Philippine Health Agenda: Universal Health Care. Enrique T. Ona, MD, FPCS, FACS Secretary of Health

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1 Philippine Health Agenda: Universal Health Care Enrique T. Ona, MD, FPCS, FACS Secretary of Health

2 Thirty percent of our countrymen who succumb to sickness die without seeing a doctor. -President Aquino s Challenge July 2010 Universal Health Care Deliberate attention to the needs of millions of poor Filipino families which comprise 40% of the Philippine population

3 Filipino Income Quintiles Monthly income Families per quintile Q1 $ M Q2 $ M Q3 $ M Q4 $ M Q5 $ M P1 = $0.02 Source: National Health and Demographic Survey, 2008 Comprehensive Reforms in Health Universal Health Care ( ) Fourmula One for Health ( ) Health Sector Reform Agenda ( )

4 Comprehensive Reforms in Health Health Sector Reform Agenda (HSRA) focused on public health, hospitals, health care financing, health regulations, and good governance. Fourmula One for Health (F1) implementation blueprint with four pillars: health financing, service delivery, health regulation, and good governance Universal Health Care focus on the very poor Filipinos to ensure equity given disparities in health outcomes, financing, and service delivery interventions for the poor Office of Secretary of Health Regional hospital Medical Centers Sanitaria Regional Offices Attached Agencies City Health Offices City Hospitals (Chartered Cities) Health Centers Barangay Health Stations Provincial Health Offices Inter-local Health Zones City Health Offices (Component Cities) City Hospitals Health Centers Barangay Health Stations Municipal health offices/ Rural Health Unit Barangay Health Stations Provincial Hospitals District hospitals

5 Health Outcomes CURRENT STATUS Demographic Characteristics Population, total (millions) 94,013,200 (projected, NSO 2007) Population < 25 years (% of total population) Population > 60 years (% of total population) Birth rate (births per 1,000 population) Death rate (deaths per 1,000 population) 52.8 % (projected, NSO 2007) 49,617,400 M Filipinos 6.7% (projected, NSO 2007) 6,637,100 M Filipinos 23.4 (NDHS 2008) 2,162,303 live births per year 5.48 (NSO 2007) 515, deaths / year

6 Top Ten Causes of Mortality Cause Total Rate 1. Diseases of the heart 70, Diseases of the vascular system 51, Malignant Neoplasms 40, Accidents 34, Pneumonia 32, Tuberculosis 26, Unclassified 21, Chronic lower respiratory diseases 18, Diabetes mellitus 16, Conditionsoriginating from the perinatal period 13, Philippine Statistical Yearbook, 2009 Towards the attainment of MDGs. Indicators 2015 Target Accomplishment MDG 4: Under 5 mortality rate (per 1,000 live births) (2008 NDHS) Infant mortality rate (per 1,000 live births) (2008 NDHS) MDG 5: Maternal mortality ratio (per 100,000 live births) (2006 FPS) Proportion of births attended by skilled health professional Contraceptive Prevalence Rate (modern methods) 70% (2010 NOH) 70% (2010 NOH) 62 % (2008 NDHS) 34% (NDHS, 2008)

7 INDICATORS 2015 Target ACCOMPLISHMENT MDG 6 Prevalence of HIV/AIDS among high risk groups Malaria morbidity rate <1% 5,364 cases ( ) 62/100,000 pop 38,135 cases (based from 1990 baseline) <1% 21.6/100,000 pop 19,555 cases (2009) Malaria mortality rate deaths (based from 1990 baseline) TB morbidity rate 137/100, ,798 cases (2010 NOH) TB mortality rate <44/100,000 41,366 deaths (PhilPACT) deaths (2009) 129 (2008) 121,277 cases 41.0 (2007) TB case detection rate 70 % 75 % (NTP, 2007) TB cure rate 85 % 83 % (NTP, 2007) 13 Mortality Trend: Communicable Diseases, Malignant Neoplasms & Diseases of the Heart Rate/100,000 Population Philippines, Communicable Diseases 700 Malignant Neoplasms & Diseases of the Heart Communicable Diseases Malignant Neoplasms Diseases of the Heart '54 '55 '56 '57 '58 '59 '60 '61 '62 '63 '64 '65 '66 '67 '68 '69 '70 '71 '72 '73 '74 '75 '76 '77 '78 '79 '80 '81 '82 '83 '84 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 ' '01 '02 '03 '05 Year 0 Source: Philippine Health Statistics, 2005

8 HEALTH FINANCING CURRENT STATUS Share of health expenditure per GDP P ercent Year Total health expenditure = P234.3 B ( $5.2B) or 3.2 percent of GDP Source: Philippine National Health Accounts

9 Total expenditure on health as a Percentage of GDP Source: World Health Statistics 2010 Distribution of Health Expenditure by Use of Funds Public Health Care 9% P 21.2 billion Others 10% P 23.3 billion Total health expenditure is P234.3 B ($ 5.2B) or 3.2 percent of GDP Personal Health Care 81% P billion Source: Philippine National Health Account, 2007

10 Distribution of Health Expenditure by Source of Funds Total health expenditure is P234.3 B or $5.2B (3.2 percent of GDP) Source: Philippine National Health Account, 2007 National Health Insurance Program A compulsory health insurance program of government as established under Republic Act 7875 which shall provide universal health insurance coverage and ensure affordable, acceptable, available and accessible health care services for all Filipinos. Managed by Philippine Health Insurance Corporation (PhilHealth), an attached agency of the Department of Health

11 Membership (as of 2009) Employed Sector (46%) covers all employed in the government and in the private sector Overseas Filipino Workers (11%)-PhilHealth took over the Medicare functions for OFWs on March 1, 2005 Lifetime Program (1%)-Covers all retirees and pensioners 60 years old and above and with at least 120 monthly contributions Individually Paying (15%)-Covers all self-employed and the informal economy workers Sponsored Program (24%)-Covers the poor families as identified through community surveys and enrolled by the Local Government Unit with National Government counterpart Enrollment of the Poor Millionen As of Aug Enrollment of poor families by the LGUs increased from in 1999 to 6.1M in August 2010

12 Health Insurance coverage by wealth quintile, PhilHealth No Insurance Philippines Lowest Second Middle Fourth Highest National Health and Demographic Survey 2008 The informal sector and self-employed Ave. Monthly Income HIGH INCOME P194, % 0,010 0,009 1,752 MIDDLE INCOME 1,566 P30, % 4,957 LOW INCOME NON POOR 4,431 >P7, % 2,470 LOW INCOME POOR 2, Number of Families (in Millions) Total: 17.4 Million families Non Wage/Salaries Wage/Salaries Source: NSCB (FIES 2006)

13 Health Insurance coverage by region, 2008 ARMM XIII-Caraga XII-SOCCSKSARGEN XI-Davao X- Northern Mindanao IX- Zamboanga Peninsula VIII- Eastern Visayas VII- Central Visayas VI- Western Visayas V- Bicol IVB- MIMAROPA IVA- CALABARZON III- Central Luzon II-Cagayan Valley I- Ilocos CAR NCR Philippines No Insurance PhilHealth PhilHealth The President was dismayed at the benefit delivery rate of the National Health Insurance Program in the country Coverage rate Availment rate Support value 53% 42% 34% 26

14 HEALTH FACILITIES CURRENT STATUS Hospitals

15 Hospitals Priority Health Policy Directions of the DOH 1. A roadmap towards universal health care through a refocused PhilHealth; 2. Particular attention to the construction, rehabilitation, and support of health facilities: LGU/regional hospitals, rural health units barangay health stations 3. Attainment of Millennium Development Goals 4, 5, and 6 Reduction of maternal, neonatal, and infant mortality Support to contain/eliminate age old pubic health diseases (malaria, dengue, TB)

16 Every Link in PhilHealth Value Chain must work to achieve financial risk protection Enrollment Accreditation Claims Availmentand Processing Insurance Payments FINANCIAL PROTECTION PROVIDED TO THE POPULATION Source: Joint DOH-PhilHealth Benefit Delivery Review (2010) Redirecting PhilHealth: Enrollment Enforce mandatory PhilHealthcoverage for all Filipinos: Autonomic enrollment of indigents identified by the DSWD (lowest quintile) Compulsory enrollment of members of the informal sector, especially those who can afford to pay the premium National government to pay for the entire premiums of the poorest quintile National government local government sharing for the second poorest quintile

17 Redirecting PhilHealth: Enrollment Work with other government agencies to enforce mandatory PhilHealthmembership for all Filipinos: School enrollment Licensing of business Renewal of driver s license Other government transactions Work with the private sector to launch innovative schemes in paying premiums (e.g. payment premium through SMS) Redirecting PhilHealth: Accreditation Licensing and accreditation shall be unified to fast track accreditation of more health facilities in the country Provisional accreditation for all government health facilities to ensure access of PhilHealth members to health services Monitoring teams to check on needs of health facilities for improvement

18 Redirecting PhilHealth: Claims Availmentand Processing PhilHealth Information Technology upgrade to accelerate processing of claims Redirecting PhilHealth: Insurance Payments Improve significantly support value from 20% to 70% for all illnesses Increase significantly the support value for catastrophic illnesses Zero balance billing in all government hospitals for the Sponsored Program Promote cost effectiveness: case-payment registration of the indigents under one GP National standard treatment guidelines in all levels of health care

19 KaSAPI Program Kalusugang Sigurado at Abot-kaya sa Philhealth Insurance Objectives: Increase enrollment and sustain membership Implement an alternative premium payment scheme through Organized Groups (OG) Identify and develop innovative approaches of marketing SHI Strengthen solidarity and risk sharing Mechanics to enroll the Informal Sector through KaSAPI Focuses on group enrollment scheme through organized groups (OG) with minimum membership size of 1000 OGs are assessed based on organizational stability and financial performance Once the OG passes the evaluation, a Memorandum of Agreement is signed with PhilHealth Provides incentives to partner-ogs through premium discounts based on group size, and flexible mode of payment (e.g. weekly premium payment through OG)

20 Health Facilities Enhancement Upgrading of health facilities: rural health units, district hospitals, provinicial hospitals, DOH Retained hospital Strategies for Health Facilities Enhancement Public-Private Partnership Regional Clustering Fiscal autonomy and income retention for government health facilities Streamlining of licensing and regulation for improved accreditation

21 Thank you!

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