Universal Health Coverage

A Civil Society and Reproductive Health Perspective

Disclaimer: The views expressed in this paper/presentation are the views of the
author and do not necessarily reflect the views or policies of the Asian Development
Bank (ADB), or its Board of Governors, or the governments they represent. ADB
does not guarantee the accuracy of the data included in this paper and accepts no
responsibility for any consequence of their use. Terminology used may not
necessarily be consistent with ADB official terms.

Jonathan A. Flavier MD, MA

Philippine Center for

Population and
Development
MA at the University of Leeds
Liquid Assets from Feast N Firkin Pub

Actors in health and development The State, Market, and Civil Society

STATE

MARKET

CIVIL
SOCIETY

Machiavelli N The Prince 1532,

Philippine Rural Reconstruction Movement 1990

PPP

Philippine Inequity in Health:

Pooling to redistribute risk
Contribution

Net Transfer

Utilization

LOW INCOME,
HIGH RISK

HIGH INCOME,
LOW RISK

Pooling and Cross-subsidy Across Incomes-Risk

Based on WHO, 2000

Philippine Inequity in Health:

With Limited Access, Affordability, Acceptability

Contribution

Net Transfer

Utilization

LOW INCOME,
HIGH RISK

HIGH INCOME,
LOW RISK
Pooling and Cross-subsidy work against those with less
information/acceptance, who cant afford costs associated with
health care, have less access to health care

Inequity in Health:
Philippine Context
Rural to Urban Ratios
Under-5 mortality rate (per 1000 livebirths)
Philippines
Births attended by skilled health personnel
Philippines
Measles immunization coverage among one-year-olds Philippines
Lowest to Highest Wealth Quintile Ratios
Under-5 mortality rate (per 1000 livebirths)
Philippines
Births attended by skilled health personnel
Philippines
Measles immunization coverage among one-year-olds Philippines
Mother With No to Higher Education Ratios
Under-5 mortality rate (per 1000 livebirths)
Philippines
Births attended by skilled health personnel
Philippines
Measles immunization coverage among one-year-olds Philippines
Relative coding used:

1.6 Ratio Averaged Across IHIs

1.7
1.9
1.1

2.7 Ratio Averaged Across IHIs

3.1
3.7
1.3

4.0 Ratio Averaged Across IHIs

3.7
6.5
1.8

- Health Inequity Ratio less than 1.6

- Health Inequity Ratio from 1.6 to 3.2
- Health Inequity Ratio more than 3.2

(WHO 2006 Health Statistics, 2003 Philippine Data)

Spreading the risk burden and

Subsidizing the poor
Based on PhilHealth, 2005
HOSPITAL BENEFITS

Health centers are accessible to 90% of

PhilHealth sponsored members and their
families. These are households with average
income of P2,500 per month.
Reaching out to PhilHealth Sponsored Members

Spreading the risk burden and

Subsidizing the poor
HOSPITAL BENEFITS

Reaching out to PhilHealth Sponsored Members

Philippine Inequity in Health:

Differences in Income
100%

100%
100%

90%

90%
90%

80%

80%
80% Households,
47%
70%
70%

70%
60%
50%
40%

Local
Government,

30%

14%
National

20%

Government,

10%

16%

0%

PhilHealth, 15%
PhilHealth, 30%

60%
60%
50%
50%
40%
40%

National
Local
Government,
Government,

Others, 14%

30%
30%
20%
20%
10%
10%
PhilHealth, 10%
0%
0%
Current Estimates

Local
National
Government,
Government,
32%
20%

Others, 16%
Others, 20%
Households,
Households,
20%

17%
20%

10%
Preferred
SuggestedTarget
Target

National Health Accounts, DOH

Philippine Inequity in Health:

Education and Information
Based on PhilHealth, 2005

Sick members not using PhilHealth ID

card for Health Center services
did not
know RH
servic es
offered
30%

Healthcare Information
did not
Gap
know ID
c ard w as
ac c epted
41%
COMMUNITY-BASED BENEFITS

Health
Center is far
15%

Healthcare Service Gap

health
services
needed not
offered
14%

PhilHealth Members

UNIVERSAL HEALTH COVERAGE

Challenge of Inequity in Health

Cities Rural Areas, Central
Peripheral, Constituents of
Politicians INEQUITY IN
ACCESS;
Disparity Between the Poor and
Non-Poor Across the Country
INCOME INEQUITY; And
Information-Communication
and Social Less Sosyal Media,
INEQUITY IN EDUCATION.

UNIVERSAL HEALTH COVERAGE

Contraceptive Inequity
Voluntary surgical contraception was
essentially hospital based, shifted to out-patient
healthcare facilities and outreach settings (noscalpel vasectomy, bilateral tubal ligation)
Reimbursement packages for long-acting
reversible contraceptives (Intra-uterine device ,
contraceptive implants);
Household budgets for NFP, condoms and
contraceptive pills, in some cases injectable
contraceptives.

FP Choices for Women at Risk of

Unintended Pregnancy

Based on WHO 2007