Health Delivery

System in the
Philippines
Maria Teresa T. Basilides, RPh
Dr. Mariano Que College of Pharmacy
De La Salle Medical and Health Sciences Institute
 Remember that you are in the Holy presence of God

A chemist's prayer.
Therese. Southgate
Journal of Chemical
Education 1946 23 (10),
507
DOI: 10.1021/ed023p507

Live Jesus in our hearts, FOREVER.

Intended Learning Outcomes
• Understand the system of the government
agencies/institution in health care delivery
• Explain similarities and differences of
health care services provided by
Government and Non-government sectors
• Design an Inter-disciplinary Health
Management Team scheme
 Objectives
At the end of this lesson, you should be able to:
1. Understand the Health Sector Reform Agenda
introduced by DOH
2. Describe the Health Financing Status in the
Philippines through RA 10606 and RA 10351
National Health Insurer

• Philippine Health Insurance

Corporation (PhilHealth)
• Established in 1995
• Goal: to provide financial risk
protection for the Filipino people
 A. FORMAL SERVICE PROVIDERS
Private • Clinics
• Infirmaries
Sector • Laboratories
• Hospitals
The private sector’s • Drugstores
collective contribution • Pharmaceutical and medical
to health service supply companies
provision is enormous • Health insurance companies
and their capacity • Academic and research
augments the gaps institutions
and inadequacies of
B. NONFORMAL SERVICE
the public sector.
PROVIDERS
• traditional healers
(herbolarios)
• traditional birth attendants
(hilots)
 Private Sector and NGOs
• Professional groups are involved in the promotion of the
highest standards of practice and competence in the
health professions and the promotion of the rights and
privileges regarding such practice.
– Philippine Medical Association
– Philippine Nurses Association
– Philippine Dental Association
– Integrated Midwives Association of the Philippines
– Philippine Pharmacists Association
 Private Sector and NGOs
• Specialty societies and specialty boards in
the medical profession are also involved in
the accreditation of training institutions,
administration of qualifying examinations
and granting of certificates for Diplomates
and Fellows for medical specialists:
– Philippine College of Physicians,
– Philippine College of Surgeons,
– Philippine Academy of Family Physicians,
– Philippine Pediatrics Society
– Philippine Obstetrical and Gynecological
 Private Sector and NGOs
Philippine Red Cross
• Functions include:
– providing staff and volunteers for humanitarian
services in times of disasters and natural calamities;
– ensuring safe and quality blood services through its
active role in voluntary blood donation, testing and
processing; and
– promoting health through its primary health care and
community-based health programmes.
 Health Service Delivery

• Good Health Services:

– Deliver effective, safe
and quality health
interventions to those
who need them; when
and where needed,
with minimum waste
of resources
 Some countries
based their
system upon one
model, while
others choose a
combination.
Health Service Delivery
• All services dealing with
disease diagnosis and
treatment
• All services for the
promotion, maintenance
and restoration of health
• Both personal and non-
personal services
 Health Service
Delivery
• Health services - most visible
functions of any health system
– Service provision: the way
inputs (money, staff,
equipment, drug, facilities,
etc.) are combined for the
delivery of health
interventions
– Ensured availability of key
resources as well as good
service management and
organization result in:
• Improved coverage
• Better quality of health
services
 Health Service
Delivery
• Key Elements
– Organizing health
services as networks of
primary care backed up
by hospitals and
specialized care
– Providing a package of
health benefits with
clinical and public health
interventions
– Ensuring access and
quality of health services
– Holding providers
accountable for access
and quality and ensuring
consumer voice
 • This was introduced by
Health the Department of Health
Sector (DOH) in 1999 to improve
the performance of the
Reform health sector by
Agenda improving the way health
(HSRA) services are being
provided and financed.
 • Expand effective coverage of
national and local public health
programs,
• Increase the access, especially
by the poor, to personal health
services delivered by both public
and private providers, and
HSRA
• Reduce the financial burden on
Objectives individual families through
universal coverage of the
National Health Insurance
Program (NHIP). It consists of
five interrelated health reform
areas:
 Local Health Systems
Development

Hospital System Reforms

Health
Public Health Program
Reform Reforms

Areas Health Regulatory

Reforms

Social Health Insurance

Reforms/Health Financing
 Health Reform Areas
Public Health Program
Local Health Systems Hospital System Reforms
Reforms
Development
• Provide fiscal and • Strengthen the capacity
managerial autonomy to of the DOH to exercise
• Promote the development government hospitals, technical leadership in
of local health systems which involves improving disease prevention and
where networking among the way hospitals are control
municipal and provincial
health facilities are
governed and financed • Enhance the
so that quality of care is effectiveness of local
functional and sustained improved, hospital
by cooperation and cost public health delivery
operations are cost systems
sharing among Local efficient, revenues are
Government Units (LGUs) • Sustain funding for
enhanced and retained, priority public health
in the catchment area and dependence on programs over a period
direct budget subsidies required to remove them
are reduced as public health threats
 Cost Sharing is a multiparty
arrangement under which costs of
a program or project are shared
by the involved parties, according
to an agreed upon formula or
contract.

http://www.businessdictionary.com/
 Health Reform Areas
Health Regulatory Social Health Insurance
Reforms Reforms/Health Financing
• Strengthen capacities of • Expand the coverage and
DOH to exercise its enhance the benefit
regulatory functions to package of NHIP so as to
ensure that health effectively reduce the
products (particularly financial burden to
pharmaceuticals), individual families
devices, and facilities are through effective risk
safe, affordable, and of pooling, and provide the
good quality NHIP greater leverage to
ensure value for money
in benefit spending
 • By insuring both low- and high-
risk customers, insurance
companies can transfer some of
Risk Pooling is an the costs of high-risk customers
insurance practice to lower-risk customers, thus
that groups large reducing the overall cost to the
numbers of people insurance company of insuring
together to minimize high-risk people.
the cost impact of the • This cost-effective practice
highest-risk helps reduce the impact of high-
individuals. risk individuals since there will
be more of a balance with low-
risk individuals.
 Health Sector Reform Agenda
(HSRA)
This was designed as a package because the components
are highly interdependent.
• This was implemented in convergence
sites (province or city) where all the five
major health reform components are
being implemented in an integrated STAKEHOLDERS:
fashion and all the major stakeholders DOH
come together and pool their efforts and Phil Health
resources to make the health reforms LGUs
succeed. Civil Society
groups
Beneficiaries
 • aims to generate sufficient
improvements in health
delivery and financing in
these local sites that are
easily discernible by the
residents targeting at least
64 convergence sites.
Convergence
Strategy The long term goals are:
1. To improve efficiency in the
delivery of health services
2. To ensure access to basic
health services
3. To secure enough funds to
sustain quality health care
 Universal Health Care (UHC)
• Another Health Reform initiated in 2010 through
the issuance of Administrative Order No. 2010–
0036
• Also known as Kalusugan Pangkalahatan (KP)
• Through UHC, the government continued the
health reform efforts through key strategies:
• Achieving universal and sustainable PhilHealth membership
• Upgrading and modernizing government health facilities
through Health Facilities Enhancement Program (HFEP)
• Fortifying efforts to achieve the Millennium Development
Goal (MDG) targets
 UNIVERSAL
HEALTHCARE
• Is the belief that
all citizens should
have access to
affordable high-
quality medical
and healthcare
services
(comprehensive)
Universal Health
Care (UHC)

The optimization of
six critical
instruments or
building blocks has
been identified as
the key to the
attainment of the
three strategic
thrusts.
 Building Blocks of UHC
Health Financing – to increase Service Delivery – to transform
resources for health that will be the health service delivery
effectively allocated and utilized structure to address variations in
to improve the financial protection health service utilization and
of the poor and vulnerable health outcomes across
sectors; socioeconomic variables;

Policy, Standards and

Governance for Health – to
Regulation – to ensure equitable
establish the mechanisms for
access to health services,
efficiency, transparency and
essential medicines and
accountability and prevent
technologies of assured quality,
opportunities for fraud;
availability and safety;

Health Information – to establish

a modern information system that
Human Resources for Health –
will provide evidence for policy
to ensure that all Filipinos have
and program development, and
access to professional health-
support for immediate and
care providers, capable of
efficient provision of health care
meeting their health needs at the
and management of provincewide
appropriate level of care; and
health systems (Department of
Health, 2010b).
Results of Universal Health Care
(UHC) Policy Implementation
– Provided PhilHealth coverage by 92%
– Subsidized PhilHealth premiums for poor families
– Upgraded and constructed 4,920 local health facilities
and National Government hospitals
– Improved an additional 4,000 LGU facilities
– Deployed 23,800 health professionals
– Mobilized 51,594 community health teams
– Distributed critical equipment and health commodities
to LGUs including vaccines, TB medicines,
insecticide-impregnated bednets and other medicines
 Service Delivery Networks (SDNs)
• The DOH issued Administrative Order No.
2014–0046 promoting the establishment of
Service Delivery Networks (SDNs) to efficiently
and effectively cover the health needs of the
population, particularly identified priority groups,
for UHC programmes and projects.

An SDN refers to the network of public and private

health providers within local health systems offering
a core package of health services in an integrated
and coordinated manner as a form of health referral
within and outside the DOH, including with LGUs,
development partners and civil society groups.
Health Financing
Two Main Characteristics of
Good Health Financing

People who use

Raises adequate health services are
funds for health to shielded from financial
ensure that people get catastrophe or
to use the needed impoverishment
services associated with having
to pay for them
Health and Healthcare
are major political and
economic issues

• Health financing
impacts the analysis
of:
– Health policies
– Fund sources
– Effectiveness and
efficiency of
health services for
populations
 Raising sufficient funds for health

Ensure adequate spending on

Health health

Financing
Effective allocation of finite
Goals financial resources to different
types of public and personal health
services

Pooling financial resources across

population groups and sharing
financial risks Using funds for
health efficiently and equitably
 Main Fund Sources:
Private
Social
(OOP, Others
Health
Government HMOs, Life (grants, aid,
Insurance
insurance, etc.)
(SHI)
etc.)
Philippine
Health
Financing
Filipino households continue
to bear the heaviest burden
(very high proportion of out-
of-pocket spending)
 Public Financing Scheme
• Mix of the
Beveridgean system
(government tax-
funded financing of
DOH and LGU health
facilities), the
Bismarckian system
(PhilHealth premium-
and tax-funded
financing), small-
pooled private
prepayment
schemes, and large
unpooled financing
comprising OOP
expenditures.
 Philippine Health
Financing
• In the General Appropriations Act of
2019, the Department of Health–Office
of the Secretary (DOH-OSEC) and the
PhilHealth was allocated a total
amount of PhP 165 billion.
• This budget is lower by 1% from the
CY 2018 budget of PhP 167 billion.
• The decrease was due to the
government’s transition to cash-based
budgeting system and the transfer of
portion of Human Resources for Health
Deployment budget to the
Miscellaneous Personnel Benefit Fund.
How does the
Sin Tax Law
affect the
Health
Financing?
 • Known as Sin Tax Reform
Act of 2012
• Based on its Implementing
Rules and Regulations (IRR),
after deducting the share of
Republic LGUs, the remaining
incremental revenues shall
Act No. be allocated for health.
• The 80% of the incremental
10351 revenue for health is
intended for universal health
care (UHC) expenditures and
20% for medical assistance
and Health Enhancement
Facilities Program (HEFP).
 Out-of-Pocket (OOP)
Expenditure
• OOP spending continued to have the lion’s
share of Health Expenditures (53.7% in 2014).
OOP spending continues to be the dominant
payment mechanism.
• OOP payments are unpooled and spent at the
point of service and tend to be inefficient,
inequitable and inflationary.
• OOP payments are mostly spent on OTC drugs
and prescription pharmaceuticals. Some are
spent on the uncovered portion of PhilHealth
and visits to private doctors.
 • National Health Insurance
Act of 2013
• amended Republic Act
No. 7875 (the National
Health Insurance Act
Republic [NHIA] of 1995)
Act No. • It provides for mandatory
coverage of all citizens in
10606 accordance with the
principles of universality
and compulsory
coverage.
• Under the National Health Insurance Act of 1995,
premium contributions for enrolling in PhilHealth for
indigent members are subsidized through a cost-sharing
arrangement between the National Government and the
LGU where the indigent member resides. In certain
cases, however, some LGUs are not able to provide their
share of the contribution.
• This cost-sharing arrangement was amended with the
enactment of the National Health Insurance Act of 2013,
with the National Government fully assuming the subsidy
through the budget of the DOH.
• Enrolment of specific sponsored members under the
care of the Department of Social Welfare and such as
orphans, persons with disability, senior citizens and
battered wo Development (DSWD) men will be fully
subsidized through the national budget of the DSWD.
 Republic Act No. 10606
(i) calls upon PhilHealth, the
DOH, LGUs, other government
agencies and NGOs to ensure
that members shall have
access to quality and cost-
effective health services; and
(ii) calls upon PhilHealth to enroll
beneficiaries and issue them
health insurance identity (ID)
cards and ID numbers for the
purpose of identification,
eligibility verification and
utilization reporting.
 Classification of PhilHealth Members
(i) members in the formal economy or
workers with formal contracts and fixed
terms of employment, including workers
Republic in the government and the private
sector whose premium contribution
payments are equally shared by the
Act No. employee and employer (1.25% each of
payroll, with an effective ceiling of PHP
10606 50 000);
(ii) members in the informal economy, or
(Sec 7) those who are not covered by formal
contracts or agreements and whose
premium contributions are self-paid or
subsidized by another individual or
institution;
 Classification of PhilHealth Members
(iii) indigents or persons who have no
visible means of income, or whose
income is insufficient for the
Republic subsistence of the family, as identified
by the DSWD, based on specific criteria
Act No. set for this purpose;
(iv) Sponsored Program members
10606 (mostly indigents) or those whose
contribution is being paid by another
(Sec 7) individual or institution; and
(v) lifetime members or those former
members who have reached the age of
retirement and have paid at least 120
monthly contributions.
 Problems
Encountered in
(PHIC)
• Membership in PhilHealth is
compulsory, but individuals and
institutions exploit administrative
loopholes to compromise this
compulsivity.
– Some firms show casual
employees to escape payment
of health insurance premiums;
– Some report a lower-than-
actual number of employees
or payrolls (for assessed
contributions).
 Problems
Encountered in
(PHIC)

Administrative
shortcomings at PhilHealth
also result to:
– firms’ nonpayment,
– delayed payment or
late remittance of
premium payments,
causing arrears
 Problems
Encountered in
(PHIC)
Other loopholes pertain to workers
in labour transition which results in
workers not having coverage:
– frictional unemployment
– becoming an overseas
Filipino worker [OFW])

There is no automatic membership at birth because the

civil registry system is not yet utilized as a means of
universal coverage, enrolment and entitlement.
Insurance Commission (IC)

• The Insurance Commission (IC) under

the Department of Finance regulates
and supervises the operations of private
insurance companies, including health
insurance and pre-need companies as
well as mutual benefit associations and
Health Maintenance Organizations
(HMOs) in accordance with the
provisions of the Insurance Code, as
amended, Pre-Need Code of the
Philippines, and EO No. 192 series
2015
 STUDENT ACTIVITY No. 4
• Prepare a Reaction Paper about your
personal views and opinions regarding the
Public Health Issues brought about by the
spread of Corona Virus and how it was
dealt and addressed. How this affect you
as a student, as a future Pharmacist and
as a citizen? Write your answer in not
more than 250 words.
 Reference:
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119-s-1987/
• https://www.officialgazette.gov.ph/1991/10/10/republic-act-no-7160/
• https://www.doh.gov.ph/
• https://www.doh.gov.ph/sites/default/files/publications/setting_agend
a_for_reform.pdf
• https://www.military-medicine.com/almanac/101-philippines-the-
republic-of.html
• Asia Pacific Observatory on Health Systems and Policies. The
Philippines Health System Review. Vol. 8 No. 2, 2018.
 Reference:
• https://www.doh.gov.ph/sites/default/files/publications/SinTax%2020
19%20Annual%20Report.pdf
• https://oxfordbusinessgroup.com/overview/expanded-coverage-
pandemic-response-and-ongoing-challenges-necessitate-
collaborative-approach-across
• https://www.statista.com/topics/6483/health-sector-in-the-
philippines/#dossierKeyfigures
• https://www.internationalinsurance.com/health/systems/philippines.p
hp