Aquino Health Agenda: Universal Health Care

Enrique T. Ona, MD, FPCS, FACS Secretary of Health 2nd Philippine Health Outlook Forum 22 October 2010

Sixty percent of our countrymen who succumb to sickness die without seeing a doctor. - PNoys Challenge

Universal Health Care

Deliberate attention to the needs of millions of poor Filipino families which comprise the majority of our population

Filipino Income Quintiles

Monthly income Q1 3,460 Q2 6,073 Q3 9,309 Q4 15,064 Q5 38,065 Families per quintile 5,218,267 4,094,164 3,912,443 3,707,494 3,485,067

Source: National Health and Demographic Survey, 2008

Comprehensive Reforms in Health

Universal Health Care (2010 -2016)
Fourmula One for Health (2005 2010) Health Sector Reform Agenda (1999- 2004)

Health Outcomes

CURRENT STATUS

Demographic Characteristics
Population, total (millions) Population < 25 years (% of total population) Population > 60 years (% of total population) Birth rate (births per 1,000 population) Death rate (deaths per 1,000 population) 94,013,200 (projected, NSO 2007) 52.8 % (projected, NSO 2007) 49,617,400 M Filipinos 6.7% (projected, NSO 2007) 6,637,100 M Filipinos 23.4 (NDHS 2008) 2,162,303 live births per year 5.48 (NSO 2007) 515,192.34 deaths / year

Top Ten Cause of Mortality

Cause Total Rate

1. Diseases of the heart

2. Diseases of the vascular system 3. Malignant Neoplasms 4. Accidents 5. Pneumonia 6.Tuberculosis 7. Unclassified 8. Chronic lower respiratory diseases 9. Diabetes mellitus

70, 861
51,680 40,524 34,483 32,098 26,770 21,278 18,975 16,552

84.8
61.8 48.9 41.3 38.4 31.0 25.5 22.7 19.8

10. Conditions originating from the perinatal period

13,180

15.8

Philippine Statistical Yearbook, 2009

UN Millennium Development Goals

Source: MDG Monitor: Quick Facts (accessed 10/11/2010)

Towards the attainment of MDGs .

Indicators 2015 Target Accomplishment

MDG 4: Under 5 mortality rate (per 1,000 live births) Infant mortality rate (per 1,000 live births) MDG 5: Maternal mortality ratio (per 100,000 live births) Proportion of births attended by skilled health professional
52 70.0 (2010 NOH) 162 (2006 FPS) 62 (2008 NDHS) 26.7 34 (2008 NDHS) 25 (2008 NDHS)

19.0

INDICATORS

2015 Target

ACCOMPLISHMENT

MDG 6
Prevalence of HIV/AIDS among high risk groups Malaria morbidity rate <1% 5,364 cases (1984-2010) 62/100,000 pop 38,135 cases
(based from 1990 baseline)

<1%

21.6/100,000 pop 19,555 cases (2009) 0.026 24 deaths (2009) 129 (2008) 121,277 cases 41.0 (2007)

Malaria mortality rate

0.75 456 deaths

(based from 1990 baseline)

TB morbidity rate

137/100,000 128,798 cases (2010 NOH) <44/100,000 41,366 deaths (PhilPACT) 70 % 85 %

TB mortality rate

TB case detection rate TB cure rate

75 % (NTP, 2007) 83 % (NTP, 2007)

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Mortality Trend: Communicable Diseases, Malignant Neoplasms & Diseases of the Heart
Rate/100,000 Population Philippines, 1953-2005 Malignant Neoplasms & Diseases of the Heart 100 Communicable Diseases 600 Malignant Neoplasms Diseases of the Heart 500 80 70 60 50 300 40 30 20 100 10 0
1953 '54 '55 '56 '57 '58 '59 '60 '61 '62 '63 '64 '65 '66 '67 '68 '69 '70 '71 '72 '73 '74 '75 '76 '77 '78 '79 '80 '81 '82 '83 '84 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 2000 '01 '02 '03 '05

Communicable Diseases 700

90

400

200

Year

Source: Philippine Health Statistics, 2005

HEALTH FINANCING

CURRENT STATUS

Share of health expenditure per GNP

4 3.5 3 2.5 2 1.5 1 0.5 0

Percent

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Year

Total health expenditure = P234.3 B or 3.2 percent of GDP

Source: Philippine National Health Accounts

2007

Total expenditure on health as a Percentage of GDP

Total expenditure on health as % GDP
16 14 12 10 8 6 4 2 0

Source: World Health Statistics 2010

Distribution of Health Expenditure by Use of Funds

Public Health Others 10% Care 9% P 23.3 billion P 21.2 billion

Total health expenditure is P234.3 B (3.2 percent of GDP)

Personal Health Care 81% P 189.7 billion

Source: Philippine National Health Account, 2007

Distribution of Health Expenditure by Source of Funds

Others 11%
National Government 13% Local Government 13%

Out-of-Pocket 54%

Social Health Insurance 9%

Total health expenditure is P234.3 B (3.2 percent of GDP) Source: Philippine National Health Account, 2007

PhilHealth
Pres. Aquino, on PhilHealth Enrolment: Sabi ng PhilHealth sa isang bibig, walumpu't pitong porsyento na raw ang merong coverage. Sa kabilang bibig naman, singkuwenta'y tres porsyento. Ayon naman sa National Statistics Office, tatlumpu't walong porsyento ang may coverage.
(Pnoys SONA July 26, 2010; emphasis supplied)
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PhilHealth
Aquino was dismayed at the miserable benefit delivery rate of the National Health Insurance Program in the country which stands at only 8 percent. (PDI, Oct 3, 2010)
Coverage rate Availment rate Support value Benefit delivery rate

53%

42%

34%

8%

19

HEALTH FACILITIES

CURRENT STATUS

Office of Secretary of Health Attached Agencies Regional hospital Medical Centers Sanitaria City Health Offices
(Chartered Cities)

Regional Offices

Provincial Health Offices Inter-local Health Zones

Provincial Hospitals

City Hospitals

Health Centers Barangay Health Stations

City Health Offices

(Component Cities)

Municipal health offices/ Rural Health Unit Barangay Health Stations

District hospitals

City Hospitals

Health Centers
Barangay Health Stations

Regional Hospitals
Corazon Locsin Montelibano Memorial Regional Hospital, Negros Occidental

Southern Philippines Medical Center, Davao

Provincial Hospitals
Davao del Sur Provincial Hospital Teresita Lopez Jalandoni Provincial Hospital, Negros Occidental

City Hospitals
Gregorio Lluch Memorial City Hospital, Butuan City JJ. Borja Memorial City Hospital, Cagayan de Oro City

STRATEGIC DIRECTIONS OF THE AQUINO ADMINISTRATION

1.

A roadmap towards universal health care through a refocused PhilHealth;

Priority Health Policy Directions of the Aquino Administration

2.

Particular attention to the construction, rehabilitation, and support of health facilities:

LGU/regional hospitals, rural health units barangay health stations

3.

Attainment of Millennium Development Goals 4, 5, and 6

Reduction of maternal, neonatal, and infant mortality Support to contain/eliminate age old pubic health diseases (malaria, dengue, TB)

Health Policy Directions of the Aquino Administration

Attain efficiency by using information technology (IT) in all aspects of health care Increased attention to trauma, the 4th leading cause of death More aggressive promotion of healthy lifestyle to prevent non communicable diseases: heart disease, stroke, diabetes, obesity Attention to emerging diseases (Superbug, nosocomial diseases, A(H1N1), diseases brought about by climate change)

Health Policy Directions of the Aquino Administration

Improve the access to quality affordable medicines
Continuing efforts in improving governance and regulation to eliminate graft and corruption in all areas of health care Improve the plight of health workers through interventions in health education, placement, compensation, among others

Revitalizing the NHIP

Paradigm shift in the implementation of NHIP: Expansion of NHIP coverage
Enrollment of the poorest of the poor Enforce mandatory enrolment of the informal sector (as per the National Health Insurance Act, R.A. 7875 as amended)

Improvement of membership services to increase awareness of PhilHealth benefits and entitlements Access to inpatient and outpatient services through PhilHealth Zero co-payment/No balance billing for health care costs incurred for the poorest in government hospitals

Health Facilities Enhancement

Upgrading of health facilities: rural health units, district hospitals, provincial hospitals, DOH Retained hospital
Improved facility preparedness for trauma (4th leading cause of death) Improved capacity of clinical/hospital care for the most common causes of mortality and morbidity Improve access to quality affordable medicines

Strategies for Health Facilities Enhancement

Public-Private Partnership Regional Clustering Fiscal autonomy and income retention for government health facilities Streamlining of licensing and regulation for improved accreditation

Public-Private Partnerships
Proposed projects: IT system for DOH and PhilHealth Philippine Orthopedic Center as Center for Bone Diseases and Trauma Air ambulance project Research Institute for Tropical Medicine for commercial production of vaccines San Lazaro Hospital as Center for Infectious Diseases

Public-Private Partnerships
Commercial utilization of vacant hospital land assets Establishment of Multi-Specialty Centers in selected regions (3) in Northern Luzon, Visayas, and Mindanao Construction of Patient and Hospital Staffs lodging facilities

Regional Clustering
Clustering of health facilities composed of regional, hospitals and district hospitals as well as rural health units and health centers, to address fragmentation of health services at local levels by. Establishment of Clustered Health Boards composed of the Secretary of Health or his representative, local chief executives, private partners, civil society/NGO for clustered health facilities

Composition of Advisory Board of Clustered Health Facilities

Chairman: the Secretary of Health or his representative Vice Chairman: Regional CHD or Hospital Director Members:
Local chief executives: Governors and mayors Legislators: Congressmen Local health officials: PHOs and MHOs Private Sector: civic and business leaders, NGOs

Attaining the MDGs

Ensure

that poorest families are reached by priority public health programs Deployment of Community Health Teams: Packaging of services using the Life Cycle Approach
Pre-pregnancy: Family Planning services Pregnancy: Four ante-natal care services and delivery in health facilities (Emergency Obstetric and Neonatal Care)

Attaining the MDGs

Packaging of services using the Life Cycle Approach Post partum: Essential newborn care and immediate post partum care Infancy/early childhood: Garantisadong Pambata

Strategies for Public Health

More aggressive promotion of healthy lifestyle to prevent non communicable diseases: heart disease, stroke, diabetes, obesity Attention to emerging diseases (Superbug, nosocomial diseases, A(H1N1), diseases brought about by climate change)

ICT Tools for Health

Information and Communications Technology will play a major part in ensuring universal health care is achieved as it can provide quality and timely information to guide decision making at all levels. Improvement of PhilHealth services will not be attained with out efficient IT Tool support Access of health to public health programs as well as clinical services can be augmented by ICT e.g. Telemedicine Regional Clustering will be dependent on information sharing

Philippine Health Outlook Forum

For the remainder of this activity, we hope that we can explore ways on how we can harmonize our efforts in focusing on these priority areas towards achieving our goal of Universal Health Care.

Thank you!