UNIVERSAL HEALTH

CARE

MOHAMMED ♦ MACARUBBO ♦ NAGASAN ♦ PAGGADU ♦ TOUNSI ♦

“ Health is a right of every Filipino
citizen and the State is duty- bound
to ensure that all Filipinos have
equitable access to effective health
care services”

Philippine 1987 Constitution

Persistent Inequities in Health Outcomes

Every year, around A Filipino child born Three out of 10

2000 mothers die to the poorest family children are stunted.
due to pregnancy- is 3 times more
related likely to not reach his
complications. 5th birthday,
compared to one
born to the richest
family.
Three Strategic Thrusts

• Rapid expansion in NHIP enrollment and

benefit delivery using national subsidies for
the poorest families

• Improved access to quality hospitals and

health care facilities through accelerated
upgrading of public health facilities;

• Attainment of the health-related MDGs by applying

additional effort and resources in localities with high
concentration of families who are unable to receive
critical public healthservices.
 Guarantee # 1.
ALL LIFE STAGES & TRIPLE BURDEN
OF DISEASE
 Guarantee # 2.
SERVICE DELIVERY
NETWORK
 Guarantee # 3.
UNIVERSAL HEALTH
INSURANCE
 Ethical Issues in Health Care Reform

• A hotly debated topic whenever health care reform is discussed.

• These difficult dilemmas may concern medical treatments, practices,
hospital management and other matters that arise in the healthcare
industry.
• Ethical issues in healthcare can require an immediate response, such as
making decisions for patients when they are not able to do so, or can
involve a prolonged, carefully considered decision, such as the debate
over the right to abortion or assisted suicide.
• The actions taken in ethical issues in healthcare clearly distinguish
between what is right and wrong, and often, many of the actions taken
today can have lasting effects on healthcare in the future..
Health practitioners and patients face in
healthcare.
Some examples of common medical
ethical issues include:
• Patient Privacy and Confidentiality
• Transmission of Diseases
• Relationships
• End-of-Life Issues
 Patient Privacy and
Confidentiality
• The protection of private patient
information is one of the most important
ethical and legal issues in the field of
healthcare. Conversations between a
physician and a patient are strictly
confidential, as is information about an
individual’s medical condition. Specific
provisions of the Health Insurance
Portability and Accountability Act, or
HIPAA, define exactly what information
 Transmission of Diseases
The recent global outbreak of the Ebola
virus put a renewed emphasis on the right of
healthcare providers to protect themselves
from communicable diseases, whether by
direct or indirect contact with an infected
patient. Ethical and legal questions arise
when a patient’s health history is not
provided to the medical staff.
 Relationships
• Sexual relationships between medical
practitioners and patients or between
medical staff are strictly forbidden at a
healthcare facility. Sexual harassment can
be harmful to all involved, including the
facility, so the code of ethics should be
explicit about this.
 End-of-Life Issues
• Terminally ill patients may have specific
wishes about the way they want their lives
to end. Families may struggle with the
decision to end life support for a loved
one.
• Healthcare practitioners and clinical
leaders need to be prepared to handle
end-of-life issues as well as problems
encountered in dealing with elderly
patients who may not be able to make
rational decisions on their own.
 Five Ethical Values Guiding
Health System Reform
• universal access,
• equitable access,
• affordable access (cost)
• Quality
• choice
 Universal Access
• Health is foundational to life’s joys and opportunities
—reproduction, family, work, play, and creativity, to
name a few.
• If a person is ill, injured, or in pain, having access to
health care that is affordable, accessible, culturally
and linguistically appropriate, and of good quality is of
high value.
• universal access should represent a core ethical
value precisely because every individual would
choose health care as a personal priority and for
family members.
 Equitable Access
• Vast inequalities exist across multiple spheres, which animates
compelling political debates. Fairness is a strong value in the United
States but so are economic freedom, individual striving, and
entrepreneurship. It is unlikely that quality health care services will be
distributed equally across all populations. Yet fairness requires a
reasonable allocation of quality services according to need, irrespective
of ability to pay.
• Popular support for Affordable Care Act guarantees—no exclusions for
preexisting conditions or lifetime caps on coverage—is testament to the
value of equity. Equity requires that the lived experiences of individuals
in access and quality of health services are not inordinately different
based on wealth, geography, race, or religion. Tolerating some
differences may be acceptable to many, but widely disparate treatment—
marked tiers in access and quality—appears unjust.
 Cost: Affordable Access
• Everyone understands that cost is important in
any societal decision.
• Resources are limited, and the polity will accept
only so much taxation.
• The line between public services and revenue
raising, and the public’s tolerance for increased
public debt, are quintessentially political
questions. But somehow in health care, attempts
to constrain costs are shrouded in partisan
accusations of rationing.
 Given scarce resources, the World Health Organization
(WHO) recommends the following priorities:

• maximizing population health, prioritizing the worse off, and shielding people
from health-related financial risks.
• Allocation of health care resources should give marked preference to clinical
evidence of cost-effectiveness.
• The WHO, and many countries, have evidence-based medicines lists,
indicating what will and will not be paid for.
• The National Institute for Health and Care Excellence, or NICE, evaluates the
evidence base for health services, paying for cost-effective services.
• Many countries also reduce costs through bulk purchase of pharmaceuticals,
but Medicare is legally prohibited from negotiating drug prices. US
consumers often pay far more for the same medicines than peer nations.
 Quality
• Individuals do not simply want affordable
access to health care but also demand
high quality. This requires systems
approaches that prevent medical
errors and institutionalize rigorous infection
control.
• Systems of training, monitoring, research,
oversight, and accountability improve
quality.
• Quality is linked also to evidence of effectiveness.
• If health professionals and institutions had incentives
to prioritize evidence-based treatment, and if systems
were in place to better ensure that well-trained health
professionals administered that treatment skillfully and
consistently, quality would improve uniformly.
• Traditions stress autonomy and the right to make
personal choices. In health care, however, there is
considerable ambiguity about what “choice” actually
entails.
 Choice
Is it the right to choose a physician, a hospital, or a health
insurance package?
• Choice is also seen as a way to drive down costs through competition.
Physician offices, hospitals, and insurers would compete for patients,
thus incentivizing quality improvement and cost reduction.
• Yet health care is not an ordinary commodity. It is highly specialized,
knowledge dependent, and complex. At the point when many choices
are made, moreover, patients are in pain, suffering, or highly
dependent. There are marked asymmetries in information and market
power. Much of the reform debate focuses on choice—the one value
that is deeply flawed.