Philippine Health Care System 2008

The Philippine Health Care System

HEALTH FOR ALL FILIPINOS Christine S. Tinio, MD, MPH, FPAFP

At the end of the session, the student should be able:

□Define health care system □Discuss the factors affecting the health care system □Describe the Philippine Health Care Delivery System □Discuss the structure, functions activities and programs of the Department of Health

Health System Interrelated system in which a country organizes available resources for the maintenance and improvement of the health of its citizens and communities.

□A health system comprises all organizations, institutions and resources devoted to producing actions whose primary intent is to improve health. The four essential functions of a health system have been defined as service provision, resource generation, financing and stewardship

Health care System Models

□Private enterprise health care □Social security health model □Publicly funded health care model □Social health insurance

Private enterprise health care model □ Purely private enterprise health care systems are comparatively rare. □ Where they exist, it is usually for a comparatively well-off subpopulation in a poorer country with a poorer standard of health care–for instance, private clinics for a small, wealthy expatriate population in an otherwise poor country. □ But there are countries with a majorityprivate health care system with residual public service

Social security health model □ Where workers and their families are insured by the state □ refers to social welfare service concerned with social protection, or protection against socially recognized conditions, including poverty, old age, disability, unemployment and others. □ Social security may refer to: □ social insurance, where people receive benefits or services in recognition of contributions to an insurance scheme. These services typically include provision for retirement pensions, disability insurance, survivor benefits and unemployment insurance. □ income maintenance—mainly the distribution of cash in the event of interruption of employment, including retirement, disability and unemployment □ services provided by administrations responsible for social security. In different countries this may include medical care, aspects of social work and even industrial relations.

Publicly funded health care model □Where the residents of the country are insured by the state □Health care that is financed entirely or in majority part by citizens' tax payments instead of through private payments made to insurance companies or directly to health care providers

Social health insurance □ where the whole population or most of the population is a member of a sickness insurance company □ (SHI) is a method for financing health care costs through a social insurance program based on the collection of funds contributed by individuals, employers, and sometimes government subsidies □ characterized by the presence of sickness funds which usually receive a proportional contribution of their members' wages. With this insurance contributions these funds pay medical costs of their members □ Affiliation to such funds is usually based on professional, geographic, religious/political and/or non-partisan criteria.

 

Structure of a Health System Health Sector

    Health Status Population Health-related sectors

 

Structure of a Health System Health Sector

    Health Status Population Health-related sectors

Health Status □Birth □Death □Morbidity □Mortality □Nutrition

The Health Status of the Filipino People oIMR

HFA 2000 < 50

oMMR

179.7/1000 00 LB 28.4/1000

oCBR oLife Expectancy o CDR

Targets 2004 49/1000 LB

> 60 y/o 6.1 /1000

Structure of a Health System   Health Sector     Health Status Population Health-related sectors

The Population □Demographic characteristics □Socio-cultural factors □Political factors

Country Philippines

Life Expectancy in years 70

Thailand

70

Malaysia

73

South Korea

75

Japan

81

Country Philippines

Population Growth 2.1 –2.3 %

Thailand

1.4 %

Malaysia

2.2 %

South Korea

0.8 %

Japan

0.3 %

Total Fertility Rate (ave. no. of children per woman)

Total Fertility Rate Country

1960

1990

2001

Philippines

7.0

4.4

3.4

Thailand

6.4

2.3

2.0

Malaysia

6.8

3.8

3.0

South Korea

6.0

1.7

1.5

Japan

2.1

1.6

1.4

The Population □Socio-Cultural Factors □The majority of Filipinos are Roman Catholics □ High functional literacy rate of 83.8% □ folk beliefs, misconceptions and practices detrimental to health are still rampant. - The family is the basic unit of Filipino society

The Population □Political Influences □the Philippines is a democratic country □local government units (LGUs) comprise the political subdivisions of the Philippines

Health Care Utilization: □Physical barriers - geographical location patterns of health care consumers in relation to health providers □Financial factors also exist that affect health seeking patterns of the Filipinos

Structure of a Health System   Health Sector     Health Status

Population Health-related sectors

Health Sector □refers to the groups of services or institutions in the community or country which are concerned with the health protection of the population □May be public (gov’t), private, and non-governmental health organizations

Functions of the Health Sector □Direct provision of health services: promotion, prevention, Dx and Tx, medical rehabilitation □Dev’t and provision of health manpower, drugs and medical supplies; financing support

Functions of the Health Sector □Research and dev’t □Coordinating, controlling and directing organizations and activities associated with other functions

The Health Sector and health-related sectors □Social organization of the health Care □Economic issues

Health Human Resources □The human resources for health are enormous but unevenly distributed. Most health practitioners are in Metro Manila and other urban centers

Registered Health Professionals 2000

□Physicians - 95,016 □Nurses - 337,939 □Midwives - 129,532

Health human resource □The availability of health professionals in the domestic health care sector depends on the number of schools offering health professional education, the number of students admitted into medical, nursing, dental and other health professional schools, and the strictness of the schooling and examination

Health human resource □manpower – supply dependent on the demand in the foreign market

Major Influences on the Health Care System

□Environmental □Demographic □Socio-Culture □Political □Economic

DEPARTMENT OF HEALTH

The DOH is the principal agency in health in the Philippines.

DOH □It is responsible: □ for ensuring access to basic public health services to all Filipinos through the provision of quality health care and regulation of providers of health goods and services.

□a policy and regulatory body for health □a technical resource, a catalyzer for health policy and a political sponsor and advocate for health issues in behalf of the health sector. □provides the direction and national plans for health programs and

Vision

The leader of health for all in the Philippines.

Mission Guarantee  equitable, sustainable and quality health for all Filipinos, especially the poor, and to lead the quest for excellence in health. 

DOH □Composed of 17 offices, 16 Centers for Health Development in various regions, 70 hospitals and 4 attached agencies

Milestones □ 1999 □ The functions and operations of the DOH was directed to become consistent with the provisions of Administrative Code 1987 and RA 7160 through Executive Order 102. The Health Sector Reform Agenda of the Philippines, 1999-2004 was launched. □

□1992 □Full implementation of Republic Act No. 7160 or Local Government Code. The DOH changed its role from one of implementation to one of governance. Significant change: branching out of the Office of the Public Health Services to form the Office for Special Concerns. Two big offices merged to become the Office of

□ 1987 □ Another re-organization under Executive Order No. 119, which placed under the Secretary of Health five offices headed by an undersecretary and an assistant secretary. These offices are the Chief of Staff, Public Health Services, Hospital and Facilities Services, Standard and Regulations, and Management Service. □ 1986 □ The Ministry of Health became Department of Health again. □ 1982 □ Under Executive Order No. 851, the Health Education and Manpower Development Service was created, and the Bureau of Food and Drugs assumed the functions of the Food and Drug Administration.

□ 1972 □ Through Letter of Implementation No. 8, pursuant to Presidential Decree No.1, Sept.24, 1972, the DOH was renamed Ministry of Health. The National Cancer Center and Radiation Health Service were created. The Ministry was divided into 12 regions covering several provinces and cities under a regional health director. Attached offices were the Philippine Medical Care Commission, the Dangerous Drugs Board, National Nutrition Council, Population Commission, National Schistosomiasis Control Council and the Tondo General Hospital.

Center for Health Development

□Responsible for field operations of the Department in its administrative region and for providing catchment area with efficient and effective medical services. □It is tasked to implement laws, regulation, policies and programs. It is also tasked to coordinate with regional offices of the other Departments, offices and agencies as well as with the local governments

DOH Hospitals □Provides hospital-based care; specialised or general services, some conduct research on clinical priorities and training hospitals for medical specialisation.

Attached Agencies □ The Philippine Health Insurance Corporation is implementing the national health insurance law, administers the medicare program for both public and private sectors. □ The Dangerous Drugs Board on the other hand, coordinates and manages the dangerous drugs control program. □ Philippine Institute of Traditional and Alternative Health Care □ Philippine National AIDS Council

Center for Health Development □Act as main catalyst and organizer in the ILHZ formation □Provide technical support and advocacy for the dev’t of local health management systems and their integration in the context of the ILHZ □Review and approve ILHZ proposals for funding □Integrate local health plans into regional plans □Undertake monitoring of the development and implementation of ILHS

District Health System □“A contained segment of the national health system which comprises a well defined administrative and geographic area either rural or urban and all institutions and sectors whose activities contribute to improve health” - World Health Organization

District Health System is subdivided into 3 levels of referral:

□Primary – barangay health stations and rural health units □Secondary – district/provincial hospitals □Tertiary – provincial and regional hospitals

In the Philippines:

Inter Local Health Zone (ILHZ) □Unit of the health system created for local health service management and delivery in the Philippines □Applied in many developing countries where responsibility for health services has been decentralized from national to local health authorities

ILHZ □Has a defined population within a defined geographical area and comprises a central or core referral hospital and a number of primary level facilities such as RHUs and BHS □Clustering of municipalities

ILHZ □Includes all stakeholders involved in the delivery of health services including communitybased NGOs and the private sectors (foreign and/or local) □Provides quality, equitable and accessible health care

Composition of ILHZ □People – community members, CHWs, NGOs, people’s organizations, local chief executives, other gov’t officials, private sector □Boundaries – clear boundaries between ILHZ □Health facilities □Health workers – district health team

Core Referral Hospital □Main hospital for ILHZ and its catchment population □Main point of referral for hospital services from the community, private medical practitioner and public health services at BHS and RHUs

Core Referral Hospital □Minimum services: □Out-patient services □Lab and radiological diagnostic services □Inpatient care □Surgical services sufficient to provide emergency care for basic life threatening conditions, obstetrics and trauma

Provincial hospital

RHU

District Hospital

Importance of establishing an ILHZ □To re-integrate hospital and public health services for a holistic delivery of health services □To identify areas of complementation of the stakeholders – LGUs at all levels, DOH, PHIC, communities, NGOs, private sector and others

Expected achievement of the ILHZ □Universal coverage of health insurance □Improved quality of hospital and RHU services □Effective referral system □Integrated planning □Appropriate health information system

Expected achievement of the ILHZ □Improved drug management □Developed human resources □Effective leadership through inter-LGU cooperation □Financially viable or selfsustaining hospital □Integration of public health and curative hospital

Minimum Package of Activity for PHC services □ Pre-natal care □ Normal delivery and post-partum care □ Immunization □ Family planning □ Nutrition – Vit. A & iron supplementation □ Growth monitoring □ Control of communicable diseases □ Minor surgery – suturing , draining of abscess, circumcision □ Dental health □ Appropriate referral □ Environmental health services

Minimum Package of Activity for PHC services

□Basic laboratory services □Health promotion and education □Management of public health services, coordination with NGOs and the private medical sector, participation in ILHZ management □Training of human resources □Supervision of health services and human resources within the municipal catchment area

Complementary Package of Activity for Core Referral Hospitals □ Outpatient consultations for patients referred from the primary level □ Inpatient medical and surgical care □ Emergency room care □ Minor surgery (placental extraction, excision, suturing , D&C □ Anesthesia □ Major emergency surgery (CS, trauma surgery, appendectomy) □ Complicated deliveries □ Basic orthopedics (ex. Setting of simple fractures

Complementary Package of Activity for Core Referral Hospitals □ Nutrition services □ Referral of more urgent cases to a higher level of care □ X-ray □ Laboratory services □ Blood transfusion □ Pharmacy services □ Management of hospital services and participation in ILHZ management □ Public health promotion and education □ Coordination with public health services □ Transport and communication linkages

Tertiary Package of Activity for provincial Gov’t Referral Hospital □ Pediatric, surgical, medical, orthopedic obstetric and gynecology departments □ Expanded surgical capability (burns) □ Intensive care, neonatal intensive care, coronary care □ Ophthalmology □ Rehabilitative medicine (physiotherapy, occupational therapy) □ A full range of dental services □ Advanced diagnostics □ Public health laboratory (malaria, schistosomiasis, water analysis, referral laboratory of RHUs and core referral hospitals □ Blood bank and transfusion services

Tertiary Package of Activity for provincial Gov’t Referral Hospital □ Medical social services, veterans, senior citizens medical services □ Pharmacy services □ Dietary and nutrition services □ Wellness center program □ Hospital administration and management services □ Emergency transport □ In-house engineering and maintenance

Factors contributing to the limited capacity of the country’s health care system to deliver better health outcomes □ poor health care financing □ The inappropriate health service delivery system, where there is excessive reliance on use of high-end hospital services rather than primary care, including an ineffective mechanism for providing public health programmes □ the brain drain of health professionals □ the excessively high price of medicines, leading to costly out-of-pocket payments and inadequate and irrational use; □ inadequate enforcement of regulatory mechanisms □ the insufficient effort expended on prevention and control of new diseases, particularly non-communicable diseases □ Data adequacy, accuracy and timeliness are other important and perennial issues to be addressed. The unavailability of timely and accurate data/information makes it difficult to make appropriate decisions on policies and programmes to improve health care.

ISSUES AND CONCERNS Some of the major factors affecting the country’s health status are as follows: □inappropriate health delivery system □inadequate regulatory mechanisms and □poor health care financing.

SGD □What are the priority programs of the DOH? □List down the objective/s and activities of each program. □SUBMISSION: Sec. A: Jun 3 @ 8 am Sec. B: Jun 4 @ 8 am

SGD □ Discuss the FOURmula ONE for Health(F1) – over-all goals, objectives □ Discuss the four components of F1as to: □ A. Strategies □ B. Activities □ C. Gov’t structure implementing the activities □ D. Available DOH program in the implementation of activities □ SUBMISSION: Sec. B: Jun 4 @ 8 am