 1977).

6. Health System Basics (WHO, 2007)

7. Health System Basics (WHO, 2007)
Health System (def.)
- Consists of all organization, people and
actions whose primary intent is to
restore or maintain health.
- Includes efforts to influence
determinants of health as well as more
direct health-improving activities
- It is MORE than the pyramid of publicly
owned facilities that deliver personal
services.
Guiding values and principles
- Values and goals enshrined in the Alma
Ata declaration
- WHO’s commitment to gender and
human rights.
- World Health Report of 2000

8. HEALTH SYSTEM (TINIO, 2008)
• A health system comprises all organizations, institutions and
resources devoted to producing actions whose primary intent is to
improve health.
• The four essential functions of a health system have been defined as:
service provision,
resource generation,
financing
stewardship

9. Health System Goals:
Overall Outcomes (World Health
Report 2000):
- Improving health and health
equity through ways that are: (1)
Responsive, (2) Financially fair, (3)
Best or most efficient use of
available resources
Intermediate Goals:
- Greater access to and coverage for
effective health interventions
- Provider quality and safety are not
compromised

10. HEALTH CARE SYSTEM MODELS (TINIO, 2008)
Private enterprise health care
Social security health model
Publicly funded health care model
Social health insurance

11. 1. PRIVATE ENTERPRISE HEALTH CARE MODEL
Purely private enterprise health care systems are comparatively rare.
When they exist, it is usually for a comparatively well-off
subpopulation in a poorer country with a poorer standard of health
care. for instance, private clinics for a small, wealthy expatriate
population in an otherwise poor country
But there are countries with a majority-private health care system
with residual public service

12. 2. SOCIAL SECURITY HEALTH MODEL
 Where workers and their families are insured by the state
 refers to social welfare service concerned with social protection, or
protection against socially recognized conditions, including poverty,
old age, disability, unemployment and others

13. Social security may refer to:
social insurance, where people receive benefits or services in
recognition of contributions to an insurance scheme. These services
typically include provision for retirement pensions, disability
insurance, survivor benefits and unemployment insurance.
income maintenance mainly the distribution of cash in the event of
interruption of employment, including retirement, disability and
unemployment
 services provided by administrations responsible for social security.
In different countries this may include medical care,
aspects of social work and even industrial relations.

14. 3. PUBLICLY FUNDED HEALTH CARE MODEL
Where the residents of the country are insured by the state
 Health care that is financed entirely or in majority part by
citizens' tax payments instead of through private payments
made to insurance companies or directly to health care
providers

15. 4. SOCIAL HEALTH INSURANCE
 where the whole population or most of the population is a
member of a sickness insurance company
 (SHI) is a method for financing health care costs through a
social insurance program based on the collection of funds
contributed by individuals, employers, and sometimes
government subsidies

16. characterized by the presence of sickness funds which
usually receive a proportional contribution of their
members' wages.
 With this insurance contributions these funds pay medical
costs of their members
 Affiliation to such funds is usually based on professional,
geographic, religious/political and/or non-partisan criteria

17. WHO Building block for Health

18. WHO Building block for Health
System building blocks  Access Coverage and Quality Safety
 Goals/Outcomes
System Building Blocks
1.Leadership/Governance
2.Health Care Financing
3.Health Workforce
4.Medical products,
technologies
5.Information and Research
6.Service Delivery
Goals/Outcomes
1.Improved health (level
and quality)
2.Responsiveness
3.Financial Risk Protection
4.Improved Efficiency

19. 1. LEADERSHIP AND GOVERNANCE
1.Leadership and Governance
Ensuring the existence of strategic
policy frameworks combined with:
- Effective oversight
- Coalition-building
- Provision of appropriate
regulations and incentives
- Attention to system design
- Accountability

20. Health Governance (stewardship)
context:
Wide range of functions carried out by
governments to:
- Improve population health while
ensuring: (1) Access to services, (2)
Quality of Services, (3) Patients’ rights
Examples:
- Administrative details
- Logistics and Operations
- Planning and Policy Making
- Monitoring and Evaluation

21. Governance:
Roles, responsibilities and
relationships (Interplay) of:
- Public sector
- Private sector
- AND Voluntary sectors (including
civil society)
In pursuit of national health goals
- Ensure clarity AND actualization of
health system vision-mission

22. In the Philippines

23. IN THE PHILIPPINES
Mandate (E.O. No. 119, Sec 3):
- The Department of Health (DOH) shall be responsible for the following: formulation
and development of national health policies, guidelines, standards and manual of
operations for health services and programs, issuances of rules and regulations,
licenses and accreditations; promulgation of national health standards, goals,
priorities and indicators; development of special health programs and projects and
advocacy for legislation on health policies and programs. The primary function of the
Department of Health is the promotion, protection, preservation or restoration of
the health of the people through the provision and delivery of health services and
through the regulation and encouragement of providers of health goods and
services.
- THE DOH IS THE LEAD AGENCY FOR PHILIPPINE HEALTH CARE.

24. VISION
Filipinos are among the healthiest people in Southeast Asia by 2022,
and Asia by 2040
MISSION
To lead the country in the development of a productive, resilient,
equitable and people-centered health system

25. Primary Goals of Health Sector
The primary goals of the health sector:
1.Better health outcomes: Attaining the best average
level of health care for the entire population and
attaining the smallest feasible differences in health
status among individuals and groups
2.More responsive health system: Meeting the
people’s expectations of how they should be
treated by health providers and the degree by
which people are satisfied with the health system
3.More equitable health care financing: Distributing
the risk that each individual faces due to cost of
health care according to ability to pay rather than
the risk of illness

26. DEVOLUTION
- RA 7160 (Local Government Code of
1991)
- The act by which the Philippine
Government “devolved” basic
services (health services, agriculture
extension, livelihood development,
forest management, barangay roads
and social welfare) to Local
Government Units (barangay,
municipality/city, province)

28. Implementation of Devolution in 1992:
Management and delivery of
health services
-From DOH to locally elected
provincial, city and municipal
governments
4 Essential Health System
Functions
-Service provision
-Resource generation
-Financing
-Stewardship

30. Devolution in ARMM:
•Retained
centralized
character of its
health system
•DOH ARMM
directly runs its
provincial and
municipal health
facilities
(hospitals, RHUs)
Interlocal Health Zones (ILHZs)
• Inspired by WHO District Health System
• Pseudo legal entities
• (Ideally) AN integrated health management and delivery
system based on defined administrative and geographical area
- District Hospital + surrounding/covered municipalities
• Usually composed of adjacent municipalities with similar health
needs
- Resource sharing
- Common health goals
- Mutual planning, policy formulations, health operations
implementation and monitoring and evaluation

31. Basic Organization

32. 2. Health/ Health Care Financing
• Good Health Financing
Two Main Characteristics
- Raises adequate funds for health to
ensure that people get to use needed
services
- People who use health services are
shielded from financial catastrophe or
impoverishment associated with having
to pay for them

33. Health and Health Care are major political and
economic issues
• Health financing impacts the analysis of:
- Health policies
- Fund sources
- Effectiveness and efficiency of health services for
populations
• Health Financing Goals:
- Raising sufficient funds for health
- Ensure adequate spending on health
- Effective allocation of finite financial resources to
different types of public and personal health services
- Pooling financial resources across population groups
and sharing financial risks
- Using funds for health efficiently and equitably
Main fund sources: Government Private
(OOP, HMOs, life insurance, etc.) Social
Health Insurance Others (grants, aid, etc.)
Current Health Expenditure by Health Care Financing Scheme: 2019
- Voluntary health care payment schemes (10.1%)
- Government schemes and compulsory contributory health care
financing schemes (42.0%)
- Household out-of-pocket payment (47.9%)

34. National Health Insurance Program

35. National Health Insurance Program
RA 7875
- National Health
Insurance Act of 1995
- Established the
Philippine Health
Insurance Corporation
(PHIC)
- More commonly
known as: PhilHealth
PhilHealth
• Employed Sector Program
- Compulsory average: ALL government AND private employees
• Individually Paying Program
- Voluntary coverage: self-employed and “others”
• Sponsored Programs
- Covers “poorest of the poor” (Quintiles 1 and 2)
• Overseas Filipino Workers
• Lifetime Member Program
- 60 y.o. and above who have completed 120 monthly
contributions (before)
- Senior Citizens automatically covered (2015)

36. DOH BUDGET 2020

37. 3. Health Workforce/ Human
Resources for Health (HRH)
Human resources for health (HRH)- people engaged
in actions whose primary intent is to enhance
health.
To achieve the best health outcomes possible:
- Sufficient numbers
- Right mix of staff
- System-wide deployment and distribution
(equitable)
- Established job-related norms
- Enabling work environments
- Just compensation/payment systems – right kind of
incentives

38. Population needs determine the
development and sustaining of health
workforce
 Education, training and continuing
competence
 Utilization, management and retention
 Strategic response to evolving unmet
health service needs
 Governance, leadership and partnerships
for sustained HRH contributions to
improved population outcomes
• Regulation
• Deployment
• Compensation
• Continuing career enhancement and
development

40. 4. Access to Medicines and Technologies

41. 4. Access to Medicines and Technologies
Supply-driven distribution scheme (PHAP 2008,
WHO 2011)
- Drugstores: 80.1%
- Hospitals: 9.7% (gov’t at 2.3%)
- Others: 10.2% (including government agencies at
0.3%)
Strong market orientation
Generics Act/Law since 1988 but compliance to it
is still an issue
Generally lax regulation with strong
pharmaceutical/nutritional company lobbying
influence (FDA lead agency)
Major Constraints in Accessing Essential
Drugs (DOH 2008)
- Limited availability
- Irrational use
- High costs
Effect of Devolution:
- LGUs left to budget for medicines
- Result: great variability among access
to such, particularly basic meds across
the country’s LGUs

42. Medical Technology and Devices

43. Medical Technology and Devices
Distribution of Medical Devices
- General radiography (basic X-ray) represents the most basic
equipment available across the country
- As of 2009, these devices totaled to 3860, 31% of which are found in
NCR
Effect of Devolution:
- LGUs left to budget for medical instruments, devices, equipment
- Result: great variability among access to such across the country’s
LGUs

44. 5. Health Information and Research

45. 5. Health Information and Research
Reliable and timely Health
Information Measures:
-Health determinants
-Health systems performance
-Health status
A good system is one where
Health Information is:
-Produced
-Analyzed
-Disseminated
-Used

46. Health information is a national asset
and used by many:
- policy-makers
- Planners
- Health care providers
- Development partners
- The general public
Uses:
- Track health system performance
- Support better health policies
- Make effective health-related
decisions

47. Health Information in the Philippines

48. Health Information in the Philippines
Poor integration and weak
governance of national and local
health information systems (Marcelo,
2002)
Telecom infrastructure mostly
concentrated in urban centers
Unclear considerations for the role
of IT in primary health care in the
Philippines
Lack of IT governance structures
(standards, etc.)
Existing DOH Information Gathering
Systems
- Allegedly computerized but still
highly reliant on outdated paper and
pen systems in the frontlines
- eFHSIS, PIDSR, SPEED, ClinicSys,
PhilHealth Dashboard

50. iClinicSys
- It is an electronic medical record and health information system that
supports the function of a primary health care facilities including
Rural Health Units (RHUs), Health Centers (HCs) and Barangay
Health Station (BHS)
- It aims to automate service delivery processes to efficiently and
effectively monitor patient care in the health facility.
- It also serves as the reference model for Electronic Medical Record
system in support of the Department of Health’s (DOH) national
health data

51. The National Telehealth Service Program
(NTSP), a joint project of the Department of
Health and the National Telehealth Center, is a
5-year program aimed at expanding
Telemedicine in 4th to 6th class municipalities
nationwide. NTSP facilitates consults between
primary care physicians in geographically
isolated and disadvantaged areas (GIDA) and
clinical specialists of the Philippine General
Hospital (PGH) using a mobile and internet-
based interface and triaging system.

52. 6. Health Service
Delivery

53. 6. Health Service Delivery
Pillars of the FOURmula
One Plus for Health
Health Service Delivery
Ensure the accessibility of essential quality
health products and services at appropriate
levels of care.
1.Increase access to quality essential health
products and services
2.Ensure equitable access to quality health
facilities
3.Ensure Equitable Distribution of human
resources for health
4.Engage Service Delivery Networks to deliver
comprehensive package of health services.
“We have to create innovative ways of
organizing Health Service Delivery to manage
new and emerging challenges brought about
by diseases of lifestyle and climate change.
We should focus on primary care and
wellness in communities that is stable across
all levels., with prevention and promotion
treated equally important as cure.”