Health Care System

Magtangol Jose C. Carait IV

Health Is a Right
• a state of complete physical, mental and social wellbeing, and not
merely the absence of disease or infirmity, is a fundamental human
right and … a most important world-wide social goal
• Alma ata Declaration - 1973
Health Care System
• method by which
healthcare is
financed, organized,
and delivered to a
population
• It includes issues of
access (for whom and
to which services),
expenditures, and
resources (healthcare
workers and facilities)
Health Sector
• Used to indicate the groups
of services or institutions in
the community/country
which are concerned with
the health protection of the
population
Health Financing
• One of the functions
of a health system
concerned with the.
mobilization,
accumulation and
allocation of money
to cover
the health needs of
the people,
individually and
collectively, in
thehealth system
Health care delivery system

• How a national, regional, or local health

care system is organized, administered,
provided, and paid for, sometimes to a
circumscribed system such as that under
the auspices of a specific medical and
hospital insurance carrier
or health maintenance organization.
Health Outcomes

• changes in healththat result

from measures or
specific health care investments
or interventions.
• Vital Statistics
• Infant Mortality
• Maternal Mortality
Health Financing
• The health financing system in the country is complex as it involves
different layers of financial sources, regulatory bodies and health
service providers.
• Main sources of financing:
• (1) national and local government
• (2) insurance (government and private)
• (3) user fees/out of pocket and
• (4) donors.
• In 1995, the National Health Insurance Program
(NHIP) managed by Philippine Health Insurance
Corporation (PHIC or PhilHealth) was
institutionalized and signaled the movement
towards a single-payer premium-based
financing or insurance system.
• However, the current system continues to
maintain a dual financing system existing
parallel to each other
 The total health Although there is an Despite the safety nets
expenditure increased increase in the total health
from Php 87 Billion in like NHIP, the share of
expenditure in nominal
1995 to almost Php 225 terms, its share on the GDP out of pocket
Billion in 2007 expenditure increased
is still at 3.5 to 3.6 percent
from 47 percent in 1997
to 57 percent in 2007
 Health Care
Delivery System
• Rapidly evolved with many challenges through time.
• Health service delivery was developed to the Local Government Units
(LGUs) in 1991, and for many reasons, it has not completely
surmounted the fragmentation issue.
• Health human resource struggles with the problems of
underemployment, scarcity and skewed distribution.
• There is a strong involvement of the private sector comprising 50% of
the health system but regulatory functions of the government have
yet to be fully maximized.
 Health
Facilities
Health Facilities
Health Facilities
Health Human
Resource
• The health human resources are the main
drivers of the health care system and are
essential for the efficient management
and operation of the public health system.
• They are the health educators and
providers of health services. The
Philippines has a huge human reservoir
for health
• However, they are unevenly
distributed in the country. Most are
concentrated in urban areas such as
Metro Manila and other cities
 • In the 2008 National Demographic and Health
Survey (NDHS), 50 percent of the clients who
sought medical advice or treatment consulted
public health facilities, 42 percent went to
private health facilities, and almost 7 percent
sought alternative or traditional health care.
• Health Units (RHUs) and Barangay Health
Utilization of Health Centers (33 percent) were the most visited
health facilities in almost all the regions except
Facilities for NCR and CAR, where most of the clients
visited private hospital/clinic for medical advice
or treatment.
• The most common reasons for seeking health
care were illness or injury (68 percent), medical
checkup (28 percent), dental care (2 percent),
and medical requirement (1 percent) (NSO,
2008).
 • With regard to child delivery, more than
thirty-six percent of infants are still
delivered by hilots despite aggressive
efforts of the Department of Health to
promote facility-based delivery
Utilization of Health (National Statistics Office, 2008).
Facilities • The hospital sector in the Philippines is
highly segmented in nature. Utilization
of hospitals may be driven by PhilHealth
insurance coverage and socio-economic
determinants.
•
 • People with PhilHealth insurance are
more likely to be confined in a private
hospital (56 percent), than those
without Philhealth insurance (28
Utilization of Health percent). Similarly, patients living in
Facilities urban area (52 percent) and belonging
to the richest quintile (74 percent) are
also more likely to be confined in
private hospitals (Lavado et al., 2010).
Satisfaction with Health Facilities
• Based on a survey by the Social Weather Station in 2006, majority of
Filipinos specifically the low income households prefer to seek
treatment in a government hospital if a family member needs
confinement.
• Affordability is the main reason for going to a government medical facility,
while excellent service is the main reason for going to a private medical
facility (Department of Health, 2010).
• The net satisfaction with services given by government hospitals has slightly
improved from +30 in 2005 to +37 in 2006.
 HEALTH
OUTCOMES
Life Expectancy
Deaths and Births
TOP TEN CAUSES OF DEATHS, PHILIPPINES, 2009
CHILD MORTALITY RATE, PHILIPPINES, 1990-2008
Maternal
Mortality Rate WHO DEFINES MATERNAL
MORTALITY AS DEATH OF A
MOTHER WHILE PREGNANT OR
WITHIN 42 DAYS AFTER
RISKS ATTRIBUTABLE TO
PREGNANCY AND CHILDBIRTH AS
WELL AS FROM POOR QUALITY
HEALTH CARE SERVICES MAKE
IN DEVELOPING COUNTRIES,
HEMORRHAGE AND
HYPERTENSIVE DISORDER ARE
THE MAJOR CAUSES OF
DELIVERY. THIS A STRONG INDICATOR FOR MATERNAL DEATH. OVER THE
HEALTH CARE STATUS. PAST DECADE, THE DECLINE IN
THE NUMBER OF MATERNAL
DEATHS PER 100,000 LIVE BIRTHS
HAS SLOWED DOWN
Disease Trends in the Philippines
Disease trend in the Philippines

• The country’s health profile depicts a distinct epidemiologic

and demographic transition characterized by double burden
of diseases consisting of communicable diseases (which
require major public health intervention) and non-
communicable diseases (which need expensive curative and
chronic-care intervention).
• This scenario makes the country’s health profile a “hybrid” or
combination of health situations found in both developed
and developing countries
Disease trend in the Philippines

• However
• Similar to Sub-Saharan Africa, many regions in the
Philippines are still struggling to eliminate hunger and
infectious diseases while continually battling on non-
communicable diseases (NCDs) as experienced in
developed countries. The health status of the country
therefore can be best described to be at the crossroads
of infectious and non-communicable diseases
Non-Communicable Diseases
• increasing rapidly in the Philippines.
• In 2009, seven of the ten leading causes of death are non-communicable in etiology.
• Majority of the NCDs mortality cases (i.e cardio-vascular diseases, cancer, chronic
obstructive pulmonary disease and diabetes) as shown in Table 11 are considered
lifestyle-related.
• Around 75 percent of the total deaths can be attributed to NCDs which is similar to the
estimates in most developing countries, and 30-50 percent occurred pre-maturely (below
60 years old) (Ulep, 2012).
• It is noteworthy that over-nutrition is increasing in the country while under-nutrition
remains a problem especially in rural and poor areas. T
Health Reform Initiatives
in the Philippines
 • P254.8 billion has been allotted for the first
year of implementation of the law
Universal • Philippine Health Insurance Corporation
Health Care (PhilHealth), along with experts and concerned
agencies are crafting the Implementing Rules
Law and Regulations (IRR). They will have 180 days
to complete the IRR, which will include details
on how the law will be executed.
 ALL Filipinos are covered

PhilHealth will become the “national purchaser” of

health goods and services

Universal
Health Care DOH will still be in charge of “population-based”
health services

Law
Health systems will become city-wide and
province-wide

A “Health Technology and Assessment Council”

(HTAC) will be created
RA 11223
• https://www.officialgazette.gov.ph/downloads/2019/02feb/2019022
0-RA-11223-RRD.pdf