Current Issues in Philippine Health System

1. 2. 3. 4. 5. 6. 7. 8. Current Population is estimated to be 94 million. Population growth rate remains high at 2.04% (2000-2007 data). More than half (52.8 %) of the population is below 25 years old. Proportion of older persons is growing from 3.83% in year 2000 to 4.19 6.7% in 2007. There are approximately 2 million live births in the country per year. Non-communicable and communicable diseases are part of the top ten causes of death among our countrymen. Cardiovascular diseases rank as the top killer. Accidents have also climbed as the 4th leading cause of deaths. Among the causes are assaults (36%), followed by motor vehicle accidents (25%). The general improvement in our health incomes hides the fact that many of our countrymen still have poor health outcomes. a. In terms of reducing infant and under-5 mortality, the Autonomous Region in Muslim Mindanao (ARMM), Eastern Visayas, Mindoro, Marinduque, Romblon and Palawan (MIMAROPA) and Cagayan Valley are above the national average. b. The incidence of infant and under-5 mortality rate is inversely related to the income level of the family. The lowest two fifths of our population have Infant Mortality Rate and Unber 5 Mortality Rate that are higher than the national average. * These disparate health outcomes can be explained by the inequities in access and utilization of health services. 9. Inequities in Access and Utilization of Health Services a. According to 2008 National Health and Demographic Survey, the poorest quintile, consisting of 5.2 million families, earns, on average, P 3, 460.00 a month. The second poorest quintile, consisting of 4.1 million families, has a monthly income of P 6,073.00. b. Almost half of all Filipino families live on roughly six thousand pesos or less. For a family of five, you can just imagine how long this will go to cover their basic needs, let alone basic health care needs. c. These poorest two fifths of the population often have the most dismal health outcomes due to their lack of access and utilization of health services. d. The National Statistical Coordination Board in 2006 has pegged the poverty threshold, or the minimum amount needed for an individual to meet the basic food and non-food requirements at P 15,057 annually. e. Translated to a family of 5, you need to earn a minimum of P 75, 285 a year or P 6,273.75 a month. To be classified as poor, you must be earning below the poverty threshold. f. Based on 2006 statistics, 26.9% of families nationwide are poor, with 13 out of 17 regions having poverty incidences higher than the national average. In terms of actual number of people, this translates to 4.7 million poor Filipino families nationwide, with great variation in distribution. g. 26.9% of Filipinos die without seeing a health worker.

10. Immunization 11. Access to Health Facilities Poor families are more likely to avail of health services at public facilities. Sadly however, our government health facilities remain poorly equipped and understaffed. 12. Access to Maternal Care. a. Less than half of births are delivered in health facilities, and only 6 out of ten births are delivered by skilled providers. The figures are much less when we go to certain regions. Seventy-five percent (75%) of maternal deaths can be averted with combined access to family planning services and skilled birth attendant and 40% of maternal deaths can be prevented by ensuring access by mothers to skilled birth attendants and basic emergency obstetric and neonatal care in facilities. b. Access to skilled providers and health facilities for birth deliveries is directly proportional to family income. The percentage of births delivered in a health facility or delivered by skilled hands for the poorest two fifths of our population is less than the national average. 13. Financial Risk Protection a. A greater percentage of our women accessing healthcare have no financial risk protection through PhilHealth. The national average is not encouraging, less than 40% have PhilHealth. In ARMM, this can be as low as less than 20%. 14. Inadequate Financial Resources for Health These inequities in health can be explained by insufficient financial resources for health. a. The share of the gross national product spent for health from 1993 to 2007 hovered between 2.75- 3.5% (vs 5% as WHO recommends). b. While health expenditure per person has apparently increased since 1993, using constant 1985 prices, the increase in expenditure for health was very minimal.

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From 1993 to 2007 the percentage of health expenditure sourced from private sources, including out of pocket, has increased. In the same period, there were meager increases in the contribution of government and social health insurance for health. The 1997 and 2007 Philippine National Health Accounts reveals the increasing reliance of the health sector on out of pocket expenditure. From 47% in 1997, out of pocket accounts for 54% of the total expenditure for health in 2007. Out of pocket sourcing is the worst possible way to finance health care.

15. Inadequate Financial Risk Protection. Fifteen years after PhilHealth was established to replace Medicare, many of our people have yet to be provided significant financial risk protection from illnesses. 16. Social Health Insurance in the Philippines. As early as 1968, our government has recognized the need for social insurance in the Philippines. Thus, the Philippine Medical Care plan, also known as Medicare, was established, initially catering to the members of the GSIS and SSS. In 1995, Republic Act 7875 was passed, paving the way for the National Health Insurance Program to be administered by PhilHealth. Among others, RA 7875, as amended mandates coverage for all Filipinos by 2010. PhilHealth law actually makes it compulsory for all Filipinos to enrol in PhilHealth in order to avoid adverse selection and social inequity. 15 years after the PhilHealth law was passed, we can see that the government and private sector employees have been adequately enrolled. However, there was insufficient effort to enrol individually paying members, such as those in the informal sector. The sponsored program, meanwhile, had mixed results. The distribution of PhilHealth cards increased the awareness of the indigent sector on the need of having social health insurance. Oftentimes though, their 1 year coverage was not sustained by their local government units. Also, the sudden influx of new members having erratic coverage gave PhilHealth more problems in data gathering for coverage and entitlement. PhilHealth has about P 110 billion in reserves as of June 2010. This is good financial health for PhilHealth. However, this huge amount of reserve can be explained by how PhilHealth has been operating for the most part of its existence. It has emulated the model of private insurance and has neglected to be a genuine social health insurance whose mandate is not to primarily generate income but to afford its paying members reasonable financial risk protection. The actual coverage of PhilHealth seems to be a mystery. Conflicting figures from PhilHealth, UP School of Economics and the 2008 National Demographic and Health Survey underscore not only the need for better record keeping, but that the intention of the law for universal coverage has yet to be accomplished. The Presidents first State of the Nation Address reveals the inconsistency of membership figures in PhilHealth. He also declared a major policy direction he wanted to pursue: the improvement of the National Health Insurance Program. Expectedly, more members of the lower quintiles are not members of PhilHealth. This is sad considering that it is them who need financial risk protection from illnesses the most. Also, PhilHealth membership per region is very variable, all nowhere near the 85% target that was supposedly reached by PhilHealth this year. The Benefit Delivery Rate (BDR) is the cumulative likelihood that any Filipino is (a) eligible to claim (registered, paid contributions); (b) aware of entitlements and is able to access and avail of health services from accredited providers; and (c) is fully reimbursed by PhilHealth as far as total health care expenditures are concerned. BDR at present is only eight (8) percent, computed by multiplying the three mentioned components which are also known as coverage rate, availment rate, and support value. Shortcomings in health financing have resulted in out of pocket expenses as the primary source of health expenditure. Out of pocket expenditure has been the rate limiting step of many of our countrymen in availing health services 17. Health Facilities Neglect After the passage of the 1991 Local Government Code, the local government units, namely the provinces, cities and municipalities were given direct control over their health systems, including health facilities. The implementation of devolution has resulted in the fragmentation of a monolithic health system into several independent health systems. The upkeep of health facilities and of the health system as well, became dependent on the resources and priorities of the specific local government unit. Results of devolution were mixed, as there were excellent as well as backward health facilities in the regions, provinces, districts, or cities. ACTIVITY After reading these data, share your thoughts on the current problems of Philippine Health shown below. Prepare to make a causeeffect model using a problem tree. (Roots = primary cause, trunk = primary effect, branches = secondary effects, leaves = tertiary effects etc.) Prepare a short explanation for each problem by providing a written and oral report. Enrich your report by using reference materials. NO photocopy of reference = NO SCORE.

1. 2. 3. 4.

Inability to avail health resources. Lack of focus on Health Promotion and Disease Prevention. Lifestyle Diseases lead the current causes of mortality. Inadequate Performance of Community Health Facilities