Philippine

Health Agenda:

Universal Health Care

Enrique T. Ona, MD, FPCS, FACS

Secretary of Health

“Thirty percent of our countrymen

who succumb to sickness die

without seeing a doctor.” without seeing a doctor.”

- President Aquino’s Challenge

July 2010

Universal Health Care

Deliberate attention to the

needs of millions of poor

Filipino families which

comprise 40% of the comprise 40% of the

Philippine population

Filipino Income Quintiles

Monthly income Families per quintile

Q1 $76.89 5.2M Q1 $76.89 5.2M

Q2 $134.96 4.1M

Q3 $206.87 3.9M

Q4 $334.76 3.7M

Q5 $845.89 3.5M

Source: National Health and Demographic Survey, 2008P1 = $0.02

Comprehensive Reforms in Health

Universal Health Care

(2010 -2016)

Fourmula One for Health Fourmula One for Health

(2005 – 2010)

Health Sector Reform Agenda

(1999- 2004)

Comprehensive Reforms in Health

• Health Sector Reform Agenda (HSRA) – focused on public health, hospitals, health care financing, health regulations, and good governance.

• Fourmula One for Health (F1) – implementation • Fourmula One for Health (F1) – implementation blueprint with four pillars: health financing, service delivery, health regulation, and good governance

• Universal Health Care – focus on the very poor Filipinos to ensure equity given disparities in health outcomes, financing, and service delivery interventions for the poor

Office of Secretary of Health

Attached Agencies

Regional Offices

Provincial Health Offices Provincial Hospitals

Regional hospital Medical Centers

Sanitaria

City Health Offices(Chartered Cities)

City Health Offices(Component Cities)

Inter-local Health Zones

City Hospitals

Health Centers

Barangay Health

Stations

District hospitals

Municipal health offices/ Rural Health Unit

Barangay Health Stations

City Hospitals

Health Centers

Barangay Health

Stations

CURRENT STATUS

Health Outcomes

Demographic Characteristics

Population, total (millions) 94,013,200 (projected, NSO 2007)

Population < 25 years

(% of total population)

52.8 % (projected, NSO 2007)

49,617,400 M Filipinos

Population > 60 years

(% of total population)

6.7% (projected, NSO 2007)

6,637,100 M Filipinos

Birth rate

(births per 1,000 population)

23.4 (NDHS 2008)

2,162,303 live births per year

Death rate

(deaths per 1,000 population)

5.48 (NSO 2007)

515,192.34 deaths / year

Top Ten Causes of MortalityCause Total Rate

1. Diseases of the heart 70, 861 84.8

2. Diseases of the vascular system 51,680 61.8

3. Malignant Neoplasms 40,524 48.9

4. Accidents 34,483 41.3

5. Pneumonia 32,098 38.4

6. Tuberculosis 26,770 31.0

7. Unclassified 21,278 25.5

8. Chronic lower respiratory diseases 18,975 22.7

9. Diabetes mellitus 16,552 19.8

10. Conditions originating from the

perinatal period

13,180 15.8

Philippine Statistical Yearbook, 2009

Towards the attainment of MDGs ….

Indicators 2015 Target Accomplishment

MDG 4:

Under 5 mortality rate(per 1,000 live births)

26.7 34 (2008 NDHS)

Infant mortality rate 19.0 25 (per 1,000 live births) (2008 NDHS)

MDG 5:

Maternal mortality ratio(per 100,000 live births)

52 162 (2006 FPS)

Proportion of births attended by skilled health professional

70%(2010 NOH)

62 %(2008 NDHS)

Contraceptive Prevalence Rate (modern methods)

70%(2010 NOH)

34% (NDHS, 2008)

INDICATORS 2015 Target ACCOMPLISHMENT

MDG 6

Prevalence of HIV/AIDS among high risk groups

<1%5,364 cases (1984-2010)

<1%

Malaria morbidity rate 62/100,000 pop 38,135 cases(based from 1990

baseline)

21.6/100,000 pop19,555 cases

(2009)

Malaria mortality rate 0.75456 deaths

0.02624 deaths

13

456 deaths(based from 1990

baseline)

24 deaths(2009)

TB morbidity rate 137/100,000128,798 cases

(2010 NOH)

129 (2008)121,277 cases

TB mortality rate <44/100,00041,366 deaths

(PhilPACT)

41.0 (2007)

TB case detection rate 70 % 75 % (NTP, 2007)

TB cure rate 85 % 83 % (NTP, 2007)

Mortality Trend: Communicable Diseases, Malignant Neoplasms & Diseases of the Heart

Rate/100,000 PopulationPhilippines, 1953-2005

400

500

600

700

Communicable Diseases

60

70

80

90

100

Malignant Neoplasms & Diseases of the Heart

Communicable Diseases

Malignant Neoplasms

Diseases of the Heart

0

100

200

300

1953 '54

'55

'56

'57

'58

'59

'60

'61

'62

'63

'64

'65

'66

'67

'68

'69

'70

'71

'72

'73

'74

'75

'76

'77

'78

'79

'80

'81

'82

'83

'84

'85

'86

'87

'88

'89

'90

'91

'92

'93

'94

'95

'96

'97

'98

'99

2000 '01

'02

'03

'05

Year

0

10

20

30

40

50

Source: Philippine Health Statistics, 2005

CURRENT STATUS

HEALTH FINANCING

Share of health expenditure per GDP

2

2.5

3

3.5

4

Per

cent

0

0.5

1

1.5

2

Per

cent

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

YearTotal health expenditure = P234.3 B ( $5.2B) or 3.2 percent of GDP

Source: Philippine National Health Accounts

Total expenditure on health as a Percentage

of GDP

Source: World Health Statistics 2010

Distribution of Health Expenditure by

Use of FundsPublic

Health Care9%

P 21.2 billion

Others10%P 23.3 billion

Total health expenditure is P234.3 B

($ 5.2B) or 3.2 percent of GDP

Personal Health Care

81%P 189.7 billion

Source: Philippine National Health Account, 2007

Distribution of Health Expenditure by

Source of Funds

Source: Philippine National Health Account, 2007

Total health expenditure is P234.3 B or $5.2B (3.2 percent of GDP)

National Health Insurance Program

• A compulsory health insurance program of

government as established under Republic Act 7875

which shall provide universal health insurance

coverage and ensure

• affordable, acceptable, available and accessible

health care services for all Filipinos.

• Managed by Philippine Health Insurance

Corporation (PhilHealth), an attached agency of the

Department of Health

Membership (as of 2009)

• Employed Sector (46%)– covers all employed in the government and in the private sector

• Overseas Filipino Workers (11%) - PhilHealth took over the Medicare functions for OFWs on March 1, 2005

• Lifetime Program (1%) - Covers all retirees and pensioners 60 years old and above and with at least pensioners 60 years old and above and with at least 120 monthly contributions

• Individually Paying (15%)- Covers all self-employed and the informal economy workers

• Sponsored Program (24%) - Covers the poor families as identified through community surveys and enrolled by the Local Government Unit with National Government counterpart

3

4

5

6

7

Mil

lio

ne

n

Enrollment of the Poor

0

1

2

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 As of

Aug.

2010

• Enrollment of poor families by the LGUs increased from

0.087 in 1999 to 6.1M in August 2010

Health Insurance coverage by

wealth quintile, 2008

50

60

70

80

90

PhilHealth

0

10

20

30

40

50

Philippines Lowest Second Middle Fourth Highest

No Insurance

National Health and Demographic Survey 2008

1,566

0,009

1,752

0,010

MIDDLE INCOME

HIGH INCOME P194,965

P30,622

Ave.

Monthly

Income

19.1%

0.1%

The informal sector and self-employed

2,208

4,431

2,470

4,957

5 4 3 2 1 0 1 2 3 4 5

LOW INCOMEPOOR

LOW INCOMENON POOR

Number of Families(in Millions)

Non Wage/Salaries Wage/Salaries

>P7,513

Source: NSCB (FIES 2006)

80.8%

Total: 17.4 Million families

Health Insurance coverage by region,

2008

VII- Central Visayas

VIII- Eastern Visayas

IX- Zamboanga Peninsula

X- Northern Mindanao

XI-Davao

XII-SOCCSKSARGEN

XIII-Caraga

ARMM

0 20 40 60 80 100

Philippines

NCR

CAR

I- Ilocos

II-Cagayan Valley

III- Central Luzon

IVA- CALABARZON

IVB- MIMAROPA

V- Bicol

VI- Western Visayas

VII- Central Visayas

No Insurance

PhilHealth

PhilHealth

“The President was dismayed at the benefit

delivery rate of the National Health Insurance

Program in the country”

26

Coverage rate Availment rate Support value

53% 42% 34%

CURRENT STATUS

HEALTH FACILITIES

Hospitals

Hospitals

Priority Health Policy Directions of

the DOH1. A roadmap towards universal health care through a

refocused PhilHealth;

2. Particular attention to the construction, rehabilitation, and support of health facilities:

– LGU/regional hospitals, – LGU/regional hospitals,

– rural health units

– barangay health stations

3. Attainment of Millennium Development Goals 4, 5, and 6– Reduction of maternal, neonatal, and infant mortality

– Support to contain/eliminate age old pubic health diseases (malaria, dengue, TB)

Every Link in PhilHealth Value

Chain must work to achieve

financial risk protection

FINANCIAL

PROTECTION

PROVIDED TO THE

POPULATION

AccreditationEnrollmentClaims

Availment and

Processing

Insurance

Payments

Source: Joint DOH-PhilHealth Benefit Delivery Review (2010)

Redirecting PhilHealth: Enrollment

• Enforce mandatory PhilHealth coverage for all Filipinos:– Autonomic enrollment of indigents identified by the

DSWD (lowest quintile)

– Compulsory enrollment of members of the informal sector, especially those who can afford to pay the

– Compulsory enrollment of members of the informal sector, especially those who can afford to pay the premium

• National government to pay for the entire premiums of the poorest quintile

• National government – local government sharing for the second poorest quintile

Redirecting PhilHealth: Enrollment

• Work with other government agencies to enforce mandatory PhilHealth membership for all Filipinos:

– School enrollment

– Licensing of business– Licensing of business

– Renewal of driver’s license

– Other government transactions

• Work with the private sector to launch innovative schemes in paying premiums (e.g. payment premium through SMS)

Redirecting PhilHealth: Accreditation

• Licensing and accreditation shall be unified to

fast track accreditation of more health

facilities in the country

• Provisional accreditation for all government • Provisional accreditation for all government

health facilities to ensure access of PhilHealth

members to health services

• Monitoring teams to check on needs of health

facilities for improvement

Redirecting PhilHealth:

Claims Availment and Processing

PhilHealth Information Technology upgrade to

accelerate processing of claims accelerate processing of claims

Redirecting PhilHealth:

Insurance Payments

• Improve significantly support value from 20% to 70% for all illnesses

• Increase significantly the support value for catastrophic illnesses

• Zero balance billing in all government hospitals • Zero balance billing in all government hospitals for the Sponsored Program

• Promote cost effectiveness: – case-payment

– registration of the indigents under one GP

– National standard treatment guidelines in all levels of health care

KaSAPI Program Kalusugang Sigurado at Abot-kaya sa

Philhealth Insurance

Objectives:

• Increase enrollment and sustain membership

Implement an alternative premium payment • Implement an alternative premium payment

scheme through Organized Groups (OG)

• Identify and develop innovative approaches

of marketing SHI

• Strengthen solidarity and risk sharing

Mechanics to enroll the Informal

Sector through KaSAPI

• Focuses on group enrollment scheme through

organized groups (OG) with minimum membership

size of 1000

• OGs are assessed based on organizational stability

and financial performance

• Once the OG passes the evaluation, a Memorandum

of Agreement is signed with PhilHealth

• Provides incentives to partner-OGs through premium

discounts based on group size, and flexible mode of

payment (e.g. weekly premium payment through OG)

Health Facilities Enhancement

• Upgrading of health facilities: rural health

units, district hospitals, provinicial hospitals,

DOH Retained hospital

Strategies for Health Facilities

Enhancement• Public-Private Partnership

• Regional Clustering

• Fiscal autonomy and income retention for

government health facilitiesgovernment health facilities

• Streamlining of licensing and regulation for

improved accreditation

Thank you!