The Philippine Health Care

System

HEALTH FOR
ALL FILIPINOS
Christine S. Tinio, MD, MPH, FPAFP
 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
 Health System
Interrelated system in
which a country
organizes available
resources for the
maintenance and
improvement of the
health of its citizens
and communities.
□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
 Health care System Models

□Private enterprise health care

□Social security health model
□Publicly funded health care
model
□Social health insurance
 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
 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.
 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
 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.
 Structure of a Health
System
 
Health Sector
 
  Health Status
Population

Health-related
sectors
 Structure of a Health
System
 
Health Sector
 
  Health Status
Population

Health-related
sectors
 Health Status
□Birth
□Death
□Morbidity
□Mortality
□Nutrition
The Health Status of the Filipino
People
HFA 2000 Targets
oIMR < 50 2004
49/1000 LB

oMMR 179.7/1000
00 LB
oCBR 28.4/1000
oLife > 60 y/o
Expectancy
o CDR 6.1 /1000
 Structure of a Health
System
 
Health Sector
 
  Health Status
Population

Health-related
sectors
 The Population
□Demographic
characteristics
□Socio-cultural factors
□Political factors
 Country Life Expectancy in
years
Philippines 70

Thailand 70

Malaysia 73

South Korea 75

Japan 81
 Country Population Growth

Philippines 2.1 –2.3 %

Thailand 1.4 %

Malaysia 2.2 %

South Korea 0.8 %

Japan 0.3 %
 Total Fertility Rate
(ave. no. of children per woman)
Total Fertility Rate
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
 The Population

□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
□Political Influences
□the Philippines is a democratic
country
□local government units (LGUs)
comprise the political
subdivisions of the Philippines
 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
 Structure of a Health
System
 
Health Sector
 
  Health Status Population

Health-related
sectors
 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
 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
 Functions of the Health
Sector
□Research and dev’t
□Coordinating, controlling and
directing organizations and
activities associated with other
functions
The Health Sector and
health-related sectors
□Social organization of the
health Care
□Economic issues
Health Human Resources
□The human resources for
health are enormous but
unevenly distributed. Most
health practitioners are in
Metro Manila and other
urban centers
 Registered Health
Professionals
2000
□Physicians - 95,016
□Nurses - 337,939
□Midwives - 129,532
 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
Health human resource
□manpower – supply
dependent on the
demand in the
foreign market
Major Influences on the Health Care
System

□Environmental
□Demographic
□Socio-Culture
□Political
□Economic
DEPARTMENT OF
HEALTH
The DOH is the principal
agency in health in the
Philippines.
 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
 Vision

The leader of health

for all in the
Philippines.
 Mission

Guarantee  equitable,
sustainable and quality health
for all Filipinos, especially the
poor, and to lead the quest
for excellence in health. 
 DOH
□Composed of 17 offices, 16
Centers for Health
Development in various
regions, 70 hospitals and 4
attached agencies
 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.
□
□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
□ 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.
□ 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.
 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
 DOH Hospitals
□Provides hospital-based care;
specialised or general services,
some conduct research on
clinical priorities and training
hospitals for medical
specialisation.
 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
 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
 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
 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
In the Philippines:
 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
 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
 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
 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
 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
 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
 Provincial hospital

RHU District Hospital

 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
 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
 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
 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
 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
 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
 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
 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
 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
 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.
 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.
 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
 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