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22 January 2019 | Manila, Philippines
Universal Health Care
The Philippine journey towards
accessing quality health services without financial hardship
Albert Francis Domingo, MD MSc
Consultant for Health Systems Strengthening
Office of the WHO Representative to the Philippines
Email: domingoa@who.int
22 January 2019 | Manila, Philippines
What is Universal Health Coverage/Care?
• All people having access to quality health services*
without suffering the financial hardship associated
with paying for care
– All people (population coverage)
– having access to quality health services (service coverage)
– without suffering financial hardship associated with paying
for care (financial risk protection)
*including prevention, promotion, treatment, rehabilitation and palliation
Senate Committees on Health and Demography, Ways and Means, and Finance
1 February 2018 | Cebu City, Philippines
Healthy population
Population at risk
Population with sickness
Sick that need
hospitalization
but have no
access to hospital
care
Sick
and
Hospitalized
People needing
rehabilitation
22 January 2019 | Manila, Philippines
The Continuum of Care
Health
Risk
exposure
Risk contact
Latent
disease/injury
Early
disease/
injury
Disease
progression
Advanced
disease/injury
Chronic
Disease or
impairment
Death
Primary Prevention:
Reduce risk exposure
Secondary
Prevention:
Detect
and intervene early
Tertiary Prevention:
Reduce progress or
complications of
established disease
ResourceGeneration,
Financing,Stewardship
Interventions
22 January 2019 | Manila, Philippines
(Berman, 2012)
W
HAT?
HOW
?
SO
THAT?
Across ALL conditions
22 January 2019 | Manila, Philippines
Building blocks of health systems (especially the
linkages) are areas for adjustment of policy
People-Centred Health Care Services
Health
workforce
Resource
generation and
health
financing
Essential
medicines,
commodities
and
technologies
Health
information
system
Good Governance
22 January 2019 | Manila, Philippines
UHC Index, etc.
Incentives
Regulatory Environment
Effective Services
What is your UHC road map?
22 January 2019 | Manila, Philippines
CORE CONSIDERATIONS FOR
THE PHILIPPINES
22 January 2019 | Manila, Philippines
What should be the roles and
responsibilities of the major institutions?
LGUs DOH PhilHealth
Private Sector Providers
22 January 2019 | Manila, Philippines
How can we reduce out of pocket payments?
55.7 54.8 54.2
16.0 17.9 17.4
7.8 9.0 10.0
7.1 6.8 7.1
7.8 5.3 5.4
2.5 2.8 2.4
1.3 1.8 …
0%
25%
50%
75%
100%
2014 2015 2016
ShareinHealthExpenditures
Financing Agents for Health Care Services (National Health Accounts)
Households PhilHealth DOH LGUs HMOs Other NGAs Private insurance GSIS, SSS
22 January 2019 | Manila, Philippines
Who does what to deliver health services?
State/government: per Sec. 17, RA 7160 – LGC; DOH standards
LGU Minimum Basic Health Services and Facilities
Barangay Health and social welfare services which include maintenance of
barangay health center and day-care center
Municipality Health services which include the implementation of programs and
projects on primary health care, maternal and child care, and
communicable and non-communicable disease control services,
access to secondary and tertiary health services; purchase of
medicines, medical supplies, and equipment needed to carry out
the services herein enumerated
Province health services which include hospitals and other tertiary health
services
City All the services and facilities of the municipality and province
Non-state: private facilities, regulated by the DOH (HFSRB, etc.)
22 January 2019 | Manila, Philippines
The mandate to consolidate
Local government units may group themselves, consolidate or
coordinate their efforts, services, and resources for purposes
commonly beneficial to them in accordance with law.
(Sec 13, Art X, 1987 Constitution)
The national government or the next higher level of local
government unit may provide or augment the basic services and
facilities assigned to a lower level of local government unit when
such services or facilities are not made available or, if made
available, are inadequate to meet the requirements of its
inhabitants.
(Sec 17f, Ch II, Title I, Book 1, Local Government Code)
22 January 2019 | Manila, Philippines
How can decentralization work for UHC?
• Need to clearly identify the role delineation between national
and local governments
• Need to consolidate local governments to reduce
inefficiencies and transactions cost in health: through referral
systems, pooling of resources, complementation with other
social services
• Need to adequately license, regulate, supervise and engage
private sector providers
• Need to support the devolution of powers and functions with
adequate financing (intergovernmental transfers)
• Need to institutionalize accountability mechanisms
1515
Service Delivery
Financing
Population
Private
Hospitals/Clinics
Pharmacies
Premium Payments
Taxes,
Including “Sin Tax”
Out of Pocket
Subsidy
Capitation
Primary
Health
Care
Referral/Secondary Care
Essential Drugs
DOH
Budget
Local
Government
Budget
DOH Referral
Hospitals
City Health Centers
Rural Health Units
Barangay Health Stations
Provincial Hospitals
District Hospitals
PHC, Secondary,
Referral CareReimbursement
Moving forward: how to integrate at PHC level?
22 January 2019 | Manila, Philippines
Philippines: Universal Health Care legislation
(Current Situation)
• The Philippines has long instituted a National Health
Insurance Program (PhilHealth) to be the preferred single
payer for healthcare services for patients
• Essential public health functions (e.g. health promotion,
disease surveillance, quarantine) are funded by line-item
government budgets
• Service delivery is through a dual system composed of the
public sector and a strong private sector
22 January 2019 | Manila, Philippines
The Philippines uses Universal Health Care interchangeably with Universal
Health Coverage.
It has been an iterative process of health reform, ongoing for almost 50 years
and under different names:
Year Name of policy Focus area Type of
issuance
1969 Philippine Medical Care Act (Medicare) Financing Statute
1991 Local Government Code (devolution) Governance Statute
1995 National Health Insurance Act (PhilHealth) Financing Statute
1999 Health Sector Reform Agenda Policy framework Regulation
2005 FOURmula ONE (F1) for Health Strategy Regulation
2011 Kalusugan Pangkalahatan (KP/UHC) Strategy Regulation
2012 Sin Tax Reform Act of 2012 Revenue generation Statute
2013 Amendments to PhilHealth law Financing Statute
2016 Philippine Health Agenda Policy framework Regulation
2018 FOURmula ONE Plus Strategy Regulation
22 January 2019 | Manila, Philippines
Legislative Process House of Representatives Senate
Preliminaries
Highlighted by the President during
State of the Nation Address 2018
Introduction and
referral of bills
30 Jun 2016 – first bill (HB 225)
26 Jul 2016 – referred to committee
16 May 2017 – first bill (SB 60)
17 May 2017 – referred to committee
Committee level
23 May 2017 – public hearing and
approval of substitute bill
30 May 2017 – committee report
2 Aug 2017 – first public hearing
Feb, Mar 2018 – nationwide public
hearings
30 Jul 2018 – committee report
Floor consideration
16, 22 Aug 2017 – sponsorship and
interpellation
22 Aug 2017 – approved on second reading
6 Sep 2017 – approved on third
reading: HB 5784
31 Jul 2018 – sponsorship
Aug, Sep 2018 – interpellation
9 Oct 2018 – approved on second reading
10 Oct 2018 – certified by the President for
immediate enactment
10 Oct 2018 – approved on third
reading: SB 1896
Bicameral Conference
Committee
Pre-bicam meetings: 23, 30 Oct 2018
Bicameral Conference Committee Report ratified: 10 December 2018
Presidential action Anticipated this Q1 2019
*With direct WHO technical assistance
22 January 2019 | Manila, Philippines
Philippines: Universal Health Care legislation
(Objectives)
• The UHC bill seeks to realize universal health coverage through a systemic
approach and clear delineation of the roles of key agencies and stakeholders
• The major reforms seek to:
– consolidate existing yet fragmented financial flows
– increase the fiscal space for benefit delivery
– improve the governance and performance of devolved local health systems
– institutionalize support mechanisms such as health technology assessment
and health promotion
22 January 2019 | Manila, Philippines
22 January 2019 | Manila, Philippines
Challenges and Opportunities
• Expectations have to be managed, especially because of the upcoming
midterm elections
• Complementary bills to increase tobacco excise taxes and provide more
funds for UHC are still pending
• There are varied perspectives on the major reforms; strategic
communication is needed
• After the bill becomes law, next opportunity is to support drafting of
implementing rules and regulations
22 January 2019 | Manila, Philippines
Salient points of the UHC law
• (see Word file of the UHC law)
22 January 2019 | Manila, PhilippinesHEALTH AND THE ENVIRONMENT
Division of Noncommunicable Diseases and Health through the Lifecourse
Albert Francis Domingo, MD MSc
Email: domingoa@who.int

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Universal Health Care

  • 1. 22 January 2019 | Manila, Philippines Universal Health Care The Philippine journey towards accessing quality health services without financial hardship Albert Francis Domingo, MD MSc Consultant for Health Systems Strengthening Office of the WHO Representative to the Philippines Email: domingoa@who.int
  • 2. 22 January 2019 | Manila, Philippines What is Universal Health Coverage/Care? • All people having access to quality health services* without suffering the financial hardship associated with paying for care – All people (population coverage) – having access to quality health services (service coverage) – without suffering financial hardship associated with paying for care (financial risk protection) *including prevention, promotion, treatment, rehabilitation and palliation
  • 3. Senate Committees on Health and Demography, Ways and Means, and Finance 1 February 2018 | Cebu City, Philippines Healthy population Population at risk Population with sickness Sick that need hospitalization but have no access to hospital care Sick and Hospitalized People needing rehabilitation
  • 4. 22 January 2019 | Manila, Philippines The Continuum of Care Health Risk exposure Risk contact Latent disease/injury Early disease/ injury Disease progression Advanced disease/injury Chronic Disease or impairment Death Primary Prevention: Reduce risk exposure Secondary Prevention: Detect and intervene early Tertiary Prevention: Reduce progress or complications of established disease ResourceGeneration, Financing,Stewardship Interventions
  • 5. 22 January 2019 | Manila, Philippines (Berman, 2012)
  • 7. 22 January 2019 | Manila, Philippines Building blocks of health systems (especially the linkages) are areas for adjustment of policy People-Centred Health Care Services Health workforce Resource generation and health financing Essential medicines, commodities and technologies Health information system Good Governance
  • 8. 22 January 2019 | Manila, Philippines UHC Index, etc. Incentives Regulatory Environment Effective Services What is your UHC road map?
  • 9. 22 January 2019 | Manila, Philippines CORE CONSIDERATIONS FOR THE PHILIPPINES
  • 10. 22 January 2019 | Manila, Philippines What should be the roles and responsibilities of the major institutions? LGUs DOH PhilHealth Private Sector Providers
  • 11. 22 January 2019 | Manila, Philippines How can we reduce out of pocket payments? 55.7 54.8 54.2 16.0 17.9 17.4 7.8 9.0 10.0 7.1 6.8 7.1 7.8 5.3 5.4 2.5 2.8 2.4 1.3 1.8 … 0% 25% 50% 75% 100% 2014 2015 2016 ShareinHealthExpenditures Financing Agents for Health Care Services (National Health Accounts) Households PhilHealth DOH LGUs HMOs Other NGAs Private insurance GSIS, SSS
  • 12. 22 January 2019 | Manila, Philippines Who does what to deliver health services? State/government: per Sec. 17, RA 7160 – LGC; DOH standards LGU Minimum Basic Health Services and Facilities Barangay Health and social welfare services which include maintenance of barangay health center and day-care center Municipality Health services which include the implementation of programs and projects on primary health care, maternal and child care, and communicable and non-communicable disease control services, access to secondary and tertiary health services; purchase of medicines, medical supplies, and equipment needed to carry out the services herein enumerated Province health services which include hospitals and other tertiary health services City All the services and facilities of the municipality and province Non-state: private facilities, regulated by the DOH (HFSRB, etc.)
  • 13. 22 January 2019 | Manila, Philippines The mandate to consolidate Local government units may group themselves, consolidate or coordinate their efforts, services, and resources for purposes commonly beneficial to them in accordance with law. (Sec 13, Art X, 1987 Constitution) The national government or the next higher level of local government unit may provide or augment the basic services and facilities assigned to a lower level of local government unit when such services or facilities are not made available or, if made available, are inadequate to meet the requirements of its inhabitants. (Sec 17f, Ch II, Title I, Book 1, Local Government Code)
  • 14. 22 January 2019 | Manila, Philippines How can decentralization work for UHC? • Need to clearly identify the role delineation between national and local governments • Need to consolidate local governments to reduce inefficiencies and transactions cost in health: through referral systems, pooling of resources, complementation with other social services • Need to adequately license, regulate, supervise and engage private sector providers • Need to support the devolution of powers and functions with adequate financing (intergovernmental transfers) • Need to institutionalize accountability mechanisms
  • 15. 1515 Service Delivery Financing Population Private Hospitals/Clinics Pharmacies Premium Payments Taxes, Including “Sin Tax” Out of Pocket Subsidy Capitation Primary Health Care Referral/Secondary Care Essential Drugs DOH Budget Local Government Budget DOH Referral Hospitals City Health Centers Rural Health Units Barangay Health Stations Provincial Hospitals District Hospitals PHC, Secondary, Referral CareReimbursement Moving forward: how to integrate at PHC level?
  • 16. 22 January 2019 | Manila, Philippines Philippines: Universal Health Care legislation (Current Situation) • The Philippines has long instituted a National Health Insurance Program (PhilHealth) to be the preferred single payer for healthcare services for patients • Essential public health functions (e.g. health promotion, disease surveillance, quarantine) are funded by line-item government budgets • Service delivery is through a dual system composed of the public sector and a strong private sector
  • 17. 22 January 2019 | Manila, Philippines The Philippines uses Universal Health Care interchangeably with Universal Health Coverage. It has been an iterative process of health reform, ongoing for almost 50 years and under different names: Year Name of policy Focus area Type of issuance 1969 Philippine Medical Care Act (Medicare) Financing Statute 1991 Local Government Code (devolution) Governance Statute 1995 National Health Insurance Act (PhilHealth) Financing Statute 1999 Health Sector Reform Agenda Policy framework Regulation 2005 FOURmula ONE (F1) for Health Strategy Regulation 2011 Kalusugan Pangkalahatan (KP/UHC) Strategy Regulation 2012 Sin Tax Reform Act of 2012 Revenue generation Statute 2013 Amendments to PhilHealth law Financing Statute 2016 Philippine Health Agenda Policy framework Regulation 2018 FOURmula ONE Plus Strategy Regulation
  • 18. 22 January 2019 | Manila, Philippines Legislative Process House of Representatives Senate Preliminaries Highlighted by the President during State of the Nation Address 2018 Introduction and referral of bills 30 Jun 2016 – first bill (HB 225) 26 Jul 2016 – referred to committee 16 May 2017 – first bill (SB 60) 17 May 2017 – referred to committee Committee level 23 May 2017 – public hearing and approval of substitute bill 30 May 2017 – committee report 2 Aug 2017 – first public hearing Feb, Mar 2018 – nationwide public hearings 30 Jul 2018 – committee report Floor consideration 16, 22 Aug 2017 – sponsorship and interpellation 22 Aug 2017 – approved on second reading 6 Sep 2017 – approved on third reading: HB 5784 31 Jul 2018 – sponsorship Aug, Sep 2018 – interpellation 9 Oct 2018 – approved on second reading 10 Oct 2018 – certified by the President for immediate enactment 10 Oct 2018 – approved on third reading: SB 1896 Bicameral Conference Committee Pre-bicam meetings: 23, 30 Oct 2018 Bicameral Conference Committee Report ratified: 10 December 2018 Presidential action Anticipated this Q1 2019 *With direct WHO technical assistance
  • 19. 22 January 2019 | Manila, Philippines Philippines: Universal Health Care legislation (Objectives) • The UHC bill seeks to realize universal health coverage through a systemic approach and clear delineation of the roles of key agencies and stakeholders • The major reforms seek to: – consolidate existing yet fragmented financial flows – increase the fiscal space for benefit delivery – improve the governance and performance of devolved local health systems – institutionalize support mechanisms such as health technology assessment and health promotion
  • 20. 22 January 2019 | Manila, Philippines
  • 21. 22 January 2019 | Manila, Philippines Challenges and Opportunities • Expectations have to be managed, especially because of the upcoming midterm elections • Complementary bills to increase tobacco excise taxes and provide more funds for UHC are still pending • There are varied perspectives on the major reforms; strategic communication is needed • After the bill becomes law, next opportunity is to support drafting of implementing rules and regulations
  • 22. 22 January 2019 | Manila, Philippines Salient points of the UHC law • (see Word file of the UHC law)
  • 23. 22 January 2019 | Manila, PhilippinesHEALTH AND THE ENVIRONMENT Division of Noncommunicable Diseases and Health through the Lifecourse Albert Francis Domingo, MD MSc Email: domingoa@who.int