The Philippine Health Care

System

HEALTH FOR
ALL FILIPINOS
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
At the end of the session, the student
Department
should be able: 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
Private enterprise health care
Social security health model
Publicly funded health care model
Social health insurance

Health care System Models

 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

Private enterprise health care 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
Social security health model
countries this may include medical care, aspects of social work and even
industrial relations.
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

Publicly funded health care model

 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.

Social health insurance

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
Birth
Death
Morbidity
Mortality
Nutrition

Health Status
 The Health Status of the Filipino
People
HFA 2000 Targets 2004
oIMR < 50 49/1000 LB

oMMR 179.7/100000
LB
oCBR 28.4/1000
oLife > 60 y/o
Expectancy
o CDR 6.1 /1000
  
Health Sector
 
  Health Status Population

Health-related
sectors

Structure of a Health System

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
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

The Population
Physical barriers - geographical location
patterns of health care consumers in
relation to health providers

Financialfactors also exist that affect

health seeking patterns of the Filipinos

Health Care Utilization:

  
Health Sector
 
  Health Status Population

Health-related
sectors

Structure of a Health System

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

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

Functions of the Health Sector

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
Physicians - 95,016
Nurses - 337,939
Midwives - 129,532

Registered Health Professionals

2000
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.

Health human resource

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.
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
DOH
 The leader
Vision of health for
all in the Philippines.
 Guarantee  equitable,
sustainable and quality
health for all Filipinos,
especially the poor, and to
lead the quest for excellence
in health. 

Mission
 Composed of 17 offices, 16 Centers
for Health Development in various
regions, 70 hospitals and 4 attached
agencies

DOH
 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.


Milestones
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.
 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.
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 for
Center as with the local
Health governments
Development
Center for Health Development
Provides hospital-based care; specialised
or general services, some conduct
research on clinical priorities and training
hospitals for medical specialisation.

DOH Hospitals
 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

Attached Agencies
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
“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

Primary – barangay health stations and
rural health units
Secondary – district/provincial hospitals
Tertiary – provincial and regional hospitals

District Health System is subdivided

into 3 levels of referral:
In the Philippines:
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

Inter Local Health Zone (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

ILHZ
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
Main hospital for ILHZ and its catchment
population
Core Referral Hospital
Main point of referral for hospital services
from the community, private medical
practitioner and public health services at
BHS and RHUs
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

Core Referral Hospital

 Provincial hospital

RHU District Hospital

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

Importance of establishing an
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

Expected achievement of the

ILHZ
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
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

Minimum Package of Activity for PHC services

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
 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
Factors contributing
perennial to the limited
issues to be addressed. capacity of
The unavailability the and
of timely
country’s health care system
accurate data/information todifficult
makes it deliver to better health
make appropriate
outcomes
decisions on policies and programmes to improve health care.
 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.

ISSUES AND CONCERNS

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

SGD