FY 2013 DOH BUDGET
National Expenditure Program
Universal
Education
Health Care
Investing in
Filipinos,
especially the poor
Housing
Conditional Cash
Transfer
1
Why should UHC focus on the poor?
• Poor families were left out in previous health reform efforts
• Poorest families spend as much as 67 percent of their income on
food, making them most vulnerable to risks of paying for costs of
health care.
• Of these poorest families, more than two-thirds of those who
reported falling ill did not see a doctor, or seek any type of health
care
UHC Phase II
UHC Phase I
Poorest
1,015
Poor
1,732
Middle
Income
2,641
Rich
Richest
4,285
11,647
Average per capita monthly income, in PhP
Source: NSO, 2009
2
How should we define coverage?
Enrolled (Registered)
in PhilHealth
Full NG
Premium
Subsidy
Covered
Can Access
Quality Care at
a Facility
Informed of
Benefits and
Entitlements;
Can Access
Preventive Care
3
Why should UHC focus on the poor?
• Poor families were left out in previous health reform efforts
• Poorest families spend as much as 67 percent of their income on
food, making them most vulnerable to risks of paying for costs of
health care.
• Of these poorest families, more than two-thirds of those who
reported falling ill did not see a doctor, or seek any type of health
care
UHC Phase II
UHC Phase I
Poor
Poorest
1,015
Poor
1,732
Middle
Income
2,641
Rich
Richest
4,285
11,647
Average per capita monthly income, in PhP
Source: NSO, 2009
4
What will Universal Health Care achieve?
Kalusugan Pangkalahatan
 All Filipinos especially poor families will be
enrolled in PhilHealth
 PhilHealth “support value” will increase from
34% (2008) to 60% in 2016
 Every PhilHealth family will have access and
obtain essential, quality and affordable health
services
 Care will be provided in modern hospitals and
other health facilities
 Poor families are informed and guided by
Community Health Teams for their health needs
5
Interventions Done (2011-2012):
Financial Risk Protection
5.3 million poor families under the NHTS-PR enrolled into
PhilHealth through full National Government subsidy
Additional 5.33 million poor families enrolled/sponsored by
LGUs
81.63 million Filipinos or 85% of the population now enrolled to
PhilHealth (from 62% in 2010)
Introduction of PhilHealth Case Rates Payment Scheme
Catastrophic Care Packages introduced last July 2012
6
PhilHealth
Membership Category
NUMBERS
in
Number of Registered Members
(in millions)
Number of Beneficiaries
(in millions)
2010
2011
2012
2010
2011
2012
Formal Government
1.95
2.01
2.02
5.76
5.90
6.02
Formal Private
7.86
8.50
9.56
15.78
18.10
18.96
Non-poor Informal (IPP)
3.75
4.34
4.68
9.31
9.91
10.72
OFW
2.34
2.57
2.64
4.73
5.09
5.21
Lifetime
0.50
0.57
0.61
0.81
0.95
1.02
Sponsored - NHTS
-
4.90
4.74
-
21.84
20.15
Sponsored – Local
Government
6.05
4.67
5.33
21.93
17.09
19.55
Total
22.4
27.92
29.28
58.32
78.87
81.63
Projected Population
94.01
95.74
95.98
Enrollment Rate
62.04%
82.38%
85%
7
23 Case Rates (No balance billing for Sponsored
Program beneficiaries in government hospitals)
8
TYPE Z (CATASTROPHIC DISEASES) BENEFIT
PACKAGE
BENEFIT
Leukemia in Children
CASE RATE
Php210,000.00
Breast Cancer
100,000.00
Prostate Cancer
100,000.00
Renal Transplantation
600,000.00
Selected Cardiac Operations
For finalization
• Can only be availed initially in PhilHealth accredited Level 3 or Level 4
government hospitals that have signed a contract on the provision of
specialized care;
• No balance billing policy will be implemented to members of the
Sponsored Program;
• In the future, for non-SP members, fixed co-pay for each condition will
be paid on top of the packaged amount.
9
Summary of HFEP Infrastructure Projects,
by Type of Health Facility, 2007-2012
2007
2008
2009
2010
2011
2012
TOTAL
BHS
0
34
179
129
586
80
1,008
RHU
0
6
117
90
994
296
1,503
Level 1
5
21
65
51
192
Level 2
17
35
59
46
107
Level 3
1
6
9
10
1
371
1,040
Level 4
0
7
3
15
5
Special/
Specialty
0
3
6
5
0
2 (PNP)
1 (PNP)
3 (P/CHO)
5 RBC; 4
P/CHO
0
9
25
113
441
355
1,885
756
Others
Total
3,575
10
Status of Health Facilities Enhancement Program
(Infrastructure/Equipment as of August 2012)*
2011
2012
Equipment
Total Cost
(as programmed)
Php 1.434 B
Php 2.550B
Bidded/Awarded
100%
91%
Infrastructure
Total RHUs & Hospitals
(as programmed)
1230
755
Completed
194 (16%)
-
Ongoing
1036 (84%)
755 (100%)
11
Complete Treatment Packages
(Compacks)
Compacks: free drug access program for poor families
covered by the Pantawid Pamilya introduced in 2011
• 24 complete treatment regimens for the most
common diseases
• Provided to RHUs in 1,020 CCT municipalities
12
REGISTERED NURSES FOR HEALTH
ENHANCEMENT AND LOCAL SERVICE
RN HEALS
DEPLOYMENT
Batch 1
9,518
(Feb. 2011 – Jan. 2012)
Batch 2
11,283
(Oct. 2011 – Sept. 2012)
Batch 3
10,000
(Mar. 2012 – Feb. 2013)
30,801
(Cumulative Total)
Total
13
DTTB and Midwives
Midwives
Doctors to the Barrios
2011
2012
113
106
BATCH I
BATCH II
(Oct. 2011 - Dec. 2012) (Mar. 2012 - Dec. 2012)
832
3,000
14
Attainment of MDGs
Indicator
2011 Accomplishments
Targets for 2016
Community Health Teams (CHT)
deployed
61,911 deployed (2012)
646,541 HH’s visited (2012)
100,000 CHTs deployed
82%
95%
48.9%*
65.4%
78%*
90%
55.2%*
90%
Infant Mortality Rate (IMR),
(per 1,000 livebirths)
22*
19
Under 5 Mortality Rate (U5MR),
(per 1,000 livebirths)
30*
26.7
Maternal Mortality Rate (MMR)
(per 100,000 livebirths)
221*
52
Fully Immunized Child (FIC)
Contraceptive Prevalence Rate
(CPR)
Antenatal Care (ANC)
(at least 4 visits)
Facility-Based Deliveries (FBD)
*2011 Family Health Survey
15
Maternal Mortality Ratio
260
224
196
182
120
128
MDG Target: 52
Data Source: FHS 2011 (NSO, DOH, USAID)
16
Attainment of MDGs
Indicator
2011 Accomplishments
Targets for 2016
Community Health Teams (CHT)
deployed
61,911 deployed (2012)
646,541 HH’s visited (2012)
100,000 CHTs deployed
82%
95%
48.9%*
65.4%
78%*
90%
55.2%*
90%
Infant Mortality Rate (IMR),
(per 1,000 livebirths)
22*
19
Under 5 Mortality Rate (U5MR),
(per 1,000 livebirths)
30*
26.7
Maternal Mortality Rate (MMR)
(per 100,000 livebirths)
221*
52
Fully Immunized Child (FIC)
Contraceptive Prevalence Rate
(CPR)
Antenatal Care (ANC)
(at least 4 visits)
Facility-Based Deliveries (FBD)
*2011 Family Health Survey
17
Attainment of MDGs
Indicator
2011 Accomplishments
Targets for 2016
502 (as of 2010)
387
TB Case Detection Rate
73%
90%
TB Cure Rate
84%
90%
Malaria Morbidity Rate
(per 100,000)
9.5
4
Malaria Mortality Rate
(per 100,000)
0.01
< 0.03
< 1% of total population
< 1% of total population
TB Prevalence Rate
(per 100,000)
HIV AIDS Prevalence Rate
18
Malaria Control Program
• Significant reduction in morbidity and mortality
• 24 provinces are malaria-free
Cavite, Batangas, Marinduque, Catanduanes, Albay, Masbate, Sorsogon,
Camarines Sur, Iloilo, Aklan, Capiz, Guimaras, Bohol, Cebu, Siquijor, Western
Samar, Eastern Samar, Northern Samar, Northern Leyte, Southern Leyte, Biliran,
Benguet, Camiguin, Surigao Del Norte
• Provinces recently evaluated to be declared as malaria-free:
Batanes and Dinagat Islands
• Target of 40 malaria-free provinces by 2016
Malaria Indicator
Morbidity Rate
(per 100,000 population)
Mortality Rate
(per 100,000 population)
2002 2003
47
51
0.01 0.08
2004
2005
2006
2007
2008
2009
2010
2011
53
55
41
41
26
22
21
9.5
0.07
0.17
0.14
0.08
0.06
0.03
0.03
0.01
19
Number of New HIV cases per month
(highest for every year)
20
MDG-Max to Address High Burden of
Non-Communicable Diseases
Data
•
•
•
•
Mortality rate from Heart Diseases:
90.4 deaths per 100,000 (PHS)
Mortality rate from Diabetes Mellitus: 21.6 deaths per 100,000 (PHS)
Prevalence rate of adults with high fasting blood sugar: 4.8% (NNS)
Prevalence rate of hypertension:
25.3% (NNS)
Strategies
• Healthy Lifestyle Promotion Programs
• Disease Registries, Surveys and Studies
• Diagnosis and Treatment
– Philhealth Outpatient Benefit Package
– PhilHealth Type Z (Catastrophic) Package
– Complete Treatment Package (ComPacks)
PHS – Philippine Health Statistics, 2005
NNS – National Nutrition Survey, 2008
21
The Proposed DOH Budget, FY 2013 NEP
PARTICULARS
GAA 2012
(in ‘000 pesos)
NEP 2013
(in ‘ 000 pesos)
Office of the Secretary
42,155,963
39,497,343 (74.4%)
Personnel Services
7,633,148
8,866,448 (16.7%)
MOOE
25,994,815
30,412,719 (57.3%)
Capital Outlay
8,528,000
218,176 (0.4%)
Health Facilities Enhancement Program*
Total New Appropriations
13,558,065 (25.6%)
42,155,963
53,055,408
* HFEP of Php 13.558 B is lodged under the Priority Social and Economic Projects Fund
22
DOH and Attached Agencies, FY 2013 NEP
Particulars
Amount (in ‘000)
% Share
(of 54.63B)
39,497,343
13,558,065
304,543
327,744
53,687,695
72.29%
24.82%
0.56%
0.60%
98.26%
173,400
202,865
345,000
187,000
908,265
0.32%
0.37%
0.63%
0.34%
1.66%
Department of Health
Office of the Secretary
Health Facilities Enhancement Program*
Commission on Population
National Nutrition Council
Sub-Total
Specialty Hospitals (Corporate)
Lung Center of the Philippines
National Kidney and Transplant Institute
Philippine Children’s Medical Center
Philippine Heart Center
Sub-Total
Attached Corporations
Philippine Health Insurance Corporation
Phil. Inst for Traditional & Alternative Health
Care
GRAND TOTAL
In DOH Office of the Secretary
40,000
0.07%
54,635,960
100%
23
FY 2013 NEP Per Capita Allocation
by Geographical Area
Mindanao*
15.02 B (28%)
Per capita 671.28
Luzon
28.5 B (54%)
Per capita 542.10
Visayas
9.5 B (18%)
Per capita 500.11
Philippines: P53.06B; Per Capita P564.34
*Budget of DOH-ARMM not included; only DOH allocations to ARMM
24
ALLOCATION OF DOH-PROPER Budget,
FY 2008 – 2013, In Billion Pesos
60
50
40
30
20
10
0
Series1
CY 2008
18.91
CY 2009
23.67
CY 2010
24.65
CY 2011
31.83
CY 2012
42.08
CY 2013
53.06
25
Comparative Allocation of DOH-Proper Budget,
By Expense Class, FY 2008-2013, In Billion Pesos
35
30
25
20
15
10
5
0
PS
MOOE
CO
GAA 2008
5.83
10.64
2.44
GAA 2009
6.73
10.58
6.35
GAA 2010
6.87
11.32
6.46
GAA 2011
7.71
15.19
8.93
GAA 2012
7.63
25.99
8.53
NEP 2013
8.87
30.41
13.78
*Allocation for PhilHealth Sponsored Program incorporated in DOH-MOOE starting 2011
26
FY 2013 Priority Programs, Activities and Projects in support of UHC
2012 GAA
(in ‘000)
2013 NEP
(in ‘000)
% Share
(of 53.06B)
Subsidy for Health Insurance Premium payment of
Indigent Families to the NHIP
Health Facilities Enhancement Program*
12,028,000
12,612,283
23.8%
5,078,000
13,558,065
25.6%
3
Implementation of the Doctors to the Barrios and Rural
Health Practice Program
1,741,801
2,799,383
5.3%
4
1,000,000
1,038,116
2.0%
5
National Pharmaceutical Policy Development including
provision of drugs and medicines, medical and dental
supplies to make affordable quality drugs available
Expanded Program on Immunization
1,874,792
1,949,783
3.7%
6
Family Health and Responsible Parenting
2,279,573
2,539,420
4.8%
7
Tuberculosis Control
1,021,000
1,021,023
1.9%
8
Elimination of diseases as public health threat such as
malaria, schistosomiasis, leprosy and filariasis
594,926
570,443
1.1%
9
Other infectious diseases and emerging diseases including
HIV/AIDS, dengue, food and water-borne disease
223,797
321,951
0.6%
72,000
118,740
0.2%
25,913,889
36,529,207
69.00%
Programs, Activities and Projects
1
2
10 Rabies Control Program
TOTAL
* Lodged under the Priority Social and Economic Projects Fund
27
FY 2013 DOH Budget Proposal (in ‘000 pesos) for Priority PPA’s
Program
2012
GAA
2013
Proposal
Remarks
FINANCIAL RISK PROTECTION
Subsidy for health
insurance premium
of indigent families
enrolled in NHIP
12,028,000
12,612,283 Premium subsidy of 5.3
Million families at P2,400
per annum per family
28
FY 2013 DOH Budget Proposal (in ‘000 pesos) for Priority Programs,
Projects, Activities (PPAs)
Program
2012
GAA
2013
Proposal
Remarks
IMPROVING ACCESS TO QUALITY HEALTH SERVICES
Health Facilities
Enhancement
Program
5,078,000
Implementation of
Doctors to the
Barrios and Rural
Health Practice
Program (RN, MWs,
etc)
1,741,801
National
Pharmaceutical
Policy Devt incl
Provision of Drugs
1,000,000
13,558,065 Lodged under the Priority
Social and Economic
Projects Fund
2,799,383 Hiring of 22,500 RN-HEALS
for deployment in CCT/4Ps
areas (Batch 4)
Deployment of 221 Doctors
to the Barrios
1,038,116 Procurement of Complete
Treatment Packages for
distribution to 1,395 RHUs
and 160 district hospitals in
CCT/4Ps municipalities
29
FY 2013 DOH Budget Proposal (in ‘000 pesos) for Priority Programs,
Projects, Activities (PPAs)
Program
2012
GAA
2013
Proposal
Remarks
PRIORITY HEALTH PROGRAMS INCLUDING ACHIEVING
HEALTH-RELATED MDGs (4, 5 & 6)
Expanded
Program on
Immunization
1,874,792
Tuberculosis
Control
1,021,000
Family Health
and Responsible
Parenting
2,279,573
1,949,783 BCG, DPT, OPV, HepB,
Measles, TT, MR,
Pneumococcal Conjugate
Vaccine, Rotavirus vaccines
1,021,023 Anti-TB Drugs and
commodities
2,539,420 Includes cost of vaccines
for Senior Citizens
(Pneumococcal and
Influenza)
30
Needed Legislative Support
•
•
•
•
•
Restructuring of Excise Taxes of alcohol and tobacco
Passage of Responsible Parenthood Bill
Amendment of the National Health Insurance Act
Laws for corporate governance of hospitals
Amendment of selected laws governing practice of
health professionals (e.g., medical act, midwifery
law, nursing law, etc)
Note: An omnibus law on universal health care that shall contain specific
provisions necessary to enact required policies or amend existing laws can also be
legislated
31