Health System

Health system is “the combination of resources, organization, financing, and

management that culminate in the delivery of health services to the
population (Roemer, 1991).”
This system consists of many parts such as the community, department or
ministries of health, health care providers, health service organizations,
pharmaceutical companies, health financing bodies, and other organizations
related to the health sector.
In the World Health Report (WHO, 2000), health system is defined as “all the
organizations, institutions, resources, and people whose primary purpose is
to improve health.” Thus, a well-performing health system provides direct
health-improving activities whether in personal health care, public health

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services, or intersectoral initiatives, to achieve high health equity.

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Goals and Functions of a Health System

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The World Health Organization (WHO) identifies three (3) main goals of a

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health system:
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1. Improving the health of populations
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• Improving the health of the population is the overarching goal of a health
system. Health status should thus be measured over the entire population
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and across different socioeconomic group.

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• Populations must be protected from existing and emerging health risks.

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• Health systems should strive for equity in health by minimizing

inequitable disparities which may be caused by certain factors such as
income, ethnicity, occupation, gender, geographic location, and sexual
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orientation, among others.

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• There are significant Variations in health out comes across the world
2. Improving the responsiveness of the health system
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• Responsiveness refers to providing satisfactory health services and

engaging people as active partners.
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• It embodies the values of respectfulness, dignity, confidentiality,

autonomy, quality, and timeliness in the delivery of health services
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• Health systems also have an obligation to respond to the legitimate non-

health needs and expectations of populations.
• Responsive health systems maximize people’s autonomy and control,
allowing them to make choices and placing them at the center of the
health system

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 3. Providing fair health financing
• An ideal health system provides social and financial risk protection in
health.
• WHO defines a fairly financed health system as one that does not deter
individuals from receiving needed care due to payments required at the
time of service, and one in which each individual pays approximately the
same percentage of their income for needed services.
• A health financing system that dissuades people from seeking needed
services or impoverishes individuals and families worsens health
outcomes.
The four (4) vital health system functions are:
1. Health service provision The most visible product of the health system is

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public and private health service provisions. A health service is any service,

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not limited to clinical services, aimed at improving the health of

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populations. Preventive measures as well as promotion of a healthy way

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of living to avoid illnesses also form part of the best systems. Thus, the
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system has to perform a wide range of activities to cater to these various
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demands.
2. Health service inputs Health service inputs, or managingresources, means
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generating the essential physical resources for the delivery of health

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services which include medications, human resources, and medical

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equipment.
Resources such as trained doctors and medical staff and supply of
medications often take time to be produced; hence, the health system
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policymakers have to respond and use the available resources to address short-
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term population needs.

3. Stewardship
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• Stewardship, or the. overall system oversight, is the main

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responsibility of the government.

• This function sets the direction, context, and policy framework for the
overall health system.
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• The core of the stewardship function includes:

• a. Identifying health priorities for allocation of public resources;
• b. Identifying an institutional framework;
• c. Coordinating activities with other systems related to external
health care;

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 • d. Analyzing health priorities and resource generation trends and
their implications;
• e. Generating appropriate data for effective decision-making and
policymaking on health matters.
4. Health financing Health system financing includes raising and pooling
resources to pay for health services.
a. Revenue collection is earned from payments for health care services.
The mechanisms for revenue collection include general taxation, direct
household out-of-pocket expenditures, mandatory payroll contributions,
mandatory or voluntary risk-rated contributions, donor financing, and
other forms of personal savings.
b. Financial risk pooling is a form of risk management whichaims to spread
financial risks from an individual to all pool members. It is considered a core

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function of health insurance companies. This mechanism prevents outright

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payment for health services which discourages patients belonging to the poor

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sector from seeking health care . Participation in effective risk pooling helps

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families from financial losses due to health shacks, thus ensuring financial
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protection.
Each country has its own approach to managing its financial risk to finance its
health care system. Multiple and fragmented forms of risk pooling arrangements
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exist in most developing countries. Most high-income countries follow one of

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the two main models:

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Bismarck model and the Beveridge model.
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Bismarck Model (Bismarck is Law on Health Insurance of 1883)

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• This model is named after the Prussian Chancellor, Otto von Bismarck,
known for inventing the welfare state in the
19th century as part of the unification of Germany
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• The Bismarck model uses an insurance system where the sickness fund
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finances both the employers and the employees through payroll

deduction. But unlike the US insurance industry, the Bismarck-type health
insurance plan covers everybody, thus collecting no profit.
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• This is considered a multi-payer model with tight regulation giving the

government the cost-control clout. Beveridge Model (Beveridge Report
or the Social Insurance and Allied Services of 1942)
• This model is named after William Beveridge, the social reformer
responsible for designing Britain’s Social Security System and the

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 National Health Service. In the Beveridge model, health care is provided
and funded by the government through tax payments
• The government owns many, but not all, hospitals and clinics in the country.
Doctors may be government or private employees who collect their
professional fees from the government.
• This results in low cost per capita since the government controls the health
care services.
C. Strategic purchasing
In strategic purchasing, risk-pooling organizations use collected financial
resources to finance health care services for the members. The purchaser
defines the substantial part of the health provider’s external incentives to
develop the provider user interaction and the health service delivery models.
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• SERVICE DELIVERY which refers to the timely delivery of quality and

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cost-effective personal and non-personal health services.

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• HEALTH WORKFORCE which includes individuals and groups working

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towards the achievement of the best health outcomes by being responsive,
fair, and efficient. rs e
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• INFORMATION (health information system) which analyzes,
disseminates, and uses reliable and relevant information on health status,
determinants, and systems performance is also a valuable building block.
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• HEALTH PRODUCTS, VACCINES, AND

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TECHNOLOGIES which are made accessible through uninterrupted

supply, welI-managed pharmaceutical services, and education on proper
use of medication.
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• FINANCING (health financing system) is a building block which takes

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care of the funding for health care services

• LEADERSHIP AND GOVERNANCE involves the task of ensuring
effective stewardship of the entire health system
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The Philippine health system

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The health reform initiatives carried out over the years in the Philippines were
primarily focused on these areas of concern:
• HEALTH SERVICE DELIVERY, • HEALTH REGULATION,
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• HEALTH FINANCING.
These health reforms aimed at addressing issues such as poor
• ACCESSIBILITY,
• INEQUITY,
• INEFFICIENCY OF THE PHILIPPINE HEALTH SYSTEM.

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 1. 1979: Adoption of Primary Health Care Strategy (L01 949) promoted
participatory management of the local health care system.
2. 1982: Reorganization of D0H (E0 851) integrated the components of
health care delivery into its field operations

3. 1988: The Generics Act (RA 6675) ushered the writing of prescriptions
using the generic name of the drug
4. 1991: Local Government Code (RA 7160) transferred the responsibility
of providing health service to the local government units
5. 1995: National Health Insurance Act (RA 7875) instituted a national
health insurance mechanism for financial protection with priority given to
the poor 6. 1999: Health Sector Reform Agenda = ordered the major
organizational restructuring of the DOH to improve the way health care is

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delivered, regulated, and financed. 7. 2005: FOURmula One (F1) for

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Health adopted an operational framework to undertake reforms" with

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speed, precision, and effective coordination and to improve the

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Philippine health system
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8. 2008: Universally Accessible Cheaper and Quality Medicines Act (RA
9502) promoted and ensured access to affordable quality drugs and medicines
for all
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9. 2010: Kalusugang Pangkalahatan or Universal Health

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Care (A0 2010-0036) provided universal health coverage and

access to quality health care for all Filipinos
Leadership and Governance
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The Department of Health (DOH) is mandated to provide the appropriate

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direction for the nation’s health care industry. Its other tasks include
(1) the development of plans, guidelines and standards for the health
sector;
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(2) technical assistance;

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(3) capacity building;

(4) advisory services for disease prevention;(5) control of medical
supplies and vaccines.
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DOH coordinates its national health programs through the local government
units (LGUs). LGUs take care of their own health services and are given
autonomy under the Local Government Code (LGC) Of 1991 (R.A. 7160).
• 78 provincial governors,

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 • 138 city mayors,
• 1,496 municipal mayors, and
• 42,025 barangay
In terms of administration, LGUs are grouped into 17 regions. Although they
operate in a decentralized system, LGUs' are under the supervision of the DOH
regional health offices.. DOH is duty-bound to:
1. develop policies and programs for the health sector, .
2. provide technical assistance to its partners,
3. encourage performance of the partners in the priorityhealth programs,
4. develop and enforce policies and standards,
5. design programs for large segments of the population,
6. provide specialized and tertiary level care.

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Under the decentralized or devolved structure, the state is represented by

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national offices and LGUs, if with provincial, city, municipal, and barangay

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or village offices. DOH, LGUs, and the private sector participate,

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cooperate, and collaborate in the care of the population.
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Before devolution, the national health system consisted of a three-tiered system
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under the direct control of the DOH:
(1) the tertiary hospitals at the national and regional levels;
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(2) the provincial and district hospitals and city and municipal health
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centers;
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(3) the barangay (village) health centers.

Directions of the Philippine Health Sector
1. The Philippine Health Agenda 2016-2022 (DOH
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Administrative Order 2016-0038)

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This agenda adopts the slogan “AII for Health Towards Health
For All" as the rallying point for its vision of a Healthy
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Philippines by 2020. It expanded the scope of the Universal Health Care

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(UHC) directions, particularly through a whole-ofgoverment approach. With

this agenda, the health System guarantees:
a. population and individual-level interventions for all life stages that
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promote health and wellness, prevent and treat the triple burden of disease,
delay complications, rehabilitation, and provide palliation for both the well
and the sick;
b. Access to health interventions through functional servicedelivery networks
(SDNs); and

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 c. financial freedom when accessing these interventions through
Universal Health Insurance,
2. The Philippine Development Plan 2017-2022 This is the first of the four
key medium-term plans to translate the vision of a “matatag, maginhawa, at
panatag na buhay” for the Filipinos and the country.
3. NEDA AmBisyon Natin 2040 A product of the Philippine Development
Plan 2017-2022, this collective long-term plan envisions better life for the
Filipinos and the country in the next 25 years by formulating policies and
implementing programs and projects to attain this AmBisyon. This plan focuses
on four areas:
• building a prosperous,
• predominantly middle-class society where no one is poor;

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• promoting a long and healthy life;

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• becoming smarter and more innovative; and building a high~trust

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society.
4. Sustainable Development Goals 2030 Also known as the 2030 Agenda,

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this compilation of 17 global development goals targets
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• to end poverty,
• fight inequality and injustice,
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• and confront issues involving climate change.

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Health system combines

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• resources,
• organization,
• financing,
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• management to deliver health services to the population. According to the

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World Health Report (WHO, 2000), health system is defined as “all the
organizations, institutions, resources, and people whose primary
purpose is to improve health.”
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The primary goals of a health system are;

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• improved health outcomes (attaining the best average level health care
for the entire population by minimizing disparities),
• more responsive health system (meeting the people’s expectations of
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and satisfaction from health service delivery),

• more equitable health care financing (protecting each individual from
financial risks).

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 The four functions of the health system are;
• health services provision (for appropriate and costeffective health
delivery);
• health service inputs (for generating human resources, technology, and
capital);
• health financing (by revenue collection, risk pooling, and strategic
purchasing);
• stewardship and initiatives (to strengthen governance, accountability, and
responsiveness).
A health system can be analyzed in its totality by using a framework
consisting of six building blocks,
• LEADERSHIP AND GOVERNANCE,

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• HEALTH FINANCING,

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• HEALTH WORKFORCE,

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• HEALTH PRODUCTS,

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• VACCINES, AND TECHNOLOGIES,
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• HEALTH INFORMATION SERVICE DELIVERY. The
Department of Health (DOH) is the lead agency for Philippine health
care. According to its mandate (EC. No.
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119, Sec. 3), the DOH shall be responsible for

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(1) formulation and development of national health policies,guidelines, standards,

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and manual of operations for health services and programs;

(2) issuance of rules and regulations, licenses, andaccreditations;
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(3) promulgation of national health standards, goals, priorities,and indicators

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(4) development of special health programs and projects, andadvocacy for

legislation on health policies and programs.
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