2.doh transition plan to achieve mdg 4 5 032510 lzl_doh
DESCRIPTION
LEIZEL P. LAGRADA MD MPH PhD Medical Officer VI/ OIC – Health Planning DivisionHealth Policy Development and Planning Bureau2F Building 3 Department of Health San Lazaro Compound, Sta. Cruz, Manila 1003Telefax: 632-7116736E-mail: [email protected] I. EXPERIENCE MEDICAL OFFICER VI/ OFFICER IN-CHARGEHealth Planning DivisionHealth Policy Development and Planning Bureau Department of Health January 2010- Present• Facilitates the formulation of the national health plans including Health Sector Expenditure Framework for the Philippine Department of Health• Monitors and evaluates the operational and work and financial plans of Department of Health Central Office bureaus/services, Centers for Health Development and national government hospitals using the Major Final Outputs• Facilitates the development and improvement of systems in central DOH including, among others, the a) Expenditure Tracking System; b) Technical Assistance Coordination System; c) Health Care Financing Strategy; Health Sector Reform Monograph Series; and, e) the implementation of the reform initiatives• Provides technical assistance in facilitating investments in the Philippine health sector including the development of project proposals for international (multilateral and bilateral) funding assistance; crafting of terms of reference for different components of several foreign projects; participates and/or represents the bureau in the identification missions, contract negotiations, project preparation studies and project implementation reviews • Monitors the status of implementation of different foreign assisted project • Delivers lectures in relation to HSRA/Fourmula 1/health system directions/ health care financing• Facilitates training and planning workshopsTRANSCRIPT
Principles of Social Principles of Social Solidarity,Solidarity,Equity, Quality Assurance Equity, Quality Assurance and Cost-Containment: and Cost-Containment: PHIC PHIC enrollment, coverage enrollment, coverage and expendituresand expenditures
Dr. Leizel P. LagradaHealth Policy Development and Planning Bureau
Department of Health14 April 2010
OutlineOutlineDoes the health financing system of the
country fulfill the principles of solidarity, equity, quality assurance and cost containment?
Market failures in the health sector are addressed through different mechanisms
PhilHealth as the main financing agent
The DOH-PHIC response: HCF Strategy 2010-2020
Does the health financing system of the country fulfill the principles of solidarity, equity, quality assurance and cost containment?
Philippine National Health Accounts, 1997
Total Health Expenditure is PhP 87.1B (3.6% of GDP)
Philippine National Health Accounts, 2005
Total Health Expenditure is PhP 180 B (3.3% of GDP)
Financing health care mainly from out of pocket indicates a sickly health system
Market failures arise from Market failures arise from health care markets because health care markets because health care goods and health care goods and servicesservices
Generate externalitiesAre public goodsAre likely to be produced and sold in monopolistic markets
Are subject in asymmetric information
Fragmented health Fragmented health financing systemfinancing system
CHD
Pharmacies
Informal providers
DoH
Overseas treatment
Donors
DBM
Households/ companies
Users
Financial flows Financial sources Financial agents Providers
Other subsystems
Philhealth
Private Medical
Insurance
All LGUs
Private providers
LGU hospitals
Health Financing Flows in the Philippines
User fees
Premiums
Premiums
Budget allocation
Reimbursement
Retained hospitals
RHUTaxes
National Health Insurance National Health Insurance Act of 1995Act of 1995Provides all citizens of the
Philippines with the mechanism to gain financial access to health services through the National Health Insurance Program
Aims to prioritize and accelerate the provisions of health services to all Filipinos, especially the poor
Source: Jowett, Banzon and Basa, 2007
PhilHealth Benefit Payments, PhilHealth Benefit Payments, 2000-20092000-2009
In Billion Pesos
Source: PhilHealth Stats and Charts, 2009
Every Link in PhilHealth Every Link in PhilHealth Value Chain must work to Value Chain must work to achieve financial risk achieve financial risk protectionprotection
FINANCIALPROTECTION
PROVIDED TO THE POPULATION
AccreditationEnrollmentClaims
Availment and Processing
Insurance Payments
Source: Solon, 2010
Weak social solidarity and Weak social solidarity and inequityinequity
Health expenditures by financing agent and by income quintile, 2003
0.0
10.0
20.0
30.0
40.0
50.0
60.0
Billio
n p
es
os
Out of pocket
PhilHealth
Local government
National government
Out of pocket 1.6 3.8 6.4 12.2 35.9
PhilHealth 1.4 0.9 1.7 3.2 5.2
Local government 4.6 5.1 5.2 4.9 4.1
Nationalgovernment
3.8 4.6 5.1 5.0 4.6
Poorest 2nd 3rd 4th Richest
Source of basic data: Racelis, et al. (2006)Source: Herrin A. 2010
PhilHealth Accredited number PhilHealth Accredited number of bedsof beds
90% claims made by hospital to PhilHealth.
Predominantly fee-for-service
Source: Jowett, Banzon and Basa, 2007
PhilHealth does not negotiate prices with
hospitals for its members
Illustrative Source: Jowett, Banzon and Basa, 2007
IllustrativeIllustrative Source: Jowett, Banzon and Basa, 2007
Illustrative Source: Jowett, Banzon and Basa, 2007
DOH-PHIC Response:DOH-PHIC Response:Health Care Health Care Financing Strategy Financing Strategy 2010-20202010-2020
HCF PRINCIPLES HCF PRINCIPLES
Solidarity in funding health services
No gray areas with respect to responsibilities and roles
More choice, less protection
New rules, easier time
HCF GOALSHCF GOALS
Resource mobilization
Universal membership
Allocative efficiency
Technical efficiency
Strategy One: Increase Strategy One: Increase resources for healthresources for health
2010 2014 2020
THE at 3.3% of GDP THE at 4% of GDP THE at 5% of GDP
Government spending on health at 5.5% of total public spending
Government spending on health at 6% of total public spending
Government spending on health at 7% of total public spending
OOP as major financing source for health expenses
Average premium level of PhilHealth to increase by 5 times the 2009 level in real termsPhilHealth as major financing source for health expensesOOP spending at 30% of THE
Strategy Two: Sustain membership in Strategy Two: Sustain membership in social health insurance of all Filipinossocial health insurance of all Filipinos
2010 2014 2020Formal sector (including casual and contractual): payroll contributions
OFWs: Fixed premium
OFWs: Premium payment as requirement prior to migration
OFW: Continuous premium payment
Informal sector: Voluntary
Informal sector: Partial subsidy from LGU with contributions linked to administrative licenses/ permits/ documentation
Informal sector: Some on partial subsidy from LGU; others fully paying members
Indigents: Sponsored program as a shared subsidy between LGU and NG
Indigents: Sponsored program fully subsidized by NG
Strategy Three: Allocate resources Strategy Three: Allocate resources according to most appropriate according to most appropriate financing agentfinancing agent
2010 2014 2020PhilHealth: Main payer of personal careDOH: Subsidies for salaries and MOOE of retained hospitals, subsidies and distribution of drugs through vertical programs
DOH: Subsidies for salaries of retained hospitals, subsidies for public heath in provinces without PhilHealth universal membership
DOH: Main funder of capital outlay for tertiary hospitals; limited role in public health funding
LGU: Subsidies for salaries and MOOE of primary and secondary facilities
LGU: Subsidies for salaries of all primary facilities and some secondary facilities
LGU: Main funder of capital outlay of LGU-owned facilities and community-focused public health interventions
PhilHealth: one of the funders of public health interventions through outpatient packages
Strategy Four: Shift to new Strategy Four: Shift to new provider payment provider payment mechanismsmechanisms
2010 2014 2020Capitation for outpatient benefits for Sponsored Program beneficiaries
Capitation as a major tool to pay for primary health care services for all Filipinos
Fee-for-service for inpatient care
DRG for in-patient carePer case payment under a case-mix systemBenefits to include outpatient drugs
Per case payment for maternity care package and surgical proceduresPhilHealth spending: PHP22 billion
PHP 40 billion PHP 162-234 billion
Strategy Five: Secure fiscal Strategy Five: Secure fiscal autonomy of facilitiesautonomy of facilities
2010 2014 2020
DOH retained hospitals with income retention
DOH retained hospitals receive salaries from DOH budget
DOH retained hospitals are fully corporatized and autonomous; they do not receive subsidies
LGU health facilities without income retention
LGU health facilities with income retention
LGU health facilities receive minimal subsidy
Revenues = local taxes
DOH and LGU fund capital outlay
DOH and LGU fund capital outlay
GOP spending on supply side: PHP 45 billion
PHP 60 billion
Initial Outputs of HCF Initial Outputs of HCF Strategy ImplementationStrategy ImplementationAdministrative Order 2009-0029:
Guidelines for the Implementation of HCF 2010-2020
Consideration of HCF estimates and strategic directions on Health Sector Expenditure Framework 2011-2012
Legislative track: Health Care Financing Bill vs. Amendment of NHIL (RA 7875)
Initial Outputs of HCF Strategy Initial Outputs of HCF Strategy Implementation Implementation Strategy On-going work
1: Increase resources for health
DOH: Health Sector Expenditure FrameworkLGU: PIPH and Local Health AccountsPhilHealth: efficient collection of premium contributions
2: Sustain membership in SHI of all Filipinos
Segmenting the Informal Sector to Strengthen the Individually Paying Program:
3: Allocate resources according to most appropriate financing agent
Development of Essential Health Package
4: Shift to new provider payment mechanisms
Contracting with Service ProvidersPiloting of Case Payment
5: Secure fiscal autonomy of facilities
Income Retention for DOH HospitalsEconomic Enterprise for LGU Hospitals
Thank You and Thank You and Good MorningGood Morning