Health Financing Summit

04.14.10

World Bank Sector Assessment Team (Sarbani Chakraborty, George Scheiber, Ajay Tandon, Oscar Picazo, Eduardo Banzon

et al)

Presented by: Dr. Eduardo Banzon Senior Health Specialist

World Bank

Methodology

•  Trends over time on readily measurable performance indicators and health systems inputs against other comparable income and health spending countries

•  Assessing the country against global averages –  Nothing right or wrong about a global average –  But large deviations indicate areas that may require changes in

health policies.

Three areas •  HEALTH SPENDING

–  total, public or government , private, and out-of-pocket (OOP) health spending

•  HEALTH OUTCOMES –  Life expectancy, IMR and MMR

•  HEALTH INPUTS –  Health workers and Hospital beds

HEALTH FINANCING

HEALTH FINANCING TOTAL HEALTH SPENDING PER CAPITA

Total spending for health per capita in constant pesos (1995-2007)

3.9% growth

Composition of total spending for health (1995-2007)

Total spending for health per capita in US$ PPP in selected comparators (1995-2007)

HEALTH FINANCING HEALTH SPENDING AS SHARE of GDP

Health spending component share of GDP (1995-2007)

3.4% 3.9%

Total spending for health as share of GDP in selected comparators (1995-2007)

HEALTH FINANCING GOVERNMENT HEALTH SPENDING

Department of Health budget (2005-2010)

Source: General Appropriations Acts 2005 to 2010

Government spending for health as share of GDP (1995-2007)

Real Per Capita Government Health Expenditures (1997-2008)

Source: Sicat et al 2010

HEALTH FINANCING SOCIAL HEALTH INSURANCE

% of uninsured Filipinos (based on PhilHealth reports 2000-2008)

Source: PhilHealth annual reports

Out of pocket spending for health as share of total health spending vs. GDP per capita (1995-2007)

> 50%

Private spending for health as share of total health spending vs. income per capita (1995-2007)

65%

3%

2% 2%

3% 3% 3% 3%

5%

0%

2%

4%

6%

8%

10%

12%

1985 1988 1991 1994 1997 2000 2003 2006

OOP as % of Total Income

5%

10%

15%

20%

25%

Catastrophic Health Expenditure Headcounts, by Various Thresholds

Source: Lavado et al 2010

HEALTH OUTCOMES

POPULATION HEALTH INDICATORS, 1960-2007

HEALTH OUTCOMES INFANT MORTALITY RATE

INFANT MORTALITY RATE as to INCOME and TOTAL HEALTH SPENDING, 2007

FEMALE LITERACY versus INCOME, 2000-2007

IMR (2007) as to YEARS of FEMALE EDUCATION

INFANT MORTALITY RATE, 1960-2007

INFANT MORTALITY RATE (2007)

HEALTH OUTCOMES LIFE EXPECTANCY

LIFE EXPECTANCY at birth in selected Asian countries (1960-2008)

53 years

72 years

LIFE EXPECTANCY versus INCOME and TOTAL HEALTH SPENDING, 2007

LIFE EXPECTANCY (2006)

HEALTH OUTCOMES MATERNAL MORTALITY

MATERNAL MORTALITY versus INCOME and TOTAL HEALTH SPENDING, 2005

MMR (2005) as to YEARS of FEMALE EDUCATION

Source: WDI; Barro-Lee

Skilled birth attendance relative to income and spending, 2003-2007

% of Births attended by health professionals (comparison across countries and Philippine regions), 2008

HEALTH INPUTS

Physician to Population ratio in selected Asian countries (1960- available current year)

Total Health Worker to Population ratio Relative to Total Health Spending and Income

Hospital Beds to Population ratio in selected Asian countries (1960- available current year)

Total Hospital Bed to Population ratio Relative to Total Health Spending and Income

Hospital/inpatient facility as Place of Death for Filipinos

Source: National Statistics Office

IMPLEMENT A-B-C TOWARDS MORE VALUE FOR MONEY:

IMPLEMENT:

•  A-O 29 series of 2008 or the Rapid Reduction of Maternal and Neonatal Mortality particularly promotion of facility-based deliveries

•  B-enefits Reforms in PhilHealth –  Converting PhilHealth into an Active Purchaser of health

services (thru contracts and case payments) –  Expansion of primary care benefits to the entire enrolled

population –  PhilHealth coverage of P100 drugs

•  C-overage for all Filipinos in the PhilHealth Sponsored Program with National Government financing using the DSWD’s proxy means test from its National Household Targeting System for Poverty Reduction or the NHTS-PR PMT –  TEACH the member of the poor (SP members) utilize their

benefits

IMPLEMENT:

•  D- ata dictionaries (for health) towards a national health IT system/ improved PhilHealth IT system

•  E- xpansion of Results-based Financing – Needs-based facilities and health personnel master

plan to guide future investments in the health sector by expanding capacity in underserved areas of the country

– Performance –based budgets/grants – Hold LGUs, hospitals and PhilHealth accountable

for services and outputs

•  F-acility autonomy reforms

•  G-ame plan against Non-Communicable Diseases

Health Financing Summit

04.14.10