Final DRPH Sunday Report

Quality Improvement
Projects in Health Care

Systems in the
Philippines
Christian D. Mesina
2
Investing in primary health
care.
Placing primary care and

essential public health
functions at the core.
3
Primary health care ensures
that people have a partner in
their health needs from birth
and all throughout life
A vision where all people get

quality health services without
financial hardship.
4
 Universal Health  Health system
Care Bill (Republic amendments.
Act 11223)
 Paradigm shift
 Expansion of to primary care
population,
service, and
financial coverage
5
BIG CONCEPT
Improving and strengthen existing health
sector processes and systems by highlighting
primary care close to families and
communities 6
1.
TRANSITION HEADLINE
Let’s start with the first set of slides
1.
TRANSITION HEADLINE
1.
TRANSITION HEADLINE
Population-based Individual based
health services health services
Outcomes contribute
to general public 1.
Definitively trace back
TRANSITION
health, safety, and HEADLINE
to one recipient.
protection Let’s start with the first set of slides
In response to a
public health
emergency or disaster
1.
TRANSITION HEADLINE
1.
TRANSITION HEADLINE
Framework of Universal
Health Care
1.
TRANSITION HEADLINE
Improvements in the health
care system through the UHC
14
UNIVERSAL HEALTH CARE
SERVICE GOVERNANCE
HUMAN
DELIVERY
RESOURCES
AND LOCAL
FOR HEALTH
HEALTH
SYSTEMS FINANCING REGULATION
15
SERVICE DELIVERY AND LOCAL HEALTH SYSTEMS
GIDA
High morbidity and high mortality due

to poor access and delivery of quality
health services, lack of health
facilities, and inadequate logistical
support.
16
“
Physical: 25% of puroks/sitios lacks access
Socioeconomic: IP, Armed Conflict, 4Ps,

Indicators
17
• Prioritize investments on
health services,
infrastructures, and human
resources in hard-to-reach
areas.
Annual update on list of

hard-to-reach areas
18
2.
EXTRA RESOURCES
For Business Plans, Marketing Plans, Project
Proposals, Lessons, etc
2.
EXTRA RESOURCES
2.
EXTRA RESOURCES
Essential Health Benefit Package
 Primary care
 Medicines
Individual-based
Entitlements  Diagnostic and
laboratory
 Promotive, preventive,
curative, and
rehabilitative services
22
Outpatient
Benefit Packages
and Other Special
Benefits
23
 Treatment, procedures,
or surgeries
Outpatient  Less than 24 hours
Benefit Packages Outpatient basis
 Case-based payment
mechanisms
24
 Sustainable
Development Goals
 Medical detoxification
Other Special
package
Benefits
 Covid-19
 Increased case rates of
maternity care packages
in non-hospital settings 25
Primary Care
Benefit Package
(Konsulta
Package)
26
Primary Care
Benefit Package
 Quality health goods and

services at the primary level of
care
27
Primary Care
Benefit Package
 Initial and follow-up primary care
consultations
 Health screening and assessment
 Diagnostic and laboratory services and

medicines 28
Inpatient Benefit
Packages
29
Z Benefit Packages
(Catastrophic
Packages)
30
FINANCING
◦a. Increasing revenues from tobacco,

alcohol, sugar-sweetened beverages
taxes
◦b. Funds from Philippine Charity

Sweepstakes Office (PCSO) etc.
31
FINANCING
◦c. Annual appropriations of the DOH
◦d. Proposed increased premium rates

and collection efficiency in Philhealth
◦e. Supplemental funding
32
FINANCING
CORE FUNCTIONS
REVENUE GENERATION
POOLING OF FUNDS
PURCHASING OR SERVICES
33
FINANCING
Provider Payment Refers to how PhilHealth pays

Mechanisms
healthcare providers to deliver
services.
34
FINANCING
Provider Payment
1. Global Budget - Perspective
Mechanisms based payment mechanism
35
FINANCING
2. Diagnosis-Related Groups
Provider Payment
Each case is classified into a group
Mechanisms
with the same characteristics
Cases that fall into the same group
are paid the same rate
36
FINANCING
Provider Payment 3. Capitation - paying the primary

Mechanisms care facility for specific services it
provides for a particular period.
37
Mechanisms
Cost-sharing
Pr Co-
at ede pa
po te ym
i n rm e n
t-o in t
f-s ed
er ra
2
Pe vic te
Th cer C e pa
id
FINANCING
e nt o-in
re ag
st e su
pa pa ranc
id id e
by by
th th
e e
in in
su su
ra re
nc d.
e
pl
an
.
38
FINANCING
◦ Special Health Fund

(SHF)
39
40
HUMAN RESOURCES FOR HEALTH
Appropriate generation,
recruitment, retraining,
regulation, retention, and
reassessment of the health
workforce based on population
health needs.
41
aims to ensure the sustainable

production, equitable
distribution, and continuous
development
42
WHO health labor

market approach
43
44
National Health Workforce Registry

45

Data collection
National Database on Human Resources for Health Information

System (NDHRHIS)
46
Determining HRH needs at all levels of the health care system.
47
Policy shift from being curative-
focused and hospital-centric to a
Scholarship and Training Program and
primary health care approach with
Return Service agreement
emphasis on the preventive and
promotive side
48
Scholarship and  HRH

Training production is  Integrated
Program and targeted for government
Return service priority areas scholarships
agreement of need
49
Scholarship and
 Three full years within one year
Training
upon graduation or after acquiring
Program and the necessary license or
Return service
Return certification to practice.
agreement
service
agreement
50
REGULATION
Clinical Practice Guidelines
(CPG)
Reduce unexplained variation

in practice
Monitor inappropriate care
Manage costs of health care

51
REGULATION
Health Technology Assessment (HTA)
52
REGULATION

Challenges
Appropriate allocation of limited resources across the needs of

the entire population
53
REGULATION

Challenges  Medicines
 Vaccines
Considering different levels of health services and costs.
 Health technologies or services
54
REGULATION
Core Principles:
Evidence-based and Scientific defensibility

Transparency and accountability
Enforceability
55
REGULATION
Core Principles:
Efficiency
Inclusiveness and preferential regard for the underserved
56
REGULATION
Health Technology Assessment Council
57
REGULATION
Essential Medicines
Maximum
Fairly Priced
Retail Price
generics
(MRP)
Government
List of drugs in the
mandated ceiling
Primary Care
prince on selected
Formulary
drugs
58
GOVERNANCE
Health Promotion Bureau
 Health literacy
HEALTH  Coordinate health promotion policies
PROMOTION  Health promotion programs across
social determinants of health
 Research and development in the field
of health promotion
59
GOVERNANCE
Ethics in public health practice will also
Ethics in Public be strengthened
Health Policy  Declaration and management of
and Practice conflict of interest
 Financial relationships between health
care professionals and manufacturers
60
GOVERNANCE
All health-related entities are required to
submit health data to PhilHealth
Monitoring and
 PSA to conduct household surveys
Evaluation
annually
 DOH to publish annual provincial
burden of disease estimates
61
Universal health care: the best investment the Philippines will make
(
https://www.who.int/philippines/news/commentaries/detail/univ
ersal-health-care-the-best-investment-the-philippines-will-make)
https://doh.gov.ph/uhc
REFERENCES
Universal Health Care in the Philippines from policy to practice.
Implementing Rules and Regulations of the Universal Health Care

Act (Republic Act No. 11223)
62
THANK
YOU! 💃
63

Final DRPH Sunday Report

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Final DRPH Sunday Report

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Quality Improvement

Projects in Health Care

Placing primary care and

A vision where all people get

High morbidity and high mortality due

Socioeconomic: IP, Armed Conflict, 4Ps,

Annual update on list of

 Quality health goods and

 Health screening and assessment

 Diagnostic and laboratory services and

◦a. Increasing revenues from tobacco,

◦b. Funds from Philippine Charity

◦c. Annual appropriations of the DOH

◦d. Proposed increased premium rates

◦e. Supplemental funding

Provider Payment Refers to how PhilHealth pays

Provider Payment 3. Capitation - paying the primary

◦ Special Health Fund

aims to ensure the sustainable

WHO health labor

HUMAN RESOURCES FOR HEALTH

National Health Workforce Registry

National Database on Human Resources for Health Information

National Health Workforce Registry

Determining HRH needs at all levels of the health care system.

Scholarship and  HRH

Reduce unexplained variation

Monitor inappropriate care

Manage costs of health care

Health Technology Assessment (HTA)

Health Technology Assessment (HTA)

Appropriate allocation of limited resources across the needs of

Health Technology Assessment (HTA)

Health Technology Assessment (HTA)

Evidence-based and Scientific defensibility

Health Technology Assessment (HTA)

Health Technology Assessment Council

Implementing Rules and Regulations of the Universal Health Care

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