Presntation by Zorayda E. Leopando, MD, MPH Professor of Family and Community Medicine University of the Philippines Manila at the WHO/TNO/Dutchgovernment Congres 'Connecting Health and Labour' 29 - 1 December 2012

1. Universal Health Care:
The Philippine Experience
Zorayda E. Leopando, MD, MPH
Professor of Family and Community Medicine
University of the Philippines Manila

2. • “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

3. Universal Health Care
Deliberate attention to the
needs of millions of poor
Filipino families which
comprise the majority of
our population

4. Comprehensive Reform Agenda
Reforms Focus
Health Sector Reform public health, hospital,
Agenda, 1999-2004 health care financing,
governance, and
regulations.
Fourmula One For financing, service
Health, 2005-2010 delivery, regulation,
governance
Universal Health Care, to improve, streamline,
2011-2016 and scale up above
reforms

5. Filipino Income Quintiles
Monthly income Families per quintile
Q1 3,460 5,218,267
Q2 6,073 4,094,164
Q3 9,309 3,912,443
Q4 15,064 3,707,494
Q5 38,065 3,485,067
Exchange rate US$ 1.00= Php 43.00
Source: National Health and Demographic Survey, 2008

6. The Philippine Health Care System
• Public Sector:
– Services devolved to local government
units
• Private sector
– More doctors are in the private sector
– Almost the same number of hospitals and
hospital beds between public and private
sectors

7. Office of Secretary of Health
Attached Agencies
Regional hospital
Medical Centers Regional Offices
Sanitaria
City Health Offices Provincial Health Offices Provincial
(Chartered Cities) Hospitals
Inter-local Health Zones
City Health
Hospitals Centers City Health Offices Municipal health District
offices/ Rural hospitals
Barangay (Component Cities)
Level of Health Unit
Health
Supervision Health
Stations City Barangay Health
Centers
DOH Hospitals Stations
Province Barangay
City government Health
Municipal gov’t Stations

8. Utilization of Health
Facilities %
HEALTH FACILITY TYPE
Government 50 %
Private 42 %
Traditional healer 7%
Common reasons for seeking health care:
illness or injury ---------------------- 68 %
medical check-up --------------- 28 %
dental care --------------- 2 %
medical requirement ---------- 1 %
Source: NDHS, 2008

9. • Improved public health services such as
PhilHealth for all within three years
– President Aquino’s Inaugural Speech
• to enroll the poorest 5,000,000 Filipino
families with PhilHealth
– President Aquino’s State of the Nation Address

10. Health Coverage in the Philippines
• 1960’s- Medical Care Commission,
implemented for the employed and their
families, hospitalization benefits only
• 1995: National Health Insurance Program
with Philippine Health Insurance Corporation
as implementing agency, Phase 1 for the
employed and their dependent,
Hospitalization initially, then with selective
outpatient package; plus sponsored
members

11. Distribution of Health
Expenditure by Source of Funds
Total health expenditure is P234.3 B (3.2 percent of GDP)
Source: Philippine National Health Account, 2007

12. Distribution of Health Expenditure
by Use of Funds
Public Health Others Total health expenditure is P234.3 B
Care 10% (3.2 percent of GDP)
9% P 23.3 billion
P 21.2 billion
Personal
Health Care
81%
P 189.7 billion
Source: Philippine National Health Account, 2007

13. National Health Insurance Program and the
Philippine Health Insurance Corporation
Pres. Aquino, on PhilHealth Enrolment:
According to the National Statistics Office,
38% of Filipinos Have PhilHealth coverage.
(Pnoy’s SONA – July 26, 2010; emphasis supplied)
13

14. Given priority poorest of the poor families

15. DOH, 2010
GOALS
Better health Responsive health Equitable health
outcomes system financing
Objectives
Instruments utlized
Health Service Policy, standards Health Health Governance
Financing Delivery and regulation Human Information for Health
Resource

16. Three Strategic Thrusts
Improve financial risk protection through
improvements in NHIP benefit delivery
Achieve health-related Millennium
Development Goal -Max (MDGmax)
targets
Improve access to quality health care
facilities
Plus: 1. Attain efficiency by using information technology
2. More aggressive promotion of healthy lifestyle
DONH, 2010

17. STRATEGY # 1
Ensure that each family has an assigned
competent primary health care provider
STRATEGY # 2
Produce health professionals that are
responsive to the current needs of the health
sector
STRATEGY # 3
Manage the exit or re-entry

18. Best Practices for Health Human
Resource Development Initiatives
• University of the Philippines Manila School of
Health Sciences (1976)
– Ladderized curriculum- student can become
midwife, nurse, doctor with service leave in
between
– Students nominated by communities
– Do not pay tuition fees, given allowance
– To serve for 2 years for every year of education
– Retention rate of 85-90 %Now with 3 campuses

19. Best Practices for Health Human
Resource Development Initiatives
• Department of Health
– Doctors to the Barrios program (1995)- doctors recruited
for underserved, doctorless communities, serve for 2 years,
with financial incentives and CME activities
– Pinoy MD- scholarship for doctors who are required to
serve fort two years for every year of education
– Midwifery Students Scholarship Program - midwives to
serve for two years for every year of education
– RNHeals – 10000 nurses to be fielded to train community
health teams.

20. Universal Health Care or
“Kalusugan Pangkalahatan” (KP)
Access to KP as an Operational Solution
Quality IP
and OP Care
NHIP Public
Benefit Health
Delivery Services
Poorest
Families • Convergence of three
strategic thrusts to serve
poor families

21. Access to
Quality IP
Kalusugan Pangkalahatan (KP)
and OP Care
NHIP Benefit Public Health
Delivery Services
Poorest
Families
Analysis of the Problem
• Neither Government subsidy nor the NHIP have adequately
protected the poor from financial risk
• The poor have limited access to quality outpatient (RHUs)
or inpatient (hospital) facilities
• Current public health effort may not meet MDG
commitments by 2015, specially those related to maternal
and child health
DOH, 2011

22. The goals set by the DOH
Financial Risk Protection
• Enroll 5.2 million families (Q1) identified by NHTS-PR
under the PhilHealth Sponsored Program__> DONE
• Train and deploy 10,000 RNHeals nurses as trainers and
supervisors to capacitate community-level health
workers ongoing
• Secure drugs, medicines and supplies for DOH-retained
hospitals serving NHTS-PR families for implementation
of NBB policy ONGOING
DOH, 2011

23. The goals set by the DOH
Health Facilities Enhancement
• Upgrade DOH-retained hospitals, provincial
hospitals, district hospitals and RHUs to ensure
access to better-quality inpatient and outpatient
care for NHTS-PR families ONGOING, WITHIN
TARGET
• Procure and distribute treatment packs for
hypertension and diabetes to RHUs for the use of
4Ps beneficiaries
DOH, 2011

24. The goals set by DOH
Attaining Health-related MDGs
• Procure and distribute health commodities to RHUs
serving 4Ps beneficiaries ONGOING
• Deploy Community Health Teams ONGOING
DOH, 2011

25. What Phil Health Says:
Moving forward with KP

26. Phil Health Membership
• Aim for 100 % coverage
• Sponsored Program Coverage to be
sustained
• Coverage of the Rest of the Informal Sector
– Revive organized group enrollment
• Educating the Sponsored and Informal
Sector Members
– RN Heals
– Family Development seminars with DSWD
•
E. P. Banzon, PHIC, 2011

27. Health care providers
• Facilitate accreditation of Autonomous Region of Muslim
Mindanao facilities and MDG benefit providers
• Incentive package for healt5h providers
• Facilitate investments in innovative health care providers
such as specialty surgical hospitals
• Maximize use of information technology with
POLICIES on Health data dictionaries, AND security
and privacy of health data disseminated
E. P. Banzon, PHIC, 2011

28. Benefits for members
• Total shift to case payment
• CONSIDER Differential case payments based on facility
type, remoteness, incentive for quality
• Intensify implementation of No Balance Billing for the
SPONSORED PROGRAM in GOVERNMENT HOSPITALS
• Improved OPB now to be called the PRIMARY CARE
BENEFIT
– Gate-keeping !
– Continued support for innovative models like the Bukidnon model
– Open to all types of health care providers complying with accreditation
requirements

29. Benefits for members
• Supplemental health insurance benefits
for government employees
• Catastrophic fund in collaboration with
President’s social fund, PCSO, PAGCOR,
etc.
• Closer collaboration with HMOs to
simplify PhilHealth availment of
PhilHealth members who are also HMO
members

30. Thank you very much