The Philippines Health System Review - WHO Western Pacific ...

More documents

Recommendations

Info

Executive SummaryThe Health Systems in Transition (HiT) profiles are country-based reportsthat provide a detailed description of a health system and of policyinitiatives in progress or under development. HiTS examine differentapproaches to the organization, financing and delivery of health servicesand the role of the main actors in health systems; describe the institutionalframework, process, content and implementation of health and health carepolicies; and highlight challenges and areas that require more in-depthanalysis.Section 1 introduces the country, its people and the political context, andbriefly describes trends in health status. The Philippines is an archipelagoof 7107 islands, subdivided into 17 administrative regions. A low middleincomecountry, its economy has not kept pace with its ‘Asian Tiger’neighbours, and the benefits of growth have been inequitably distributed:average annual family income is as high as US$ 6058 in the NationalCapital Region (where Manila is located), while families in the poorestregions earn less than a third of this amount.One break on the economy is the high population growth rate of 2% peryear; the total population now stands at 94 million. Driving this is a highfertility rate of three children per woman. This average masks considerableinequalities between income groups, with the poorest women having onaverage almost six children, and the richest less than two.The Philippines experienced dramatic improvements in levels of child andmaternal mortality and communicable disease control during the secondhalf of the twentieth century. However, gains have slowed in recent years,in part due to the poor health status of those on low-income and living inless developed regions of the country. Life expectancy in richer provinces ismore than 10 years longer than in poorer ones.Section 2 summarizes the organization and governance of the healthsystem, including the underpinning governance and regulations. Under thecurrent decentralized structure, the Department of Health (DOH) serves asxviii
the principle governing agency of the health system, mandated to providenational policy direction and develop national plans, technical standardsand guidelines on health.Decentralisation was first introduced in 1991, when Local GovernmentUnits were granted autonomy and responsibility for their own healthservices, and provincial governments given responsibility for secondaryhospital care. Initially, the quality of services deteriorated due to lowmanagement capacity and lack of resources. A health sector reformprogramme introduced in 2005 helped to address some of theseissues and improve overall health sector performance. It focused onexpanding public and preventative health programmes and access tobasic and essential health services in underserved locations. However,the involvement of three different levels of government in the threedifferent levels of health care has created fragmentation in the overallmanagement of the system. Local and provincial authorities retainconsiderable autonomy in their interpretation of central policy directions,and provision of the health services is often subject to local politicalinfluence. As a result, the quality of health care varies considerablyacross the country.Section 3 describes the financing of the health sector in the Philippines;it includes an overview of the system, levels of spending, sources offinancing and payment mechanisms. It finds that total health expenditureper capita has grown slowly in real terms: by 2.1% per year between1995 and 2005. Total health spending now stands at 3.9% of GDP – lowcompared to the Western Pacific regional average of 6.1%.The major health financing concern in the Philippines is the high levelof out-of-pocket payments, which account for 48% of total healthexpenditure. The Philippines has a national health insurance agency– PhilHealth – however the level of financial protection it provides islimited as patients are often liable for substantial copayments. In 2010,the newly-elected government launched a major reform effort aimed atachieving ‘universal coverage’ which focused on increasing the numberof poor families enrolled in PhilHealth, providing a more comprehensivebenefits package and reducing or eliminating co-payments. So far theresults are promising. As of April 2011 almost 4.4 million new poorfamilies had been enrolled in PhilHealth, equivalent to a 100 per centincrease in enrolment for the real poor. In 2011, PhilHealth introduced ano-balanced-billing policy for these sponsored households.xix
Page 1: Health Systems in TransitionVol. 1
Page 5 and 6: ContentsPreface....................
Page 7 and 8: List of TablesTable 1-1 Population/
Page 9 and 10: Figure 4-2 Number of beds in govern
Page 11 and 12: A standardized profile has certain
Page 13 and 14: Peer Reviewers on behalf of the Asi
Page 15 and 16: CPRDALEDBMDHSDILGDODOFDOHDOLEDOSTDT
Page 17 and 18: OOPOut-of-pocketOPBOutpatient Benef
Page 19: AbstractHealth status has improved
Page 23 and 24: Hospital admissions data from PhilH
Page 25 and 26: 1. Introduction1.1 Geography and So
Page 27 and 28: Indicator 1970 1980 1990 2000 2005
Page 29 and 30: Table 1-2 Economic indicators, 1970
Page 31 and 32: Women tend to live longer than men
Page 33 and 34: Rate per 100 000 population (Rank)R
Page 35 and 36: Table 1-7 Maternal and child health
Page 37 and 38: 2. Organization and Governance2.1 S
Page 39 and 40: Rural Health Act, which transformed
Page 41 and 42: that supplement PhilHealth coverage
Page 43 and 44: plan, covering all government emplo
Page 45 and 46: The DOH has attempted to address th
Page 47 and 48: 2.7 Regulation2.7.1 Overview and hi
Page 49 and 50: through the institutionalization of
Page 51 and 52: Figure 2-3 Nursing Licensure Examin
Page 53 and 54: epresent another level of regulatio
Page 55 and 56: The law stresses the need for a hig
Page 57: coverage of the population vary, th
Page 60 and 61: Figure 3-1Health expenditure as a s
Page 62 and 63: Figure 3-2Financial FlowsOut-of-poc
Page 64 and 65: the results are promising. As of Ap
Page 66 and 67: Table 3-6 PhilHealth Special Benefi
Page 68 and 69: Taxes or contributions pooled by a
Page 70 and 71:
Table 3-8 Allotments, obligations &
Page 72 and 73:
LGUs procure all commodities throug
Page 74 and 75:
payment of salaries and other allow
Page 76 and 77:
Accreditation contracts are renewed
Page 78 and 79:
3.6 Voluntary Health InsuranceBased
Page 80 and 81:
pricing in local hospitals, observe
Page 82 and 83:
4. Physical and Human Resources4.1
Page 84 and 85:
Figure 4-1 Number of government and
Page 86 and 87:
Table 4-2 Beds in government and pr
Page 88 and 89:
Table 4-4 Patient care utilization
Page 90 and 91:
Figure 4-3DOH total appropriations
Page 92 and 93:
4.2.3 Medical Equipment, Devices an
Page 94 and 95:
attempted to document the number of
Page 96 and 97:
Health Worker DistributionSince dat
Page 98 and 99:
(Figure 4-6). As for the nurse-to-p
Page 100 and 101:
Figure 4-9 Ratio of pharmacists per
Page 102 and 103:
of 2002. While CNS is essentially a
Page 104 and 105:
To manage migration flows of health
Page 106 and 107:
5.2 Public HealthImproving access t
Page 108 and 109:
• The prevention of cardiovascula
Page 110 and 111:
Private sector health professionals
Page 112 and 113:
Access to essential drugs is constr
Page 114 and 115:
5.9 Palliative CareIn 1991, the Phi
Page 116 and 117:
5.12 Alternative/Complementary Medi
Page 118 and 119:
drug stores. Later in 2009, the DOH
Page 120 and 121:
Year Reform Brief description2005 F
Page 122 and 123:
health care approach of putting hea
Page 124 and 125:
asic health packages. To this end,
Page 126 and 127:
The Generics Act of 1988 aims to pr
Page 128 and 129:
know the generics of oral/suspensio
Page 130 and 131:
As a result of these strategies, th
Page 132 and 133:
Improvements in the delivery of key
Page 134 and 135:
7.4 Allocative and Technical Effici
Page 136 and 137:
8. ConclusionsAs measured by standa
Page 138 and 139:
Further elaboration of the Human re
Page 140 and 141:
De Rosas-Valera M (2009). Health te
Page 142 and 143:
Gonzaga E, Navarra D (2004). The Re
Page 144 and 145:
National Statistics Office (2006).
Page 146 and 147:
Taguiwalo M (2004). Strategy for Lo
Page 148 and 149:
9.2 Useful websitesAvailable in Eng
Page 150 and 151:
The World Bankhttp://www.worldbank.
Page 152 and 153:
Jennifer Frances E. dela Rosa is a
Page 155:
The Asia Pacific Observatory on Hea
show all

The Philippines Health System Review - WHO Western Pacific ...

Create successful ePaper yourself

Delete template?

Save as template?