philippine health care system

The Philippine Health Care The Philippine Health Care SystemSystem

HEALTH FOR ALL FILIPINOS

At the end of the session, the student At the end of the session, the student should be able:should be able:

Define health care systemDiscuss the factors affecting the health care system

Describe the Philippine Health Care Delivery System

Discuss the structure, functions activities and programs of the Department of Health

Health SystemHealth System

Interrelated system in which a country organizes available resources for the maintenance and improvement of the health of its citizens and communities.

A health system comprises all organizations, institutions and resources devoted to producing actions whose primary intent is to improve health.

The four essential functions of a health system have been defined as service provision, resource generation, financing and stewardship

Health care System ModelsHealth care System Models

Private enterprise health careSocial security health modelPublicly funded health care modelSocial health insurance

Private enterprise health care modelPrivate enterprise health care model

Purely private enterprise health care systems are comparatively rare.

Where they exist, it is usually for a comparatively well-off subpopulation in a poorer country with a poorer standard of health care–for 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 modelSocial 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, including poverty, old age, disability, unemployment and others.

Social security may refer to:◦ social insurance, where people receive benefits or services in recognition of

contributions to an insurance scheme. These services typically include provision for retirement pensions, disability insurance, survivor benefits and unemployment insurance.

◦ income maintenance—mainly 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 modelPublicly 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 insuranceSocial health insurance

where the whole population or most of the population is a member of a sickness insurance company

(SHI) is a method for financing health care costs through a social insurance program based on the collection of funds contributed by individuals, employers, and sometimes government subsidies

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 Structure of a Health System

Health Sector Health Status Population

Health-related sectors

Health StatusHealth Status

Birth DeathMorbidityMortalityNutrition

The Health Status of the Filipino The Health Status of the Filipino PeoplePeople

HFA 2000 Targets 2004

oIMR < 50 49/1000 LB

oMMR 179.7/100000 LB

oCBR 28.4/1000

oLife Expectancy

> 60 y/o

o CDR 6.1 /1000


Health Sector

Health Status Population


The PopulationThe PopulationDemographic characteristics

Socio-cultural factorsPolitical factors

Country Life Expectancy in years

Philippines 70

Thailand 70

Malaysia 73

South Korea 75

Japan 81

Country Population Growth

Philippines 2.1 –2.3 %

Thailand 1.4 %

Malaysia 2.2 %

South Korea 0.8 %

Japan 0.3 %

Country 1960 1990 2001

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

Total Fertility Rate

Total Fertility Rate Total Fertility Rate (ave. no. of children per woman)(ave. no. of children per woman)

The PopulationThe Population

Socio-Cultural 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 is the basic unit of Filipino society

The PopulationThe Population

Political Influences ◦the Philippines is a democratic country◦local government units (LGUs) comprise

the political subdivisions of the Philippines

Health Care Utilization:Health Care Utilization:

Physical barriers - geographical location patterns of health care consumers in relation to health providers

Financial factors also exist that affect health seeking patterns of the Filipinos


Health Sector

Health Status Population


Health SectorHealth 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 SectorFunctions 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 SectorFunctions of the Health Sector

Research and dev’tCoordinating, controlling and directing

organizations and activities associated with other functions

The Health Sector and The Health Sector and health-related sectorshealth-related sectors

Social organization of the health Care

Economic issues

Health Human ResourcesHealth 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 ProfessionalsRegistered Health Professionals20002000

Physicians - 95,016Nurses - 337,939Midwives - 129,532

Health human resourceHealth 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 resourceHealth human resourcemanpower – supply dependent on the demand in the foreign market

Major Influences on the Health Care Major Influences on the Health Care SystemSystem

EnvironmentalDemographicSocio-CulturePoliticalEconomic

DEPARTMENT OF DEPARTMENT OF HEALTHHEALTH

The DOH is the principal agency in health in the

Philippines.

DOHDOH

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 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

VisionVisionThe leader of health for all in the Philippines.

MissionMission

Guarantee equitable, sustainable and quality health for all Filipinos,

especially the poor, and to lead the quest for excellence

in health.

DOHDOH

Composed of 17 offices, 16 Centers for Health Development in various regions, 70 hospitals and 4 attached agencies

MilestonesMilestones

1999The 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.

1992Full 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.

1972Through 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 General Hospital.

Center for Health DevelopmentCenter 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, regulation, policies and programs. It is also tasked to coordinate with regional offices of the other Departments, offices and agencies as well as with the local governments

DOH HospitalsDOH Hospitals

Provides hospital-based care; specialised or general services, some conduct research on clinical priorities and training hospitals for medical specialisation.

Attached AgenciesAttached 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 Alternative Health Care

Philippine National AIDS Council

Center for Health DevelopmentCenter for Health DevelopmentAct 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 SystemDistrict 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 health”

- World Health Organization

District Health System is subdivided District Health System is subdivided into 3 levels of referral:into 3 levels of referral:

Primary – barangay health stations and rural health units

Secondary – district/provincial hospitalsTertiary – provincial and regional hospitals

In the Philippines:In the Philippines:

Inter Local Health Zone (ILHZ)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

ILHZILHZ

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

ILHZILHZ

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 ILHZComposition of ILHZPeople – community members, CHWs,

NGOs, people’s organizations, local chief executives, other gov’t officials, private sector

Boundaries – clear boundaries between ILHZ

Health facilitiesHealth workers – district health team

Core Referral HospitalCore Referral HospitalMain hospital for ILHZ and its catchment

populationMain point of referral for hospital services

from the community, private medical practitioner and public health services at BHS and RHUs

Core Referral HospitalCore Referral Hospital

Minimum services:◦Out-patient services◦Lab and radiological 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 Importance of establishing an ILHZILHZ

To re-integrate hospital and public health services for a holistic delivery of health services

To identify areas of complementation of the stakeholders – LGUs at all levels, DOH, PHIC, communities, NGOs, private sector and others

Expected achievement of the Expected achievement of the ILHZILHZ

Universal coverage of health insuranceImproved quality of hospital and RHU

servicesEffective referral systemIntegrated planningAppropriate health information system

Expected achievement of the Expected achievement of the ILHZILHZ

Improved drug managementDeveloped human resourcesEffective leadership through inter-LGU

cooperationFinancially viable or self-sustaining

hospitalIntegration of public health and curative

hospital

Minimum Package of Activity for PHC Minimum Package of Activity for PHC servicesservices

Pre-natal careNormal delivery and post-partum careImmunizationFamily planningNutrition – Vit. A & iron supplementationGrowth monitoringControl of communicable diseasesMinor surgery – suturing , draining of abscess,

circumcisionDental healthAppropriate referralEnvironmental health services

Minimum Package of Activity for PHC servicesMinimum Package of Activity for PHC services

Basic laboratory servicesHealth promotion and educationManagement of public health services,

coordination with NGOs and the private medical sector, participation in ILHZ management

Training of human resourcesSupervision of health services and human

resources within the municipal catchment area

Complementary Package of Activity for Complementary Package of Activity for Core Referral HospitalsCore Referral Hospitals

Outpatient consultations for patients referred from the primary level

Inpatient medical and surgical careEmergency room careMinor surgery (placental extraction, excision,

suturing , D&CAnesthesiaMajor emergency surgery (CS, trauma surgery,

appendectomy)Complicated deliveriesBasic orthopedics (ex. Setting of simple

fractures

Complementary Package of Activity for Complementary Package of Activity for Core Referral HospitalsCore Referral Hospitals

Nutrition servicesReferral of more urgent cases to a higher level

of careX-rayLaboratory servicesBlood transfusionPharmacy servicesManagement of hospital services and

participation in ILHZ managementPublic health promotion and educationCoordination with public health servicesTransport and communication linkages

Tertiary Package of Activity for Tertiary Package of Activity for provincial Gov’t Referral Hospitalprovincial Gov’t Referral Hospital 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) A full range of dental services Advanced diagnostics Public health laboratory (malaria, schistosomiasis, water

analysis, referral laboratory of RHUs and core referral hospitals

Blood bank and transfusion services

Tertiary Package of Activity for Tertiary Package of Activity for provincial Gov’t Referral Hospitalprovincial Gov’t Referral Hospital

Medical social services, veterans, senior citizens medical services

Pharmacy servicesDietary and nutrition servicesWellness center programHospital administration and management

servicesEmergency transportIn-house engineering and maintenance

Factors contributing to the limited capacity of the Factors contributing to the limited capacity of the country’s health care system to deliver better health country’s health care system to deliver better health outcomes outcomes

poor health care financing The inappropriate health service 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 out-of-

pocket 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 makes it difficult to make appropriate decisions on policies and programmes to improve health care.

ISSUES AND CONCERNSISSUES AND CONCERNS

Some of the major factors affecting the country’s health status are as follows:

inappropriate health delivery system

inadequate regulatory mechanisms and

poor health care financing.

SGDSGD

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

SGDSGD

Discuss the FOURmula ONE for Health(F1) – over-all goals, objectives

Discuss the four components of F1as to:A. StrategiesB. ActivitiesC. Gov’t structure implementing the activitiesD. Available DOH program in the implementation

of activities

SUBMISSION: Sec. B: Jun 4 @ 8 am

philippine health care system

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