The Philippine Health Care System
HEALTH FOR ALL FILIPINOS Christine S. Tinio, MD, MPH, FPAFP
At
the end of the session, the student should be able:
Define health care system Discuss the factors affecting the health care system Describe the Philippine Health Care Delivery System Discuss the structure, s tructure, functions activitiess and programs of the activitie Department of Health
Health System Interrelated
system in which a country organizes avai av aila labl ble e re resou sourc rces es for for the the maintenance and improvement of the health of its citizens and communities.
health system comprises all organizations, institutions and resources devoted to producing actions whose primary primary intent is to improve health. A
The four essential functions of a health system have been defined as service provision, resource generation, financing and stewardship
Health care System Models
Private enterprise health care Social security health model Publicly funded health care model Social health insurance
Private enterprise health care model Purely p rivate enter p rise health care systems are comparatively rare.
Where
they exist, it is usually for a comparatively well-off subpopulation subpopulation in a poorer country with a poorer standard of health care²for instance, private clinics for a small, wealthy expatriate population in an otherwise poor country.
But there are countries with a majority-private health care system with residual public service
Social security health model
Where
workers and their families are insured by the
state refers to social welfare service concerned with social protection, or protection against socially recognized conditions, conditions, including poverty, old age, disability, disabili ty, unemployment and others. Social security may refer to:
social insurance, where people people receive benefits or services in recognition of contributions to an insurance scheme. These services typically include provision for retirement pensions pensions,, disability insurance, insurance, survivor benefits and unemployment insurance.. insurance income maintenance³mainly maintenance³mainly the distribution of cash in the event of interruption of employment, including retirement, disability and unemployment services provided by administrations responsible for social security. In different countries this may include medical care, aspects of social work and even industrial relations.
Publicly funded health care model Where the residents of the country are insured by the state Health care that is financed entirely or in majority part by citizens' tax payments instead of through private payments made to insurance companies or directly to health care providers
Social health insurance where the whole population or most of the population is a member of a sickness insurance company company (SHI) is a method for finan financing cing heal health th care costs through a social insurance program based on the collection of funds contributed contribute d by individuals, employers, employers, and sometimes government governme nt subsidies characterized characterized by the presence of sickness funds which usually receive a proportional contribution of their members' wages. With this insurance contributions these funds pay medical costs of their members
Affiliation
to such funds is usually based on professional, geographic, religious/political and/or non-partisan criteria.
Structure of a Health System Heal He alth th Se Sect ctor or Health Status
Population Health-related sectors
Structure of a Health System Heal He alth th Se Sect ctor or Health Status
Population Health-related sectors
Health Status Birth Death Morbidity Mortality Nutrition
The Healt h Status of t he Fili pino Peo ple HFA 2000
oIMR
< 50
Targets 2004 49/1000 LB
oMMR
179.7/100000 LB
oCBR
28.4/1000
oLife Expectancy o CDR
> 60 y/o 6.1 /1000
Structure of a Health System Heal He alth th Se Sect ctor or Health Status
Population Health-related sectors
The Po pulation Demographic characteristics Socio-cultural factors Political factors
Country
Life Expectancy in years
Philippines
70
Thailand
70
Malaysia
73
South Korea
75
Japan
81
Country Philippines
Population Growth 2.1 ²2.3 %
Thailand
1.4 %
Malaysia
2.2 %
South Korea
0.8 %
Japan
0. 3 %
Total Fertility Rate (ave. no. of children per woman)
Total Fertili F ertility ty Rate Country
1960
1990
200 1
Philippines
7.0
4. 4
3. 4
Thailand
6.4
2.3
2. 0
Malaysia
6.8
3.8
3. 0
South Korea
6.0
1.7
1.5
Japan
2.1
1.6
1 .4
The Po pulation Socio-Cultura Socio-Culturall Factors The majority of Filipinos are Roman Catholics High functional literacy rate of 83.8% folk beliefs, misconceptions and practices detrimental to health are still rampant.
- The family family is the the basic unit unit of Filipino Filipino socie society ty
The Po pulation Political Influences the Philippines is a democratic country local government units (LGUs) comprise the political subdivisions of the Philippines
Health Care Utilization: Physica sicall ba barrie rriers rs - geo geogra graph phica icall Phy location patterns of health care consumers in relation to health providers Financial factors also exist that affect health seeking patterns of the Filipinos
Structure of a Health System Heal He alth th Se Sect ctor or Health Status
Population Health-related sectors
Health Sector refers to the groups of services or institutions in the community or country which are concerned with the health protection of the population May be public (gov·t), private, and non-governmental health organizations
Functions of the Health Sector Direct provision of health services: promotion, prevention, Dx and Tx, medical rehabilitation Dev·t and provision of health manpower, drugs and medical supplies; financing support
Functions of the Health Sector Research and dev·t Coordinating, controlling and directing organizations and activities associated with other functions
The Health Sector and health-related health-related sectors Social organization of the health Care Economic issues
Health Human Resources The human resources for health are enormous but unevenly distributed. Most health practitioners are in Metro Manila and other urban centers
Registered Health Professionals 2000 Physicians - 95,016 Nurses Midwives
- 337,939 - 129,532
Health human resource The availability of health professionals in the domestic health care sector depends on the number of schools offering health professional education, the number of students admitted into medical, nursing, dental and other health professional schools, and the strictness of the schooling and examination requirements.
Health human resource manpower ² supply dependent on the demand in the foreign market
Major Influences on the Health Care System
Environmental Demographic Socio-Culture Political Economic
DEPARTMENT OF HEALTH
The DOH is the principa principall agency in health in the Philippines.
DOH It is responsible: for ensuring access to basic public health services to all Filipinos through the provision of quality health care and regulation of providers providers of health goods and services.
a policy and regulatory body for health a technical resource, a catalyzer for health policy and a political sponsor and advocate for health issues in behalf of the health sector. provides the direction and national plans for health programs and services
Vision
The leader of health for all in the Philippines.
Mission
Guarantee equitable, sustainable and quality health for all Filipinos, especially the poor, po or, an and d to lea lead d the qu ques estt for for excellence in health.
DOH Composed of 17 offices, 16 Centers for Health Development in various regions, 70 hospitals and 4 attached agencies
Milestones 1999 The functions and operations of the DOH was directed to become consistent with the provisions of Administrative Code 1987 and RA 7160 through Executive Order 102. The Health Sector Reform Agenda of the Philippines, 1999-2004 was launched.
1992 Full implementation of Republic Act No. 7160 or Local Government Code. The DOH changed its role from one of implementation to one of governance. Significant change: branching out of the Office of the Public Health Services to form the Office for Special Concerns. Two big offices merged to become the Office of Hospital Facilities, Standards and Regulation.
1987
Another
re-organization under Executive Order No. 119, which placed under the Secretary of Health five offices headed by an undersecretary and an assistant secretary. These offices are the Chief of Staff, Public Health Services, Hospital and Facilities Services, Standard and Regulations, and Management Service.
1986 The Ministry of Health became Department of Health again. 1982 Under Executive Order No. 851, the Health Education and Manpower Development Service was created, and the Bureau of Food and Drugs assumed the functions of the Food and Drug Administration.
1972 Through Letter of Implementation No. 8, pursuant to Presidential Decree No.1, Sept.24, 1972, the DOH was renamed Ministry of Health. The National Cancer Center and Radiation Health Service were created. The Ministry was divided into 12 regions covering several provinces and cities under a regional health director. Attached offices were the Philippine Medical Care Commission, the Dangerous Drugs Board, National Nutrition Council, Population Commission, National Schistosomiasis Control Council and the Tondo T ondo General Hospital.
Center for Health Development Responsible for field operations of the Department in its administrative region and for providing catchment area with efficient and effective medical services. It is tasked to implement laws, laws, regulation, policies and programs. programs. It is also tasked to coordinate with with regional offices of the t he other Departments, offices and agencies as well as with the local governments
DOH Hospitals Provides hospital-based care; specialised or general services, some conduct research on clinical priorities and training hospitals for medical specialisation.
Attached Agencies The Philippine Health Insurance Corporation is implementing the national health insurance law, administers the medicare program for both public and private sectors. The Dangerous Drugs Board on the other hand, coordinates and manages the dangerous drugs control program. Philippine Institute of Traditional and Philippine National AIDS Council
Alternative
Health Care
Center for Health Development
Act
as main catalyst and organizer in the ILHZ formation Provide technical support and advocacy for the dev·t of local health management systems and their integration in the context of the ILHZ Review and approve ILHZ proposals for funding Integrate local health plans into regional plans Undertake monitoring of the development and implementation of ILHS
District Health System ´A contained segment of the national health system which comprises a well defined administrative and geographic area either rural or urban and all institutions and sectors whose activities contribute to improve healthµ - World Health Organization
District Health System is subdivided into 3 levels of referral:
Primary ry ² bara barangay ngay healt health h stations stations and Prima rural health units Sec Second ondary ary ² dis distric trict/p t/prov rovinc incial ial hospitals Tert Tertiar iary y ² pro provin vincia ciall and regio regional nal hospitals
In the Philippines:
Inter Local Health Zone (ILHZ) Unit of the health system created for local health service management and delivery in the Philippines Applied in many developing countries where responsibility for health services has been decentralized from national to local health authorities
ILHZ Has a defined population within a defined geographical area and comprises a central or core referral hospital and a number of primary level facilities such as RHUs and BHS Clustering of municipalities
ILHZ Includes all stakeholders involved in the delivery of health services including community-based NGOs and the private sectors (foreign and/or local) Provides quality, equitable and accessible health care
Composition of ILHZ People e ² com commun munity ity memb members ers,, CHWs, Peopl NGOs, people·s organizations, local chief executives, other gov·t officials, private sector Boundarie Boundariess ² clear boundar boundaries ies betwe between en ILHZ Health facilities
Health th worke workers rs ² distr district ict health health team team Heal
Core Referral Hospital Main hospital for ILHZ and its catchment population Main point of referral for hospital services from the community, private medical practitioner and public health services at BHS and RHUs
Core Referral Hospital Minimum services: Out-patient services Lab and radiologica radiologicall diagnostic services Inpatient care Surgical services sufficient to provide emergency care for basic life threatening conditions, obstetrics and trauma
Provincial hospital
RHU
District Hospital
Importance of establishing an ILHZ To re-integrate hospital and public health services for a holistic holisti c delivery of health services To identify areas of complementation of the the stakeh stakehold olders ers ² LGUs at at all levels, levels, DOH, PHIC, communities, NGOs, private sector and others
Expected achievement of the ILHZ Universal coverage of health insurance Improved quality of hospital and RHU services Effective referral system Integrated planning Appropriate health information system
Expected achievement of the ILHZ Improved drug management Developed human resources Effective leadership through inter-LGU cooperation Financially viable or self-sustaining hospital Integration of public health and curative hospital
Minimum Package of
Activity
for PHC services
Pre-natal care Normal delivery and post-partum care Immunization Family planning Nutr Nu trit itio ion n ² Vi Vit. t. A & iron supplementatio supplementation n Growth monitoring Control of communicable diseases Minorr surgery Mino surgery ² sutur suturing ing , draining draining of abscess abscess,, circumcision Dental health Appropriate referral Environmental health services
Minimum Package of
Activity
for PHC services
Basic laboratory services Health promotion and education Management of public health services, coordination with NGOs and the private medical sector, participation in ILHZ management Training of human resources Supervision of health services and human resources within the municipal catchment area
Complementary Package of Activity for Core Referral Hospitals consultations for patients referred Outpatient consultations from the primary level Inpatient medical and surgical care Emergency room care Minor surgery (placental extraction, excision, suturing , D&C Anesthesia Major emergency surgery (CS, trauma surgery, appendectomy) Complicated deliveries Basic orthopedics orthopedics (ex. Setting of simple fractures
Complementary Package of Activity for Core Referral Hospitals Nutrition services Referral of more urgent cases to a higher level of care X-ray Laboratory services Blood transfusion Pharmacy services Management of hospital services and participation participat ion in ILHZ management Public health promotion and education Coordination with public health services Transport and communication linkages
Tertiary Package of Activity for provincial Gov·t Referral Hospital Pediatric, Pediatric, surgical, medical, orthopedic obstetric and gynecology departments Expanded surgical capability (burns) Intensive care, neonatal intensive care, coronary care Ophthalmology Rehabilitative medicine (physiotherapy, occupational therapy)
full range of dental services Advanced diagnostics Public health laboratory (malaria, schistosomiasis, water analysis, referral laboratory laboratory of RHUs and core referral hospitals Blood bank and transfusion services services A
Tertiary Package of Activity for provincial Gov·t Referral Hospital Medical social services, veterans, senior citizens medical services Pharmacy services Dietary and nutrition services
Wellness
center program
Hospital administration administration and management services Emergency transport In-house engineering and maintenance
Factors contributing contributing to the limited capacity of the country·s health care system to deliver better health outcomes poor health care financing The inappropriate inappropriate health service se rvice delivery system, where there is excessive reliance on use of high-end hospital services rather than primary care, including an ineffective mechanism for providing public health programmes the brain drain of health professionals the excessively high price of medicines, leading to costly co stly out-ofpocket payments and inadequate and irrational use; inadequate enforcement of regulatory mechanisms the insufficient effort expended on prevention and control of new diseases, particularly non-communicable diseases Data adequacy, accuracy and timeliness are other important and perennial issues to be addressed. The unavailability of timely and accurate data/information data/information makes it difficult to make appropriate decisions on policies and programmes to improve health care.
ISSUES AND CONCERNS Some of the major factors affecting the countrys health status are as follows: inappropriate health delivery system inadequate regulatory mechanisms and poor health care financing.
SGD What are the priority programs of the DOH? List down the objective/s and activities of each program. SUBMISSION: Sec.
A:
Jun 3 @ 8 am Sec. B: Jun 4 @ 8 am
SGD Discuss Discuss the FOURmula FOURmula ONE ONE for Health(F1) Health(F1) ² over-a over-all ll goals, objectives Discuss the four components of F1as to:
A.
Strategies B. Activities structure implementing implementing the activities C. Gov·t structure D. Available DOH program in the implementation of activities SUBMISSION: Sec. B: Jun 4 @ 8 am
