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PHILIPPINE HEALTH FINANCING Health Sector Reform Agenda  “Fiscal autonomy” for govt hospitals  Promote health insurance

schemes with private sector  Tokenism in “public health programs”, “community health” and “development of local health systems” “FOURmula ONE for Health” (2005-2010)  Integrated public health into hospital services  Medical tourism  “Innovative financing arrangements” Health Services for Sale: Medical Tourism  Principally being promoted by the Philippine government using the public health care system  Linked to the issue of organ trade (i.e. sale of kidneys for US$3,000-4,000)  Expected revenues: US$ 10B in 5 years “Medical Terrorism”: Growing military presence The Unhealthy Philippine Health Care System  “A health care system that cannot maintain its own health human resource is not healthy at all.” MAIN PROBLEMS IN HEALTH FINANCING IN THE PHILIPPINES  Not enough money available  Weak Political will  Corruption  Preventive, Not Curative Health Financing Strategy: Building a Path towards Universal Health Care Why do we need to pursue the HCF strategies?  Underspending in health  Fragmentation of financing  Lack of social protection, equity and solidarity  Inappropriate incentive structure  Marginal impact of past reforms Health Care Finance PRINCIPLES  Solidarity in funding health services  No gray areas with respect to responsibilities and roles  More choice, less protection  New rules, easier time STRATEGIES Strategy 1: more resources Strategy 2: Sustain membership in social health insurance of all Filipinos Strategy 3: Allocate resources according to most appropriate financing agent

particularly to enrol the Informal Sector – Increase PhilHealth premium based on household’s capacity to pay 2: Sustain membership in social health insurance of all Filipinos – Segment.g. OFWs and elderly – Facilitate enrollment of contractual employees 3: Allocate resources according to most appropriate financing agent – Funding out-patient packages through capitation 4: Shift to new provider payment mechanisms – Use of capitation for primary health care services – Implement case mix system – Arrange contracts with service providers 5: Secure fiscal autonomy of facilities – Accreditation of local health systems/ other service providers like pharmacies Influencing LGU spending for health 1: Increase resources for health – Increase LGU budget for health through Provincewide Investment Plan for Health (PIPH) Counterpart – Increase LGU subsidy for Sponsored Program/IPP premiums 2: Sustain membership in social health insurance of all Filipinos .Strategy 4: Shift to new provider payment Mechanisms Strategy 5: Secure fiscal autonomy of Facilities How will this reform affect the DOH budget? 1: Increase resources for health – Utilization of Health Sector Expenditure Framework to lobby for increase budget for health 2: Sustain membership in social health insurance of all Filipinos – 100% national subsidy to enroll the poor 3: Allocate resources according to most appropriate financing agent – Provide funding for public health commodities e. 2002 on Waiver of Excess Fees for Sponsored Program in DOH Hospitals – Rationalize government subsidies to national Hospitals 5: Secure fiscal autonomy of facilities • Implementation of performance based grants for hospitals • DOH hospitals fully corporatized and Autonomous Re-directing the National Health Insurance Program 1: Increase resources for health – Expand Collection Network. PMP – Investing on capital outlay of tertiary hospitals 4: Shift to new provider payment mechanisms – Implementation of case based payment in all hospitals – DOH AO 137 s. expand and sustain the enrollment of informal sector.

informal. BHS) to retain income – Covert LGU hospitals to become economic enterprises Presidential Platform and Policy Pronouncements on Health • Universal Healthcare coverage for all Filipinos • Access to health through improved health infrastructure • A holistic and comprehensive healthcare system • Good governance The Formula for Health. Health Insurance as Driver of Health Sector Reforms in the Philippines Framework for Health Sector Reform  Good Governance  Health Care Delivery  Health Regulation  Health Care Financing Good Governance • Enhance the Performance of the Health Sector – Strengthen national and local health systems – Pursue public health and hospital reforms – Improve management systems – Expansion & development of health human resource – A rationalize and more efficient DOH – Corporate transformation of certain DOH facilities – Greater transparency and accountability – Greater assistance. leadership & management training to LGUs Health Care Delivery • Universal Access to Basic and Essential Health Care Services – Campaign for universal health insurance coverage – Services that will help reduce mortality and morbidity from certain diseases – Services that will eliminate certain diseases as public health problems – Services that promote health lifestyle – Services that cater to special health & nutrition needs – Improved health care delivery infrastructure to include referral system . HC.– Promote and sustain membership in PhilHealth of all sectors of the LGU population: formal. Sponsored Program 3: Allocate resources according to most appropriate financing agent – Provide adequate funding for salaries and capital outlay of local health facilities 4: Shift to new provider payment mechanisms – Implement contracts between PhilHealth and LGU owned primary and secondary facilities 5: Secure fiscal autonomy of facilities – Allow LGU non-hospital health facilities (RHUs.

enjoy the same level of benefits in any and all of the accredited health facilities nationwide.Health Regulatory • Assuring the Quality and Affordability of Health Goods and Services – Strengthen the regulatory bureaus in tandem with PhilHealth’s quality assurance. • The portability of benefits nationwide by all the members ensure majority of Filipinos have basic health services Responding to the MDG Goals • PhilHealth likewise introduced specific benefit packages that addresses the MDG (Millenium Development Goals) goals of maternal health. allocation and utilization for health – Progressive and socialized contribution schemes with the NHIP – Development of health care financing models – Increased PhilHealth reimbursements to help improve quality of care Giving Access to the Poor Through Health Insurance • The PhilHealth’s Sponsored Program – For those without any visible means of income or whose income is insufficient for the subsistence of the family – Beneficiaries are identified through a Means Test – Premium of Indigent Members are subsidized by the National Government and the Local Government Units Equity through Health Insurance • All members of PhilHealth regardless of membership type. accreditation and cost containment measures • Bureau of Food and Drugs (BFAD) • Bureau of Health Devices and Technology (BHDT) and • Bureau of Health Facilities Services (BHFS) – Greater and higher income generation and retention by regulatory bureaus – Help reduce cost of quality medicines and drugs Health Care Financing • Increasing Investments in Health – Sustain and expand the National Health Insurance Program (NHIP) – Mobilize more resources for health – Encourage greater private sector participation – Efficient production. infant mortality and control of certain diseases – reimbursement of normal deliveries – primary care package .

– TO defined package .