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Name of School
LESSON II
Lesson 1

HEALTH SYSTEM
1.1 Definition of Vision,
Mission, Goals and
Objectives
1.2 Comparison of Vision
and Mission
1.3 Purpose and Inclusion
of Vision and Mission
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 DEFINITION OF HEALTH CARE SYSTEM

Health system is “the combination of resources, organization, financing, and

Emil Gatus that culminate in the delivery of health services to the population” (Roemer,
management
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1991). This system consists of many parts such as the community, department or ministries of
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health, health care providers, health service organizations, pharmaceutical companies, health
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1.1financing bodies, and other organizations related to the health sector. Each plays a role in the
Definition of Vision,
system
Mission, Goalssuch
and as governance, health service provision, and financing and managing resources.
Objectives
1.2 Comparison of Vision
and Mission In the World Health Organization
(WHO) Report (2000), health system is defined as
1.3 Purpose and Inclusion
“all the
of Vision organizations, institutions, resources,
and Mission and people whose primary purpose is to improve
health.”
Lesson 2 Thus, a well-performing health system provides direct health-improving activities
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whether
Lesson 4 in personal health care, public health services, or intersectoral initiatives, to achieve
high health equity.
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 GOALS AND FUNCTIONS OF A HEALTH SYSTEM

WHO identifies three (3) main goals of health systems:

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(1) Improving
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Lesson 1 Improving health of the population is the overarching goal of a health system.
1.1 Definition of Vision,
Health
Mission, Goalsstatus
and should thus be measured over the entire population and across different
socioeconomic groups. Populations must be protected from existing and emerging health risks.
Objectives
1.2 Comparison of Vision
andIntensive
Mission preparations for resilience to impending but still unknown health risks must be
1.3 Purpose and Inclusion
executed
of Vision to ensure the safety of populations. Health systems should strive for equity in health
and Mission
by 2minimizing inequitable disparities which may be caused by certain factors such as income,
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ethnicity,
Lesson 3 occupation, gender, geographic location, and sexual orientation, among others. There
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are5 significant variations in health outcomes across the world, within regions, and within
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countries.
Lesson 7 Countries and regions with relatively similar socioeconomic status may have quite
disparate
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These
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becomes
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 (2) Improving the responsiveness of the health system

Responsiveness refers to providing satisfactory health services and engaging people

as active partners. It embodies the values of respectfulness, dignity, confidentiality, autonomy,
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quality,Number
Student and timeliness in the delivery of health services. Health systems also have an obligation
to respond
Name of School to the legitimate non-health needs and expectations of populations. Responsive
health
Lesson 1 systems maximize people’s autonomy and control, allowing them to make choices and
1.1placing them
Definition of Vision,at the center of the health system.
Mission, Goals and
Objectives
1.2(3) Providing
Comparison of Visionfair health financing
and Mission
1.3 Purpose and Inclusion
An ideal health system provides social and financial risk protection in health. Thus, all
of Vision and Mission

health systems must be adequately funded to provide essential services to all citizens. WHO
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defines
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needed
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pays approximately the same percentage of their income for needed services. A health
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financing
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individuals
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 There are 4 vital health system functions are:

(1) Health service provision

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The most visible product of the health system is public and private health service
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provision.
Name A health service is any service, not limited to clinical services, aimed at improving the
of School
health
Lesson 1 of populations. Preventive measures as well as promotion of a healthy way of living to
1.1 Definition of Vision,
avoid
Mission, illnesses
Goals and also form part of the best systems. Thus, the system has to perform a wide range
of activities to cater to these various demands.
Objectives
1.2 Comparison of Vision
and Mission
1.3 Purpose and Inclusion
(2) Health
of Vision and Missionservice inputs
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Lesson 3 Health service inputs, or managing resources, means generating the essential
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physical
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resources,
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supply
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have
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 (3) Stewardship

Stewardship, or the overall system oversight, is the main responsibility of the

government.
Emil Gatus This function sets the direction, context, and policy framework for the overall
health system.
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1.1The coreof of
Definition the stewardship function includes:
Vision,
Mission, Goals and
Objectives
a. Identifying
1.2 Comparison of Vision health priorities for allocation of public resources;
and Mission
1.3 Purpose and Inclusion
b.Mission
of Vision and Identifying an institutional framework;
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Lesson 3 c. Coordinating activities with other systems related to external health care;
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Lesson 6 d. Analyzing health priorities and resource generation trends and their implications; and
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e. Generating appropriate data for effective decision-making and policymaking on health
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 (4) Health financing

Health system financing includes raising and pooling resources to pay for health
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services.
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A. Revenue collection
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1.1 Definition of Vision,
Mission, Goals andRevenue is earned from payments for health care services. The mechanisms for
revenue collection include general taxation,
Objectives
1.2 Comparison of Vision
direct household out-of-pocket expenditures,
andmandatory
Mission payroll contributions, mandatory or voluntary risk-rated contributions, donor
1.3 Purpose and Inclusion
financing,
of Vision and other forms of personal savings.
and Mission
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Lesson 3 Each source of health financing is associated with a specific manner of organizing
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and5 pooling of funds and purchasing services. Public health systems rely on general taxation for
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its financing, while social security organizations are funded through the mandatory payroll
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contributions
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 B. Risk pooling

Financial risk pooling is a form of risk management which aims to spread financial
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risks Gatus an individual to all pool members (WHO, 2000). It is considered a core function of
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health insurance companies. This mechanism prevents outright payment for health services
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which discourages patients belonging to the poor sector from seeking health care. Participation
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1.1in effective
Definition risk pooling helps families from financial losses due to health shocks, thus ensuring
of Vision,
financial
Mission, protection.
Goals and
Objectives
1.2 Comparison of Vision
and Mission Each country has
its own approach to managing its financial risk to finance its health
1.3 Purpose and Inclusion
care and
of Vision system.
Mission Multiple and
fragmented forms of risk pooling arrangements exist in most
developing
Lesson 2 countries. Most high-income countries follow one of the two main models: the
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Bismarck
Lesson 4 model and the Beveridge model.
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 BISMARCK MODEL (Bismarck’s Law on Health Insurance of 1883)

This model is named after the Prussian Chancellor, Otto von Bismarck, known for
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inventing the welfare state in the 19th century as part of the unification of Germany. The
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Bismarck model uses an insurance system where the sickness fund finances both the employers
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and the employees through payroll deduction. But unlike the U.S. insurance industry, the
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1.1Bismarck-type
Definition of Vision, health insurance plan covers everybody, thus collecting no profit. This is
considered
Mission, Goals and a multi-payer model with tight regulation giving the government the cost-control
Objectives
1.2clout. Thisof Vision
Comparison model is widely used in Germany, France, Belgium, Netherlands, Japan, Switzerland,
and Mission
1.3and, toand
Purpose a degree,
Inclusion in Latin America.
of Vision and Mission
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 BEVERIDGE MODEL (Beveridge Report or theSocial Insurance and Allied Services of 1942)

This model is named after William Beveridge, the social reformer responsible for
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designing Britain’s Social Security System and the National Health Service. In the Beveridge
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model, health care is provided and funded by the government through tax payments. The
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government owns many, but not all, hospitals and clinics in the country. Doctors may be
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1.1government or private employees who collect their professional fees from the government. This
Definition of Vision,
results
Mission, Goalsinandlow cost per capita since the government controls the health care services. Countries
Objectives
1.2using theofBeveridge
Comparison Vision plan include Hong Kong, Great Britain, Spain, most of Scandinavia, New
and Mission
1.3Zealand,
Purpose andand Cuba. The Cuban government, for instance, uses total government control.
Inclusion
of Vision and Mission
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 C. Strategic purchasing

In strategic purchasing, risk-pooling organizations use collected funds and pooled

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financial resources to finance the health care services of the members. The purchaser defines
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the substantial part of the provider's external incentives to develop the provider-user
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interaction and the health service delivery models.
Lesson 1
1.1 Definition of Vision,
Mission, Goals and
Objectives
1.2 Comparison of Vision
and Mission
1.3 Purpose and Inclusion
of Vision and Mission
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 WHO HEALTH SYSTEM FRAMEWORK

In its World Health Report 2000, WHO released a single framework (Figure 2.1) with
six clearly defined building blocks and priorities which are necessary in strengthening health
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systemsNumber
Student and improving the overall health outcomes.
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Lesson 1
1.1 Definition of Vision,
Mission, Goals and
Objectives
1.2 Comparison of Vision
and Mission
1.3 Purpose and Inclusion
of Vision and Mission
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Lesson 11 Figure 2. 1 The WHO Health Systems Framework
Lesson 12 (Figure by World Health Organizaion (2007), licensed under CC BY-SA 4.0
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 One building block is service delivery which refers to the timely delivery of quality
and cost-effective personal and non-personal health services. Another is health workforce
which includes individuals and groups working towards the achievement of the best health
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outcomes by being responsive, fair, and efficient. The number of staff should be sufficient and
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fairly distributed
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information system) which analyzes, disseminates, and uses reliable and relevant information
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1.1on health
Definition status, determinants, and systems performance is also a valuable building block.
of Vision,
Mission, Goals and
Another important building block is that of health products, vaccines and technologies
Objectives
1.2which
Comparisonare made accessible through uninterrupted supply, well-managed pharmaceutical
of Vision
and Mission
1.3services,
Purpose andand education on proper use of medication. Financing (health financing system) is a
Inclusion
of Vision and Mission
building block which takes care of the funding for health care services to guarantee that people
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can3 use health services when needed without fear of having not enough resources to pay for
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them.
Lesson 4 Lastly, leadership and governance involves the task of ensuring effective stewardship of
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the6entire health system. This building block also covers the monitoring of the accountability of
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private
Lesson 8 and public health agencies, proper system design, and appropriate regulation of health
systems.
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 PHILIPPINE HEALTH SYSTEM

Historical Background
Emil GatusThe health reform initiatives carried out over the years in the Philippines were
primarily
Student focused on these areas of concern: health service delivery, health regulation, and
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healthoffinancing.
Name School These health reforms aimed at addressing issues such as poor accessibility,
inequity,
Lesson 1 and inefficiency of the Philippine health system.
1.1 Definition of Vision,
1. 1979: Adoption of Primary Health Care Strategy (LOI 949) – promoted participatory
Mission, Goals and
Objectives
management
1.2 Comparison of Vision of the local health care system
and Mission
2. 1982:
1.3 Purpose Reorganization of DOH (EO 851) – integrated the components of health care
and Inclusion
of Vision anddelivery
Mission into its field operations
Lesson 23. 1988: The Generics Act (RA 6675) – ushered the writing of prescriptions using the
Lesson 3
Lesson 4 generic name of the drug
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4. 1991: Local Government Code (RA 7160) – transferred the responsibility of providing
Lesson 7 health service to the local government units
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Lesson 95. 1995: National Health Insurance Act (RA 7875) – instituted a national health insurance
Lesson 10 mechanism for financial protection with priority given to the poor
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 6. 1999: Health Sector Reform Agenda– ordered the major organizational restructuring of
the DOH to improve the way health care is delivered, regulated, and financed
7. 2005: FOURmula One (F1) for Health – adopted an operational framework to undertake
reforms with speed, precision, and effective coordination and to improve the Philippine
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Student health
Number system
Name
8. of SchoolUniversally Accessible Cheaper and Quality Medicines Act (RA 9502) –
2008:
Lesson 1 promoted and ensured access to affordable quality drugs and medicines for all
1.1 Definition of Vision,
Mission,9. 2010:
Goals and Kalusugang Pangkalahatan or Universal Health Care (AO 2010-0036) –
Objectives provided universal health coverage and access to quality health care for all Filipinos
1.2 Comparison of Vision
and Mission
1.3 Purpose and Inclusion
of Vision and Mission
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 Leadership and Governance

The Department of Health (DOH) is mandated to provide the appropriate direction

forEmil
theGatus
nation’s healthcare industry. Its other tasks include (1) the development of plans,
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guidelines and standards for the health sector; (2) technical assistance; (3) capacity building; (4)
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advisory services for disease prevention; and (5) control of medical supplies and vaccines.
Lesson 1
1.1 Definition of Vision,
Mission, Goals andDOH coordinates its national health programs through the local government units
Objectives
1.2(LGUs).
Comparison LGUs take care of their own health services and are given autonomy under the Local
of Vision
andGovernment
Mission Code (LGC) of 1991 (R.A. 7160). 78 provincial governors, 138 city mayors and 1496
1.3 Purpose and Inclusion
municipal
of Vision mayors, and 42,025 barangay chairpersons compose the local government units of
and Mission

the2country
Lesson (NSCB, 2010).
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 In terms of administration, LGUs are grouped into 17 regions. Although they operate
in a decentralized system, LGUs are under the supervision of the DOH regional health offices.
The provincial government is tasked to provide health services through provincial and district
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hospitals. The city and municipal governments rely on public health and primary health care
Student Number
centers
Name of (BHCs)
School for their primary care. (For a detailed organizational structure of the Philippine
health sector, see The Philippines Health System Review (2011) published in Health System in
Lesson 1
1.1Transition, vol. 1, no. 2.)
Definition of Vision,
Mission, Goals and
Objectives
1.2 Comparison of DOH
Vision is duty-bound to:
and Mission
1.3 Purpose and Inclusion
1. develop policies and
of Vision and Mission programs for the health sector;
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2. provide technical assistance to its partners;
Lesson 4
Lesson 5 3. encourage performance of the partners in the priority health programs;
Lesson 6
Lesson 7 4. develop and enforce policies and standards;
Lesson 8
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Lesson 10 5. design programs for large segments of the population; and
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Lesson 12 6. provide specialized and tertiary level care.
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 Figure 2. 2 The Philippine Health System
(Alliance For Improving Health Outcomes, Inc. 2017)

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Student Number
Name of School
Lesson 1
1.1 Definition of Vision,
Mission, Goals and
Objectives
1.2 Comparison of Vision
and Mission
1.3 Purpose and Inclusion
of Vision and Mission
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 Under the decentralized or devolved structure, the state is represented by national
offices and LGUs, with provincial, city, municipal, and barangay or village offices. DOH, LGUs,
and the private sector participate, cooperate, and collaborate in the care of the population.
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Before devolution, the national health system consisted of a three-tiered system under the
Student Number
direct of
Name control
Schoolof the DOH: (1) the tertiary hospitals at the national and regional levels; (2) the
provincial and district hospitals and city and municipal health centers; and (3) the barangay
Lesson 1
1.1(village)
Definition ofhealth
Vision, centers.
Mission, Goals and
Objectives
1.2 Comparison of With
Vision the enactment of the LGC of 1991, the government health system now consists
and Mission
1.3of basic
Purpose andhealth
Inclusion services—including health promotion and preventive units—provided by cities
and and
of Vision municipalities,
Mission provincial and province-run district hospitals of varying capacities, and
mostly tertiary medical centers,
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specialty hospitals, and a number of re-nationalized provincial
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hospitals
Lesson 4 managed by the DOH.
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 Directions of the Philippine Health Sector

(1) The Philippine Health Agenda 2016 – 2022 (DOH Administrative Order 2016-0038)
Emil Gatus This agenda adopts the slogan “All for Health Towards Health For All” as the rallying
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point for its vision of a Healthy Philippines by 2020. It expanded the scope of the Universal
Name of School
Health Care (UHC) directions, particularly through a whole-of-government approach. With
Lesson 1
this agenda,
1.1 Definition of Vision, the health system guarantees:
Mission, Goals and
Objectives
1.2 Comparisona.ofpopulation-
Vision and individual-level interventions for all life stages that promote health
and wellness, prevent and treat the triple burden of disease, delay complications,
and Mission
1.3 Purpose and Inclusion
rehabilitation, and provide palliation for both the well and the sick;
of Vision and Mission
Lesson 2
Lesson 3 b. access to health interventions through functional service delivery networks (SDNs);
Lesson 4
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Lesson 7 c. financial freedom when accessing these interventions through Universal Health
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 (2) The Philippine Developmental Plan 2017-2022

This is the first of the four key medium-term plans to translate the vision of a
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“matatag,
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(3) NEDA AmBisyon Natin 2040
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1.1 Definition of Vision,
Mission, Goals andA product of the Philippine Development Plan 2017–2022, this collective long-term
plan envisions better life for the Filipinos and the country in the next 25 years by
Objectives
1.2 Comparison of Vision
formulating policies and implementing programs and projects to attain this AmBisyon. This
and Mission
1.3 Purpose and Inclusion
of Visionplan focuses on four areas: building a prosperous, predominantly middle-class society
and Mission
Lesson 2where no one is poor; promoting a long and healthy life; becoming smarter and more
Lesson 4innovative; and building a high-trust society.
Lesson 3

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(4) 7Sustainable Developmental Goals 2030
Lesson
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Lesson 9 This is a compilation of 17 developmental goals that targets to end poverty, fight
Lesson 10
inequality and injustice and confront issues involving climate change and
Lesson 11 its effects.
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 KEY POINTS TO REMEMBER:

Emil Health
Gatussystem combines resources, organization, financing, and management to deliver
Studenthealth services to the population. According to the World Health Organization (WHO)
Number
Name Report in 2000, health system is defined as “all the organizations, institutions, resources, and
of School
Lesson 1people whose primary purpose is to improve health.”
1.1 Definition of Vision,
Mission, Goals and
 The primary goals of the health system are improved health outcomes (attaining the best
Objectives
1.2 Comparison of Vision
average level health care for the entire population by minimizing disparities), more
and Mission
responsive health system (meeting the people’s expectations of and satisfaction from health
1.3 Purpose and Inclusion
of Vision and Mission
service delivery), and more equitable health care financing (protecting each individual from
Lesson 2
Lesson 3financial risks).
Lesson 4
Lesson 5
 6The four functions of the health system are health services provision (for appropriate and
Lesson
Lesson 7
Lesson 8cost-effective health delivery); health service inputs (for generating human resources,
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technology, and capital); health financing (by revenue collection, risk pooling, and strategic
Lesson 10
purchasing); and stewardship and initiatives (to strengthen governance, accountability, and
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responsiveness).
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  A health system can be analyzed in its totality by using a framework consisting of six
building blocks, i.e., leadership and governance, health financing, health workforce, medical
products, vaccines, and technologies, health information, and service delivery.
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 TheNumber
Student Department of Health (DOH) is the lead agency for Philippine health care. According to
Nameits of
mandate
School (E.O. No. 119, Sec. 3), the DOH shall be responsible for the (1) formulation and
Lesson 1development of national health policies, guidelines, standards, and manual of operations for
health
1.1 Definition services and programs; (2) issuance of rules and regulations, licenses, and
of Vision,
Mission, Goals and
accreditations; (3) promulgation of national health standards, goals, priorities, and
Objectives
1.2 Comparison of Vision
indicators; and (4) development of special health programs and projects, and advocacy for
and Mission
legislation
1.3 Purpose and Inclusionon health policies and programs. the ability to pay rather than the risk of illness).
of Vision and Mission
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 Emil Gatus
Student Number
Name of School
Lesson 1
1.1 Definition of Vision,
Please take the
Mission, Goals and
Objectives Learning Outcomes Assessment
1.2 Comparison of Vision
and Mission
1.3 Purpose and Inclusion
of Vision and Mission
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