THE ROLE OF GOVERNMENT IN HEALTH CARE FINANCING

Presented by Group 2

Objective 1:

Understand the role of government as affecting resource allocation pattern in health and the extent to which it can influence the overall performance of the sector.

The Role of Government

The government performs various functions such as promoting the effective performance of markets through the setting up of legal frameworks or ground rules for the market to follow. The government also encourages fair play through the promotion of competition and the down playing of monopolies(imperfect systems where one or very few sellers totally dominate the supply and pricing of a product service) and enhances general economic growth and stability through regulation and market intervention.

Also, the government serves as the receiver of funds and income primarily taxes, which it derives from the other sectors through individual and household incomes, and businesses profits. On the other hand, the government is also a spender, because just like business firm, it requires elements of production(land, labor, capital, entrepreneurial ability) to be able to operate and produce what it wants.

The Government and Allocation

What is allocation??? Allocation is deciding what and how much will be produced with the limited resources available.

Simply, allocation is the process of choosing which needs should be satisfied and how much of the existing resources should be used to satisfy them.

The government, being the prime agency tasked by the people to work for its welfare, has a leading role in the allocation of resources. Among its chief functions in this regard are the following:

Protection of Materials, Producers and Consumers

The government ensures that the resources are properly utilized, produced and distributed as equitability as possible.

Production and Distribution Of Goods and Services

Private businesses organizations are the ones usually involved in the production and distribution of goods and services in the market economies such as the United States and the Philippines. In these countries, however, the government plays an important role in the production and distribution of some very important services such as health care, infrastructure, defense and education.

Regulation and Deregulation

These are two types of policies that are frequently used by governments in having some control over businesses, and thus, over the allocation of resources. Regulation-limiting the use of resources by a particular industry, and usually imposed on the industries that have access to a very limited source. Deregulation- done to lessen control of monopolies or a group of private businesses and motivate new players to enter a particular industry.

The Services Sectors

The services sectors consists of those industries that perform the giving of services to consumers as well as to other businesses. This sector does not involve the production of physical goods. For this reason, this sector is also known as the tertiary sector of industry.

The Scope of Services Sector

Banking and insurance- this provides financial services and future guarantees to consumers. Tourism- this takes care of needs of locals ad foreigners who are going about certain beautiful places as part of their rest and relaxation. Retail and Wholesale trade- involves the distribution of goods and services to more specific clients.

Education- this involves the transmission of knowledge, information and understanding by teachers to students as well as the creation of educational materials.

Restaurants- these include high end restaurants as well as the popular fast food chains. Entertainment- includes the record and music industry, which provides songs and music for everyones entertainment.

Transport-provides transport and delivery service for people and goods. Health care- includes hospitals, clinics, and all other providers of medical and health care. Under these are the doctors, nurses, midwives, chiropractors and other various health professionals.

Consulting service- this is a major group comprising various experts such as lawyers, accountants, investment experts and writers who may provide freelance consulting assistance on their particular expertise. Government service- includes the services rendered by the soldiers policemen, firemen, and other public service personnel.

To formulate law that will elevate the status of the nation. To conduct variety health programs to raise the level of health in the nation. (e.g. allocating budget of DOH, Iwas Paputok Campaign gor 2013, Ads about Health Care Awareness, etc.)

To form research institute that will help in epidemiological studies and practical assistance in epidemic control. example: -BFAD -Philippine National Health Research System -Philippine Health Insurance Corporation -Philippine Institute of Traditional and Alternative Health Care

To provide low cost but effective medical facilities.

To provide new and improved ambulatory services especially for the chronically ill and aged. Example: mental retardation facilities, community mental health care centers. To provide traineeships for professional public health personnel. Assist in the construction of all health professions schools.

Governments play a major role in health care financing by mobilizing the necessary resources through public budgets and other contributive mechanisms, pooling resources allocated to health development, guiding the process of resource allocation and purchasing health services from various providers. Ministries of health are entrusted to protect equity in access by improving financial risk protection, by reducing financial barriers to access particularly to the poor and to vulnerable populations, and By ensuring that health care financing by all income groups is fair. Health care financing is becoming an important function in health systems as inequities inside and between countries with respect to access increase because of financial barriers and lack of appropriate social protection.

Objective 2:

Analyze the possible measures that can be taken to alleviate the health problems of developing countries

-Agencies should plan for the mobilization and equitable distribution of all health resources of a community or a region.
-Government must identify gaps in services and provide the leadership and funds whereby voluntary agencies must fill the gaps.

-In the implementation of these programs official health and welfare agencies must be accountable for the quality, cost, and utilization of the services they purchase.

-Assessment of present and future health manpower needs. -Guarantees to all, regardless of race and color, equal access to health care, equal opportunity for professional education, equal access to health facilities by both patients and physicians and other health workers and legal opportunity to participate in the formulation of policy.

Alleviating problems in a 3RD world nation

First of all, you can eliminate most problems by health education (the more people know, the better. They can have health interventions on either TV during the news--which happens frequently here, or within their communities or schools). Second of all, you need money to alleviate problems. If your country is poor then you cant afford to give any money to the health sector.

Why?

It may seem cruel but it is true. Money is needed to be given to health care professionals in order for them to do their jobs. If there is a lack of funds, why bother working?

And lastly

The Church. Can you ignore your Pope?

Ecclesiastical affairs vs Secular Affairs:

Why is this so important to note?

BECAUSE

It may be a bitter pill to swallow for most people, but it is true that because religion is prevalent here in PH, it sets people back a hundred years . Also, because the Church plays such an important role in most Filipinos lives, this causes interference with many secular affairs and the passing of important acts (RH Bill, Rizal Bill, etc.) that may improve the countrys mental state (Rizal Bill + patriotism) or physiological (health + womens right + population control) state.

Religion plays an integral part in causing mans greatest ignorance.

The best thing to do between a rock and hard place?

The best thing YOU can do is set aside your religious bias and focus on what YOU know can help our country. Do you know the scientific facts? The facts that are true and are scientifically tested, time and time again without any religious tinkering? Since YOU are the future of the country and are studying in a pre-medical course, YOU decide.

Objective 3:
Appreciate the problems of health policy in developing countries

Public health policies are those that protect health and prevent illnesses in entire communities or populations. Medical care or clinical policies also focus on disease treatment and prevention, but for individual patients. Public health programs, for example, seek to assure clean water and improve sanitation, as well as to encourage people to be physically active, get vaccinated, stop smoking and avoid injuries from motor vehicle crashes.

Legislating Appropriating Oversight

Question

Describe the major problems of Health Systems in developing countries

Healthcare embraces the factors that empower development: economics, politics, social services, utility infrastructure, agriculture/food, education and individual responsibility. preventive, curative and palliative interventions, whether directed to individuals or to populations. (WHO, 2000. Why do health systems matter?).

Healthcare systems are characterized by: interrelated components of input (human, technology, financing and equipment resources), structure (organization of public health infrastructure, hospitals, clinics and extended care facilities) processes (operations, services to patients in all settings by providers including Managed Care Organizations) and outputs (outcomes, quality, access and costs) -Busse and Wismar, 2002

All healthcare systems share features including: components of financing service delivery and insurer/payer features Health systems can also be distinguished in part by: method of financing (government, individuals, employers, etc) payment for services methods (by doctors, hospitals, extended care facilities), or management processes including that of Managed Care Organizations (MCO).

Problems inadequate water supply sub-par sewer treatment systems substandard housing overcrowding and overpopulation inadequate food poor nutrition and agricultural systems unemployment and illiteracy lack of health personnel, infrastructure and storage facilities for pharmaceuticals

poor distribution systems impassable or non-existent roads lack of motor vehicles and public transportation systems lack of electricity lack of communication systems

Question

What are the possible solutions by the governments for those problems?

Solutions

Organizational Structure of Health Institutions

Economy Health Sector Financing Education Epidemiological Indices Health Planning and Policies

Regional Health Authorities (RHA) Act, 1994 Ministry of Health and the Ministry of Planning and Development

Key Public Health Programs

Human resources Research and technology

Immunization program Mental health program Disability programs Cancer screening program Dental care program Environmental health program Waste disposal Medical care program

Question

What is the relevance of encouraging diversity and competition in improving the health system?

It takes, on average, 17 years for the results of clinical trials to become standard clinical practice state-controlled system or a singlepayer system

Competition between organizations providing healthcare may improve clinical outcomes, reduce costs and help the system function more efficiently. Competition is a means not an end. It is a mechanism which, by engendering rivalry between alterative public and private providers, may drive down costs and / or improves the quality of goods and services delivered to patients.
Goddard

M, Mannion R., 2000

How did it went wrong?

Zero-Sum Competition: The system participants divide value instead of increasing it. In some cases, they may even erode value by creating unnecessary costs. The Wrong Level of Competition It takes places at the level of health plans, networks, and hospital groups. It should occur in the prevention, diagnosis, and treatment of individual health conditions or co-occurring conditions.

What to do?
Positive-Sum Competition competition at the level of diseases or treatments becomes the engine of progress and reform

THE GOOD
Impacts in competition: improved clinical outcomes in some settings reduced costs in some settings improved efficiency in some settings No strong impact in competition: patient choice patient centered care safety flexibility in supply or capacity innovation and improvement

THE BAD
Other consequences of competition: resistance among professionals, patients and other stakeholders role conflicts between managers and clinicians self serving professional behaviour reduced professionalism fragmentation of services increased mergers

Question
Describe the implication of value for money with respect to the purchasing process of government organization.

WHAT IS IT?
This is referring to government expenditure and its relation to the implication of, value for money. First of all, VfM is actually what it says it is. VALUE FOR MONEY. It is the longevity of an item or service that is useable and should be at a reasonable price and still as efficient as its more expensive counterparts

So the expenditure of any government in relation to VfM should be based on three terms. Economy: minimising the cost of resources for an activity (doing things at a low price)

Efficiency: performing tasks with reasonable effort (doing things the right way) Effectiveness: the extent to which objectives are met (doing the right things)

If the cost or expenditure has all three qualities, it is therefore deemed as Value for Money. If it is missing any three of these qualities, it is therefore deemed as a normal cost with its respect to its price and efficiency.

So, in the end, VFM for a government could be any health intervention that is economical in price, still efficient but also as effective as other interventions that are more costly.

SSS

What is SSS?

The Philippine Social Security System (SSS) is a privatized social insurance program for Filipino workers in the private sector. According to Philippine law, any individual working as a regular employee in a private company must be covered by the SSS. The member's employer pays part of his monthly contribution. The salary bracket determines how much a member must pay and how much benefit he receives.

Who are covered under SSS?

Employers Employees Self-Employed Voluntary

Member Loan Benefits

3 types: Salary Loan Calamity Loan Emergency Loan

Other Benefits

Sickness Benefit Retirement Benefit Disability Benefit Maternity Benefit Death and Funeral Benefit OFW Coverage Program

GSIS

What is GSIS?

The GSIS (Government Service Insurance System) is a social insurance institution created under Commonwealth Act Number 186 that was passed on November 14, 1936. To secure the future of all employees of the Philippine government, it provides and administers a pension fund that has the following social security benefits: compulsory life insurance, optional life insurance, retirement benefits, and disability benefits for work-related accidents and death benefits.

Coverage

The GSIS covers all government workers irrespective of their employment status, except: - Members of the Judiciary and Constitutional Commissions who are covered by separated retirement laws; - Contractual employees who have no employeeemployer relationship with their agencies; - Uniformed members of the Armed Forces of the Philippines and the Philippine National Police, including the Bureau of Jail Management and Penology and the Bureau of Fire Protection.

Benefits

Retirement Benefit Survivorship Benefit Burial and Funeral Benefit Separation Benefit Unemployment Benefit Disability Benefit Employee Compensation Benefit Hospitalization Benefit Life Insurance GSIS loans

eCard Plus

Disadvantages

Philippine Health Insurance Corporation

What is Philhealth?

PhilHealth is the governments health insurance system. On February 14, 1995, the Philippine Government passed Republic Act 7875, otherwise known as National Health Insurance Act to institute the National Health Insurance Program for all Filipinos. The Law established the Philippine Health Insurance Corporation (PhilHealth) to be a government owned and controlled corporation, to implement the countrys health insurance program.

Goals

(1) to be able to provide health insurance coverage for all Filipinos, (2) to ensure affordable and quality health care services, and (3) to manage its resources economically. If Filipinos will support and enroll in PhilHealth, our country may well be on its way to giving adequate healthcare to an estimated 50% of Filipinos living with meager incomes.

Benefits Coverage

Inpatient coverage Outpatient coverage Special Benefit Packages

Case

Rates TB Treatments through DOTS SARS and Avian Influenza Novel Influenza A(H1N1)

How Philhealth works?

How can PhilHealth alleviate the health needs of the poor? Simply put, it is as if PhilHealth acts like a collective bank, where its members will pay an annual fee (called premium) of P1,200 a year. With this money at hand, PhilHealth can then pay a substantial portion of the medical expense of its sick members.

Question

What if many people get sick, will PhilHealth go bankrupt?

Disadvantages

We should encourage everyone, including the young, the healthy and the rich to enroll in PhilHealth. If you will not be confined and not be able to able of the Philhealth benefits, you will not be able to refund the premiums that you paid. Age Limitation

Fifth and subsequent normal obstetrical deliveries Non-prescription drugs and devices Alcohol abuse or dependency treatment Cosmetic surgery Optometric services Pay a substantial portion of the medical expense

Presented by Group 2

Abad, Christopher Mari Angelo Pascua, Kevin Fauni, raNDOLPH Dela pena, wendy Orense, renzy ANNE Redona, Ma. Melody Ursal, Psyche Katleen THANK YOU!!! Atap, Rosalyn David, Sunshine Villamer, JeniKka Eredera, Hannah Faye