Philippine Health Care System 2008
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The Philippine Health Care System
HEALTH FOR ALL FILIPINOS
Christine S. Tinio, MD, MPH, FPAFP
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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,
functions activities and programs of the Department of Health
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Health System
Interrelated system in which a country organizes available resources for the maintenance and improvement of the health of its citizens and communities.
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□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
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Health care System Models
□Private enterprise health care□Social security health model□Publicly funded health care
model□Social health insurance
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Private 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
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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, 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.
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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
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Social 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.
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Structure of a Health System
Health Sector
Health Status Population
Health-related sectors
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Structure of a Health System
Health Sector
Health Status Population
Health-related sectors
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Health Status
□Birth □Death□Morbidity□Mortality□Nutrition
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The Health Status of the Filipino PeopleHFA 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
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Structure of a Health System
Health Sector
Health Status Population
Health-related sectors
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The Population
□Demographic characteristics
□Socio-cultural factors□Political factors
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Country Life Expectancy in years
Philippines 70
Thailand 70
Malaysia 73
South Korea 75
Japan 81
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Country Population Growth
Philippines 2.1 –2.3 %
Thailand 1.4 %
Malaysia 2.2 %
South Korea 0.8 %
Japan 0.3 %
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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 (ave. no. of children per woman)
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□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 Population
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□Political Influences □the Philippines is a democratic
country□local government units (LGUs)
comprise the political subdivisions of the Philippines
The Population
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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
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Structure of a Health System
Health Sector
Health Status Population
Health-related sectors
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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
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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
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Functions of the Health Sector
□Research and dev’t□Coordinating, controlling and
directing organizations and activities associated with other functions
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The Health Sector and health-related sectors
□Social organization of the health Care
□Economic issues
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Health Human Resources
□The human resources for health are enormous but unevenly distributed. Most health practitioners are in Metro Manila and other urban centers
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Registered Health Professionals
2000□Physicians - 95,016□Nurses - 337,939□Midwives - 129,532
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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.
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Health human resource
□manpower – supply dependent on the demand in the foreign market
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Major Influences on the Health Care System
□Environmental□Demographic□Socio-Culture□Political□Economic
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DEPARTMENT OF HEALTH
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The DOH is the principal agency in health in the
Philippines.
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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 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
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Vision
The leader of health for all in the Philippines.
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Mission
Guarantee equitable, sustainable and quality health for all Filipinos, especially the poor, and to lead the quest for excellence in health.
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DOH
□Composed of 17 offices, 16 Centers for Health Development in various regions, 70 hospitals and 4 attached agencies
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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.
□
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□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.
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□ 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.
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□ 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 General Hospital.
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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, 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
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DOH Hospitals
□Provides hospital-based care; specialised or general services, some conduct research on clinical priorities and training hospitals for medical specialisation.
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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 Alternative Health Care
□ Philippine National AIDS Council
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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
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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 health”
- World Health Organization
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District Health System is subdivided into 3 levels of referral:
□Primary – barangay health stations and rural health units
□Secondary – district/provincial hospitals
□Tertiary – provincial and regional hospitals
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In the Philippines:
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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
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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
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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
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Composition of ILHZ
□People – community members, CHWs, NGOs, people’s organizations, local chief executives, other gov’t officials, private sector
□Boundaries – clear boundaries between ILHZ
□Health facilities□Health workers – district health
team
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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
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Core 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
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Provincial hospital
RHU District Hospital
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Importance of establishing an ILHZ
□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
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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
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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
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Minimum Package of Activity for PHC services
□ Pre-natal care□ Normal delivery and post-partum care□ Immunization□ Family planning□ Nutrition – Vit. A & iron supplementation□ Growth monitoring□ Control of communicable diseases□ Minor surgery – suturing , draining of
abscess, circumcision□ Dental health□ Appropriate referral□ Environmental health services
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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
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Complementary Package of Activity for Core Referral Hospitals
□ Outpatient consultations for patients referred 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 (ex. Setting of simple
fractures
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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 in ILHZ management□ Public health promotion and education□ Coordination with public health services□ Transport and communication linkages
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Tertiary Package of Activity for provincial 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
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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 and management
services□ Emergency transport□ In-house engineering and maintenance
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Factors contributing to the limited capacity of the country’s health care system to deliver better
health 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.
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ISSUES 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.
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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
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SGD□ Discuss the FOURmula ONE for Health(F1) –
over-all goals, objectives□ Discuss the four components of F1as to:□ A. Strategies□ B. Activities□ C. Gov’t structure implementing the
activities□ D. Available DOH program in the
implementation of activities
□ SUBMISSION: Sec. B: Jun 4 @ 8 am