Health System in the Philippines

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1 Health System in the Philippines Teodoro J. Herbosa MD FPCS College of Medicine & National Telehealth Center University of the Philippines, Manila Undersecretary of Health Republic of the Philippines

2 Outline Background information: Philippines Philippine Health System Health Financing Government Procurement Public Private Partnership

3 Republic of the Philippines Southeast Asia Archipelago 7,107 islands 100million people Democracy Low Middle Income Colonized by Spain, USA and Japan

4 Statistical Figures Population (May 2010) 92.34M Population (Aug 2007) 88.55M Inflation Rate (Jun 2015) 1.2 % Total Exports(Apr 2015) $4.38Bp Total Imports (May 2015)$4.39Bp Balance of Trade (May 2015) $508.86M Employment Rate (Apr 2015)93.6%p Unemployment Rate (Apr 2015) 6.4%p Underemployment Rate (Apr 2015) 17.8%p LFPR (Apr 2015)64.6%p Simple Literacy (2000) 92.3% Functional Literacy (2008) 86.4% Average Family Income(2012)

5 Health System "Two" health systems Private healthcare vs Public healthcare = health inequity Centralized to Decentralized Infrastructure gap hospital bed to pop is 5/10,000 Rapid population growth Increasing health costs

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7 Health Indices and Statistics Total population (2013) 98,394,000 Gross national income per capita (PPP international $, 2013) 7 Life expectancy at birth m/f (years, 2013) 65/72 Probability of dying under five (per live births, 0) not available Probability of dying between 15 and 60 years m/f (per population, 2013) 255/136 Total expenditure on health per capita (Intl $, 2013) 287 Total expenditure on health as % of GDP (2013) 4.4 Latest data available from the Global Health Observatory

8 Health Reforms Primary Health Care "Alma Ata" Corporate government hospitals Generics Law Decentralization (devolution) Local Government Code National Health Insurance Act Health Reform Agenda Universal Health Care (Sin Tax Financing)

9 Government Procurement RA 9184 Post qualification methodology Head of Procuring Entity (HOPE) Bids and Awards Committee (BAC) Technical Working Group (TWG) Recommendation to Award (RTA) Notice of Award (NOA) Purchase Order (PO) or Contract

10 Irregularities Collusion Price manipulation; overpricing Kickbacks Insider information Fake qualification documents Variability of costs

11 Procurement of Medicines Programs ("vertical") TB, vaccines, leprosy, Vaccines (EPI) Expanded Program of Immunization TB (NTP) National Tuberculosis Program Leprosy (NLP) National Leprosy Program Others

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13 What is Medicines Access Programs (MAPs) Types of MAPs MAPs for out-patient care: Botika ng Barangay (BnB) DOH Complete Treatment Pack (DOH ComPack) MAPs for in-patient care: Regular in-patient care Catastrophic Care Acute Lymphocytic Leukemia Medicines Access Program Breast Cancer Medicines Access Program Rare Disease Medicines Access Program Other MAPs DOH Insulin Access Program Valsartan Access Program Geriatric Health Care Medicines Access Program Mental Health Care Medicines Access Program

14 Universal Health Care (UHC) and Access to Medicines Universal Health Care (UHC) is the call and commitment of the Philippine Government to ensure that every Filipino has access to quality and affordable health care. In 2011, the Department of Health announced its goal to achieve UHC under the flagship program of President Benigno Aquino III known as Kalusugan Pangkalahatan (KP) focusing on improving access to health care services and reducing poverty from catastrophic healthcare expenditures especially for the poor and most vulnerable population.

15 Universal Health Care (UHC) and Access to Medicines.To achieve Universal Health Care (UHC), or Kalusugan Pangkalahatan (KP), is defined as the "provision to every Filipino of the highest possible quality of health care that is accessible, efficient, equitability distributed, adequately funded, fairly financed, and a appropriately used by an informed and empowered public". The administration puts it on top of the socioeconomic agenda to improve the health and quality of life. To attain UHC, the DOH defined three strategic thrusts to be pursued from , namely: 1) Achieve the health-related Millennium Development Goals (MDGs) of improving maternal and child health and combating priority infectious and noncommunicable diseases; 2) Provide financial risk protection through expansion in the enrollment and benefit delivery of the National Health Insurance Program (NHIP); and 3) Improve access to quality health care which includes the upgrading of public hospital and health facilities, ensuring adequate health human resources and securing the availability of essential medicines.

16 NCD Control: Primary Care Non-communicable disease burden Hypertension control Diabetes control Asthma management Acute infections

17 Public Private Partnership improve access to health facilities and services Infrastructure gap in the health system 5 hospital beds/10,000 pop. Long length of stay because of efficiency Lack of funds Brain drain

18 PPP The project aims to raise health standards through the upgrading and modernization of the facilities. The project components cover the following: Construction of new healthcare building and facilities. Hospital facilities involves the entire development and identifying the services required, and overall delivery of services. Hospital Equipment, furniture & fixtures: Provision of medical equipment including hospital beds, etc. Total Computerization. Hospital Information system linked between medical and administrative as well as external stakeholders (Philippine Health Insurance Corporation (Philhealth), Department of Health (DOH), Department of Budget and Management (DBM), etc.). Training and Technology Transfer

19 NKTI Hemodialysis Center Procured in 2003 under lease agreement for 5 years and was renewed again in 2009 At present, there are 47 dialysis machines in operation at the new hemodialysis center of NKTI Status: Second contract is being implemented; third contract will be for bidding

20 NKTI PET-CT and Cyclotron Project Include building construction in a 230 square meter vacant lot beside the Diagnostic Center of NKTI for housing of the Cyclotron for the production of fluorodeoxyglucose (FDG) Supply of equipment and related facilities in the operation of the Positron Emission Tomography (PET) and Computerized Tomography (CT);

21 Modernization of Philippine Orthopedic Center PhP5.6 Billion 83.5Million 700-bed capacity specialty hospital Build-Operate Transfer Contract for 25 years. Status: Ongoing procurement of Independent Consultant

22 Modernization of Bicol Medical Center PhP855 Million ( 12.7Million) funded by the government through DOH 800-bed capacity hospital Design and Build Scheme ongoing construction

23 Modernization of Cagayan Valley Medical Center PhP305 Million ( 4.55 Million) funded by the government through DOH 600-bed capacity hospital Design and Build Scheme ongoing construction

24 Regional Cancer Centers CVMC BGHMC NKTI, RMC BMC WVMC VSMMC NMMC ZCMC SPMC PhP75 Million ( 1.12 Million) infrastructure funded by the government through DOH Of the nine cancer centers, three (BGHMC, NKTI, RMC) has already its Oncology Equipment provided by the Private Sector investor through sharing arrangement under Service Management Contract

25 Summary Background information: Philippines Philippine Health System Government Procurement System Health Financing Public Private Partnership

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