PHILIPPINE HEALTH FINANCING Health Sector Reform Agenda Fiscal autonomy for govt hospitals Promote health insurance

ce schemes with private sector Tokenism in public health programs, community health and development of local health systems FOURmula ONE for Health (2005-2010) Integrated public health into hospital services Medical tourism Innovative financing arrangements Health Services for Sale: Medical Tourism Principally being promoted by the Philippine government using the public health care system Linked to the issue of organ trade (i.e. sale of kidneys for US$3,000-4,000) Expected revenues: US$ 10B in 5 years Medical Terrorism: Growing military presence The Unhealthy Philippine Health Care System A health care system that cannot maintain its own health human resource is not healthy at all. MAIN PROBLEMS IN HEALTH FINANCING IN THE PHILIPPINES Not enough money available Weak Political will Corruption Preventive, Not Curative Health Financing Strategy: Building a Path towards Universal Health Care Why do we need to pursue the HCF strategies? Underspending in health Fragmentation of financing Lack of social protection, equity and solidarity Inappropriate incentive structure Marginal impact of past reforms Health Care Finance PRINCIPLES Solidarity in funding health services No gray areas with respect to responsibilities and roles More choice, less protection New rules, easier time STRATEGIES Strategy 1: more resources Strategy 2: Sustain membership in social health insurance of all Filipinos Strategy 3: Allocate resources according to most appropriate financing agent

Strategy 4: Shift to new provider payment Mechanisms Strategy 5: Secure fiscal autonomy of Facilities How will this reform affect the DOH budget? 1: Increase resources for health Utilization of Health Sector Expenditure Framework to lobby for increase budget for health 2: Sustain membership in social health insurance of all Filipinos 100% national subsidy to enroll the poor 3: Allocate resources according to most appropriate financing agent Provide funding for public health commodities e.g. PMP Investing on capital outlay of tertiary hospitals 4: Shift to new provider payment mechanisms Implementation of case based payment in all hospitals DOH AO 137 s. 2002 on Waiver of Excess Fees for Sponsored Program in DOH Hospitals Rationalize government subsidies to national Hospitals 5: Secure fiscal autonomy of facilities Implementation of performance based grants for hospitals DOH hospitals fully corporatized and Autonomous Re-directing the National Health Insurance Program 1: Increase resources for health Expand Collection Network, particularly to enrol the Informal Sector Increase PhilHealth premium based on households capacity to pay 2: Sustain membership in social health insurance of all Filipinos Segment, expand and sustain the enrollment of informal sector, OFWs and elderly Facilitate enrollment of contractual employees 3: Allocate resources according to most appropriate financing agent Funding out-patient packages through capitation 4: Shift to new provider payment mechanisms Use of capitation for primary health care services Implement case mix system Arrange contracts with service providers 5: Secure fiscal autonomy of facilities Accreditation of local health systems/ other service providers like pharmacies Influencing LGU spending for health 1: Increase resources for health Increase LGU budget for health through Provincewide Investment Plan for Health (PIPH) Counterpart Increase LGU subsidy for Sponsored Program/IPP premiums 2: Sustain membership in social health insurance of all Filipinos

 Promote and sustain membership in PhilHealth of all sectors of the LGU population: formal, informal, Sponsored Program 3: Allocate resources according to most appropriate financing agent Provide adequate funding for salaries and capital outlay of local health facilities 4: Shift to new provider payment mechanisms Implement contracts between PhilHealth and LGU owned primary and secondary facilities 5: Secure fiscal autonomy of facilities Allow LGU non-hospital health facilities (RHUs, HC, BHS) to retain income Covert LGU hospitals to become economic enterprises Presidential Platform and Policy Pronouncements on Health Universal Healthcare coverage for all Filipinos Access to health through improved health infrastructure A holistic and comprehensive healthcare system Good governance The Formula for Health, Health Insurance as Driver of Health Sector Reforms in the Philippines Framework for Health Sector Reform Good Governance Health Care Delivery Health Regulation Health Care Financing Good Governance Enhance the Performance of the Health Sector Strengthen national and local health systems Pursue public health and hospital reforms Improve management systems Expansion & development of health human resource A rationalize and more efficient DOH Corporate transformation of certain DOH facilities Greater transparency and accountability Greater assistance, leadership & management training to LGUs Health Care Delivery Universal Access to Basic and Essential Health Care Services Campaign for universal health insurance coverage Services that will help reduce mortality and morbidity from certain diseases Services that will eliminate certain diseases as public health problems Services that promote health lifestyle Services that cater to special health & nutrition needs Improved health care delivery infrastructure to include referral system

Health Regulatory Assuring the Quality and Affordability of Health Goods and Services Strengthen the regulatory bureaus in tandem with PhilHealths quality assurance, accreditation and cost containment measures Bureau of Food and Drugs (BFAD) Bureau of Health Devices and Technology (BHDT) and Bureau of Health Facilities Services (BHFS) Greater and higher income generation and retention by regulatory bureaus Help reduce cost of quality medicines and drugs Health Care Financing Increasing Investments in Health Sustain and expand the National Health Insurance Program (NHIP) Mobilize more resources for health Encourage greater private sector participation Efficient production, allocation and utilization for health Progressive and socialized contribution schemes with the NHIP Development of health care financing models Increased PhilHealth reimbursements to help improve quality of care Giving Access to the Poor Through Health Insurance The PhilHealths Sponsored Program For those without any visible means of income or whose income is insufficient for the subsistence of the family Beneficiaries are identified through a Means Test Premium of Indigent Members are subsidized by the National Government and the Local Government Units Equity through Health Insurance All members of PhilHealth regardless of membership type, enjoy the same level of benefits in any and all of the accredited health facilities nationwide. The portability of benefits nationwide by all the members ensure majority of Filipinos have basic health services Responding to the MDG Goals PhilHealth likewise introduced specific benefit packages that addresses the MDG (Millenium Development Goals) goals of maternal health, infant mortality and control of certain diseases reimbursement of normal deliveries primary care package

 TO defined package