By Dr.

Alberto Romualdez
Dean, Graduate School of Health Sciences Pamantasan ng Lungsod ng Maynila

Overall health status – Lower than
Thailand, Malaysia, Japan and Korea
 The 70 years average life expectancy at birth is more than 15 years shorter than those of developed countries.
 The infant mortality rate of about 35 per thousand live births translates into 80,000 Filipino babies dying of preventable causes each year  Maternal mortality ratio that has remained well above 150 per 100,000 live births – meaning more than 3,000 Filipinas dying unnecessarily every year.

LEB under 60 years IMRover 90 MM over 150

LEB over 80 years IMRless than 10 MM less than 15

Inequity in Health Outcomes
Average Fertility Rate by Income Quintiles

Income Group

Average Fertility Rate (Desired)


2.0 (1.9) 2.4
3.7 4.7 5.6 (3.1)

Organization of Health Services
 Public- Private Sector imbalance  Highly resourced private sector servicing 20-30 % of population  Health promotion/Disease prevention lag behind Curative Service provision  Fragmentation of Services  Overspecialization of curative services (private sector cherry-picking of lucrative specialties)  Devolution of health services - national and local  Weak regulatory mechanisms

Result: Inequitable Access to Health Services
 Less than 50% of poor women get vitamin supplements compared to 80% of high income women  2% of lowest quintile women and 20% of highest quintile have caesarean sections

 Less than 50% of children from lowest quintile homes compared to 80% from highest quintile are immunized
 Each year, less than 5% of the estimated 3000 new Filipino end-stage renal disease cases can have kidney transplants

Healthcare worker distribution • 70% of ALL health workers employed in the
private sector serving 30% of the population

• 30% employed in government services
catering to the majority…
– …of whom many are also engaged in the private sector licitly or illicitly

Output of a Flawed System
• Health providers for whom service is a lower priority than personal professional advancement.
• They are ill-prepared for dealing with health problems in the Philippine setting.

Health Care Financing
 Total Health Expenditure (2005) PHP 200 billion

 % of GNP  % of GNP per WHO

<3% >5%

Only those with money (i.e., the rich) can fully pay for out of pocket payments and often they have generous health insurance
The near-poor and the lower middle classes can become impoverished to meet out of pocket payments for health care.

The very poor don’t even have pockets

Top Ten Hospitals (PhilHealth Claims) 2006
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. The Medical City St. Luke’s Medical Center Chong Hua Hospital Chinese General Hospital Dr. Pablo O. Torre, Sr. Memorial Hospital Makati Medical Center Davao Medical Center* Davao Doctors’ Hospital Cebu Doctors’ Hospital Perpetual Succour Hospital

* - The only government hospital on the list

Recommended Reforms for Universal Health Care
 Information System – Create a national council

mandated to craft a health information education-communication master plan that is designed to maximize the use of information technology for health service delivery.
 Regulation - Regulatory functions of DOH and

local governments should be further strengthened to promote the double objectives of health sector reform -- equity and efficacy .

Recommended Reforms for Universal Health Care
 Governance – DOH should effectively wield its influence on the different health sector actors – government, private and nongovernment – towards universal access.  Organization of Services - Government facilities should be reorganized and integrated in accordance with the principles of primary health care based on an updated version of the Alma Ata Declaration. They should provide integrated health services either directly or through a unified and formalized referral system.

Recommended Reforms for Universal Health Care
 Human Resources for Health - Restructure health

workforce production system to emphasize service over self-interest by integration of regulation under DOH.

 Health Care Financing - Quantum increase in tax-based

coordinated government spending and reorientation of Philhealth as a true social health insurance program that maximally spends its health fund on benefits to fully support the health requirements of all Filipinos.

It is time to elevate the level of

politicization of health from that of parochial self-interests and petty patronage to a national issue of common concern.

End of Presentation



Cost of medicines and other health supplies
 The prices of medicines in the Philippines are among the highest in the world – higher than Europe and America and most of Asia and certainly too high in relation to household incomes of most Filipinos. Given the high prices, most medicines are beyond the paying capacity of most Filipinos.

Number of day’s wages needed to purchase a 30 days treatment with Ranitidine

- Philippines, 30 days - Sri Lanka, 10 days

- Brazil, 10 days - South Africa, 5 days

Average 4-week Medicine Expenditures within Household Expenditure Quintiles
Result: Poor families cannot afford to pay for medicines
Medicine Expenditures in Last 4 Weeks by Quintiles
$153 $88

$40 $30 $20 $10 $0
Ghana Cote Senegal Tunisia d'Ivoire Morocco Pakistan India Philippines

Quintile 1

Quintile 2

Quintile 3

Quintile 4

Quintile 5

Source: WHO, World Health Survey, 2002

Characteristics of Reforms for Universal Health Care
 Coordination  Integration

 Regulation
 Participation