Health System in the
Philippines
Teodoro J. Herbosa MD FPCS
College of Medicine & National Telehealth Center
University of the Philippines, Manila
Undersecretary of Health 2010-2015
Republic of the Philippines
Outline
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Background information: Philippines
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Philippine Health System
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Health Financing
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Government Procurement
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Public Private Partnership
Republic of the Philippines
Southeast Asia
Archipelago 7,107
islands
100million people
Democracy
Low Middle Income
Colonized by Spain,
USA and Japan
Statistical Figures
Population (May 2010) 92.34M
Population (Aug 2007) 88.55M
Inflation Rate (Jun 2015) 1.2 %
Total Exports(Apr 2015) $4.38Bp
Total Imports (May 2015)$4.39Bp
Balance of Trade (May 2015)
$508.86M
Employment Rate (Apr 2015)93.6%p
Unemployment Rate (Apr 2015)
6.4%p
Underemployment Rate (Apr 2015)
17.8%p
LFPR (Apr 2015)64.6%p
Simple Literacy (2000) 92.3%
Functional Literacy (2008) 86.4%
Average Family Income(2012)
Health System
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"Two" health systems
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Private healthcare vs Public healthcare = health inequity
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Centralized to Decentralized
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Infrastructure gap hospital bed to pop is 5/10,000
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Rapid population growth
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Increasing health costs
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Health Indices and Statistics
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Total population (2013) 98,394,000
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Gross national income per capita (PPP international $, 2013)
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Life expectancy at birth m/f (years, 2013)
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Probability of dying under five (per 1 000 live births, 0) not available
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Probability of dying between 15 and 60 years m/f (per 1 000 population,
2013) 255/136
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Total expenditure on health per capita (Intl $, 2013)
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Total expenditure on health as % of GDP (2013)
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Latest data available from the Global Health Observatory
7
65/72
287
4.4
Health Reforms
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Primary Health Care "Alma Ata"
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Corporate government hospitals
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Generics Law
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Decentralization (devolution) Local Government Code
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National Health Insurance Act
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Health Reform Agenda
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Universal Health Care (Sin Tax Financing)
Government Procurement
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RA 9184
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Post qualification methodology
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Head of Procuring Entity (HOPE)
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Bids and Awards Committee (BAC)
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Technical Working Group (TWG)
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Recommendation to Award (RTA)
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Notice of Award (NOA)
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Purchase Order (PO) or Contract
Irregularities
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Collusion
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Price manipulation; overpricing
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Kickbacks
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Insider information
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Fake qualification documents
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Variability of costs
Procurement of Medicines
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Programs ("vertical") TB, vaccines, leprosy,
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Vaccines (EPI) Expanded Program of Immunization
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TB (NTP) National Tuberculosis Program
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Leprosy (NLP) National Leprosy Program
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Others
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What is Medicines Access Programs (MAPs)
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Types of MAPs
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MAPs for out-patient care:
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Botika ng Barangay (BnB)
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DOH Complete Treatment Pack (DOH ComPack)
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MAPs for in-patient care:
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Regular in-patient care
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Catastrophic Care
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Acute Lymphocytic Leukemia Medicines Access Program
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Breast Cancer Medicines Access Program
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Rare Disease Medicines Access Program
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Other MAPs
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DOH Insulin Access Program
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Valsartan Access Program
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Geriatric Health Care Medicines Access Program
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Mental Health Care Medicines Access Program
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Universal Health Care (UHC) and Access to Medicines
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Universal Health Care (UHC) is the call and
commitment of the Philippine Government to ensure
that every Filipino has access to quality and
affordable health care.
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In 2011, the Department of Health announced its goal
to achieve UHC under the flagship program of
President Benigno Aquino III known as Kalusugan
Pangkalahatan (KP) focusing on improving access to
health care services and reducing poverty from
catastrophic healthcare expenditures especially for
the poor and most vulnerable population.
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Universal Health Care (UHC) and Access to Medicines
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.To achieve Universal Health Care (UHC), or Kalusugan Pangkalahatan (KP), is
defined as the "provision to every Filipino of the highest possible quality of
health care that is accessible, efficient, equitability distributed, adequately
funded, fairly financed, and a appropriately used by an informed and
empowered public". The administration puts it on top of the socioeconomic
agenda to improve the health and quality of life.
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To attain UHC, the DOH defined three strategic thrusts to be pursued from
2011-2016, namely:
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1) Achieve the health-related Millennium Development Goals (MDGs) of
improving maternal and child health and combating priority infectious and noncommunicable diseases;
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2) Provide financial risk protection through expansion in the enrollment and
benefit delivery of the National Health Insurance Program (NHIP); and
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3) Improve access to quality health care which includes the upgrading of public
hospital and health facilities, ensuring adequate health human resources and
securing the availability of essential medicines.
NCD Control: Primary Care
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Non-communicable disease burden
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Hypertension control
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Diabetes control
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Asthma management
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Acute infections
Public Private Partnership
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improve access to health facilities and services
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Infrastructure gap in the health system
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5 hospital beds/10,000 pop.
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Long length of stay because of efficiency
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Lack of funds
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Brain drain
PPP
▪ The project aims to raise health standards through the
upgrading and modernization of the facilities. The project
components cover the following:
• Construction of new healthcare building and facilities.
• Hospital facilities involves the entire development and
identifying the services required, and overall delivery of
services.
• Hospital Equipment, furniture & fixtures: Provision of
medical equipment including hospital beds, etc.
• Total Computerization. Hospital Information system linked
between medical and administrative as well as external
stakeholders (Philippine Health Insurance Corporation
(Philhealth), Department of Health (DOH), Department of
Budget and Management (DBM), etc.).
• Training and Technology Transfer
NKTI Hemodialysis Center
• Procured in 2003 under lease agreement for 5 years and was renewed again in 2009
• At present, there are 47 dialysis machines in operation at the new hemodialysis center of
NKTI
• Status: Second contract is being implemented; third contract will be for bidding
www.doh.gov.ph
NKTI PET-CT and Cyclotron Project
• Include building construction in a 230 square meter vacant lot beside the Diagnostic Center
of NKTI for housing of the Cyclotron for the production of fluorodeoxyglucose (FDG)
• Supply of equipment and related facilities in the operation of the Positron Emission
Tomography (PET) and Computerized Tomography (CT);
www.doh.gov.ph
Modernization of Philippine Orthopedic Center
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•
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PhP5.6 Billion £83.5Million
700-bed capacity specialty hospital
Build-Operate Transfer Contract for 25 years.
Status: Ongoing procurement of Independent Consultant
www.doh.gov.ph
Modernization of Bicol Medical Center
• PhP855 Million (£12.7Million)– funded by the government through DOH
• 800-bed capacity hospital
• Design and Build Scheme – ongoing construction
www.doh.gov.ph
Modernization of Cagayan Valley Medical Center
• PhP305 Million (£4.55 Million) – funded by the government through DOH
• 600-bed capacity hospital
• Design and Build Scheme – ongoing construction
www.doh.gov.ph
Regional Cancer Centers
• CVMC
• BGHMC
• NKTI, RMC
• BMC
• WVMC
• VSMMC
• NMMC
• ZCMC
• SPMC
• PhP75 Million (£1.12 Million) – infrastructure funded by the government through DOH
• Of the nine cancer centers, three (BGHMC, NKTI, RMC) has already its Oncology Equipment
provided by the Private Sector investor through sharing arrangement under Service
Management Contract
www.doh.gov.ph
Summary
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Background information: Philippines
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Philippine Health System
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Government Procurement System
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Health Financing
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Public Private Partnership