Politics,
Law and
Health
Policies
HOMER C. BALMES, RN
MCD CSAS
CHN Facilitator
The ECONOMICS OF
HEALTHCARE
• From a macro perspective having
US as the case in point
• Looking into the perspective of how
countries around the world look
into managing their health care?
• How things work and not work in
the health system among different
countries?
LET US LOOK CLOSER
IN THE PHILIPPINE
HEALTH SITUATION
• PH Ailing Health 10 Years ago
• Duterte Government Health
Initiative
P H I L I P P I N E H E A LT H A G E N D A 2016-2022
H eal t hy Phi l i ppines 2 0 2 2
GOALS
T h e Health S y s t e m We As pire Fo r
FINANCIAL
P R O T E C T IO N
B E T T E R H E A LT H
OUTCOMES
RESPONSIVENESS
Filipinos, especially t he
poor, margi nalized, a n d
vulnerable are
p ro t e c t e d f ro m h i g h
co s t of health care
Filipinos attain t h e b e s t
possible health
outcomes with no
disparity
F i l i p i n o s fe e l r e s p e c t e d ,
val ue d, a n d e m p o w e r e d in
all o f t h e i r i n t e ra c t i o n w i t h
the health system
2
VALUES
T h e Health S y s t e m We As pire Fo r
E Q U I TA B L E & I N C L U S I V E T O
ALL
T R A N S PA R E N T &
A C C O U N TA B L E
USES RESOURCES
E F F I C I E N T LY
PROVIDES HIGH
QUALITY S E RV I C ES
3
D u r i n g t h e last 3 0 years of H e al th S e c t o r R e f o r m , w e h a v e
u n d e r t a k e n k e y structural r e f o r m s a n d c o n t i n u ou s l y built o n
p r o g r a m s that t a k e u s a s t e p c l ose r to our aspiration.
Milestones
D evol ut i on
U s e of G eneri cs
Milk C o d e
PhilHealth (1995)
D O H res ources to
p ro m o t e local
health s y s t e m
development
F i s cal a u t o n o my
for g o v e r n m e n t
hospitals
G o o d G o ve r n a n c e
P ro g ra m s
(ISO, I MC , P G S )
F u n d in g
for U H C
Per siste nt Inequities in Health O u t c o m e s
2000
Ev e r y year, a ro u n d
2 0 0 0 m o t h e rs die d u e
to p re g n a n c y - re l a t e d
co m p l i cat i o n s .
A Filipino child b o r n to t h e
p o o re st family is 3 t i m e s
m o r e likely to n o t re a c h his
5 t h birthday, c o m p a r e d to
o n e b o r n to t h e richest
family.
T h re e o u t o f 10
children are
stunted .
5
R e s t r i c t i v e a n d I m p o v e r is h in g H e alt h c ar e C o s t s
Tiisin ko n a
l a n g ito..
Ev e r y year, 1.5 million
families are p u s h e d to
p o ve r t y d u e to health
ca re ex p e n d i t u re s
Filipinos fo re g o or d e l ay
ca re d u e to prohibitive
a n d u n p re d i c ta b l e user
fe e s or c o - p a y m e n t s
Php 4,000/month
healthca re e x p e n s e s
c o n s i d e re d
cata st ro p h i c for s i n g l e
i n c o m e families
6
P o o r quality a n d undignified c a r e s y n o n y m o u s
with p u b lic clinics a n d hospitals
L o n g wai t t i m e s
Pri vacy a n d confidentiality
t a ke n lightly
L i m i t e d a u t o n o my
to c h o o s e provider
L e s s t han hyg i e n i c rest rooms ,
l a c k i n g a men i t i es
Po o r re co rd - ke e p i n g
O v e rc ro w d i n g &
under - provi s i on of care
7
Lahat Para sa Kalusugan!
Tungo sa Kalusugan Para sa Lahat
•
•
I nv e s t i n g in P e o p l e
•
U N I V E R S A L H E A LT H
COVERAGE
STRENGTHEN
I M P L E M E N TAT I O N O F
R P R H L AW
WA R AGAINST
DRUGS
•A D D ITI O N A L
P ro t e c t i o n A g a i n s t
I nstabi l it y
FUNDS FROM
PA G C O R
AT T A I N H E A L T H - R E L A T E D S D G T A R G E T S
Financial R i s k Protect i on |Better H eal t h O u t c o m e s |Re s p o n s i ve n e s s
Va l u e s : E q u i t y, Q u a l i t y, Ef f i c i e n c y, Tra n s p a r e n c y, A c c o u n t a b i l i t y, S u sta i n a b i l i t y, Re s i l i e n c e
SERVICE DELIVERY
NETWORK
3 G uarantees
ALL LIFE STAGES &
TRIPLE BURDEN OF
DISEASE
UNIVERSAL
HEALTH
INSURANCE
A
C
H
I
E
V
E
G U A R A N T E E #1
A L L L I F E S TA G E S &
TRIPLE BURDEN OF DISEASE
S e r vice s for B o t h th e Well & th e S i c k
Guarantee 1: All Life S t a g e s & Triple B u rd e n of D i s e a s e
P re g n a n t N e w b o rn
In fa n t
C h ild
A d o le s c e n t
A d u lts
E ld e rly
F i rst 1 0 0 0 d a y s |R e p r o d u c t i v e a n d s e x u a l h e a l t h |m a t e r n a l , n e w b o r n , a n d c h i l d h e a l t h |
e x c l u s i v e b r e a s t f e e d i n g |f o o d & m i c r o n u t r i e n t s u p p l e m e n t a t i o n |I m m u n i z a t i o n |
A d o l e s c e n t h e a l t h |G e r i at r i c H e a l t h
|H e a l t h s c r e e n i n g , p r o m o t i o n &i n f o r m a t i o n
C O M M U N IC A B L E
DISEASES
NONC O M M U N IC A B L E
DISEASES &
MALNUTRITION
DISEASES OF RAPID
U R B A N I Z AT I O N &
I N D U S T R IA L I Z AT IO N
12
Guarantee 1: All Life S t a g e s & Triple B u rd e n of D i s e a s e
C O M M U N IC A B L E
DISEASES
• H I V/A I D S , T B, Malaria
• D i s e a s e s for Elimination
• D e n g u e , L epto,
E b ol a, Z i ka
NONC O M M U N IC A B L E
DISEASES &
MALNUTRITION
• C a n c e r, D i abetes, H eart
D i s e a s e a n d their R i s k
Fa c t o rs – obesity,
s m o k i n g , diet,
s edentar y lifestyle
• Malnutrition
DISEASES OF RAPID
U R B A N I Z AT I O N &
I N D U S T R IA L I Z AT IO N
•
•
•
•
•
Injuries
Substance abuse
Mental Illness
Pa n d e m i c s , Travel Medi ci ne
H eal t h c o n s e q u e n c e s of
cl i mate c h a n g e / disaster
13
GUARANTEE #2
SERVICE DELIVERY NETWORK
Functional N e t w o r k of Health Facilities
Guarantee 2: S e r v i c e s are delivered
b y n e t w o r k s that are
F U L LY F U N C T I O N A L
(Complete Equipment,
M edicines, H e a l t h
Professiona l)
COMPLI ANT WITH
CLINICAL PRACTICE
GUIDELINES
AVA I L A B L E 24/7 &
EVEN DURING
DISASTERS
PRACTICING
G AT E K E E P IN G
L O C AT E D C L O S E
TO THE P E O P L E
(Mobile C linic or S u b s i d i ze
Transportation C o st )
E N H A N C E D BY
T E L E M E D IC IN E
15
GUARANTEE #3
UNIVERSAL
H E A LT H I N S U R A N C E
Financial F r e e d o m w h e n A c c e s s i n g S e r vice s
Guar ant ee 3: S e r v i c e s are f i n a n c e d pr edominant ly b y PhilHealth
PHILHEALTH AS THE
GATEWAY TO FREE
AFFORDABLE CARE
• 100% of Filipinos are members
• Formal sector premium paid through payroll
• Non-formal sector premium paid through tax
subsidy
SIMPLIFY
PHILHEALTH
RULES
•No balance billing for the poor/basic
accommodation & Fixed co-payment
for non-basic accommodation
PHILHEALTH AS MAIN
REVENUE SOURCE
FOR PUBLIC HEALTH
CARE PROVIDERS
• Expand benefits to cover comprehensive
range of services
• Contracting networks of providers within
SDNs
17
Our Strategy
A
Advanc e quality, health promotion and primary care
C
H
Cover all Filipinos against health-related financial risk
I
E
V
Invest in eHealth and data for decision-making
E
Harness the power of strategic H R H development
Enforce standards, accountability and transparency
Value all clients and patients, especially the poor,
marginalized, and vulnerable
Elicit multi-sectoral and multi-stakeholder support for
health
18
A
A d v a n c e quality, heal t h p r o m o t i o n a n d p r i m a r y c a r e
1 . C o n d u c t annual he al th visits for all p o o r families a n d
s pe c i al p o p u l at i o ns ( N H T S , IP, P W D , Se ni or Ci ti ze ns)
2 . D e v e l o p a n explicit list of pr i mar y c a re e nti tl e me nts that
will b e c o m e t h e bas i s for l i c e nsi ng a n d c o nt ra c t i n g
a r r a n g e m e nt s
3 . Tra n sfo r m se l e c t D O H hospi tals into m e ga - h o s p i t a l s w i t h
capabilities for m u l t i - sp e c i a l ty training a n d t e a c h i n g a n d
refe re nc e laboratory
4 . S u p p o r t LG U s in a d v a n c i n g p ro - he a l th resolutions or
o rd i n a n c e s (e.g. c i t y - w i d e s m o ke - f r e e or s p e e d limit
ordi nanc e s)
5 . E stabl i sh ex p e r t b o d i e s for he al th p ro m o t i o n a n d
sur veillance a n d re s p o n s e
C
C o v e r all Filipinos a g a i n s t h e a l t h - r e late d financial risk
1 . R a i s e m o r e reve n u e s for health, e.g. i m p o s e h e a l t h p r o m o t i n g taxes, i nc re as e N H I P p r e m i u m rates, i m p r o v e
p r e m i u m col l e ction efficiency.
2 . A l i g n G S I S , M A P, P C S O , PA G C O R a n d m i n i m i ze ove rl aps w i t h
Phi l H e alth
3 . E x p a n d Phi l H e alth be nef i ts to c ove r outpati e nt di agnosti c s ,
m e d i c i n e s , b l o o d a n d b l o o d p ro d u c t s a i d e d b y he al th
technology assessment
4 . U p d a t e c o s t i n g of c urre nt Phi l H e alth c a s e rates to e n s u re that
it c ove rs full c o s t of ca re a n d link p a y m e n t to se r vi c e quality
5 . E n h a n c e a n d e nfo rc e Phi l H e alth c o nt ra c t i n g policies for
bette r viability a n d sustainability
H
H a r n e s s t h e p o w e r of s t r a t e g i c H R H d e v e l o p m e n t
1 . Re v i s e he al th profe ssi ons c urri c ul um to b e m o r e
pri mar y c a re - o r i ente d a n d re s p o n s i ve to local a n d
global needs
2 . Streaml i ne H R H c o m p e n s a t i o n p a c k a g e to
i nc e ntivize se r vi c e in h i g h - r i s k or G I D A are as
3 . U p d a t e frontline staff i ng c o m p l e m e n t s ta n d a rd s
f ro m p ro fe s s i o n - b a s e d to c o m p e t e n c y - b a s e d
4 . M a ke available f u l l y - f u n d e d s c hol ars hi ps for H R H
hailing f ro m G I D A are as or I P g ro u p s
5 . Fo r m u l ate m e c h a n i s m s for m a n d a t o r y return of
se r vi c e s c h e m e s for all h e at h g ra d u a t e s
I
I n v e s t in e H e a l t h a n d d a t a for d e c i s i o n - m a k i n g
1.
M andate the u s e of electronic me di cal records in all health
facilities
2.
M ake online submi ssi on of clinical, d r u g dispensing,
administrative a n d financial records a prerequisite for
registration, licensing a n d contrac ting
3.
C o m m i s s i o n nationwide surveys, streamline information
systems, a n d support efforts to i mprove local civil
registration a n d vital statistics
4.
A u to m ate major busi ne ss proc e s s e s a n d invest in w a re housi ng a n d busi ne ss intelligence tools
5.
Facilitate e ase of a c c e s s of researchers to available data
E
E n f o r c e s t a n d ar d s, a c c o u n t ab i l i t y a n d t r a n s p a r e n c y
1 . P u b l i s h heal th i nformat i on t hat c a n
t ri g ger better p e r fo r m a n c e a n d
a c co u nta bi l i t y
2 . S e t u p d e d i c a t e d p e r fo r m a n c e
m o n i t o r i n g unit t o t ra c k
p e r fo r m a n c e or p ro g re s s of refo r m s
V
V a l u e all cli ent s a n d patients, especially t h e poor,
m a r g i n al ize d, a n d vul nerabl e
1.
2.
3.
4.
5.
Prioritize t h e p o o re st 2 0 million Filipinos in all he al th
p r o g r a m s a n d s u p p o r t t h e m in n o n - d i re c t he al th
ex p e n d i t u re s
M a ke all he al th e nti tl e me nts s i m pl e , explicit a n d
w i d e l y p u b l i s h e d to facilitate u n d e rsta n di n g , &
ge n e rate d e m a n d
S e t u p participation a n d re dre ss m e c h a n i s m s
R e d u c e turnaround t i m e a n d i m p r o v e t ra n s p a re n c y
of p ro c e s s e s at all D O H he al th facilities
E l i mi nate q u e u i n g , g u a ra nte e d e c e n t
a c c o m m o d a t i o n a n d c l e a n re st ro o m s in all
g o v e r n m e n t hospi tals
E
Elicit m u l t i - se c t o r al a n d m u l t i - s t a k e h o l d e r s u p p o r t for heal t h
1.
2.
3.
4.
H a r n e s s a n d al i gn t h e private s e c t o r in p l a n n i n g
s u p p l y si de i n v e s t m e n t s
W o r k w i t h othe r national g o v e r n m e n t a g e n c i e s to
a d d r e s s soc i al d e t e r m i n a n t s of he al th
M a k e he al th i m p a c t a s s e s s m e n t a n d p u b l i c he al th
m a n a g e m e n t pl an a prerequisite for initiating
l arge - sc al e , h i g h - r i s k infrastructure pr oj e c ts
Col l aborate w i t h C S O s a n d othe r stak e hol de r s o n
b u d g e t d e v e l o p m e n t , m o n i t o r i n g a n d e val uati on
S E RV I C E DELIVERY
NETWORK
ATTAIN HEALTHRELATED SDGs
A L L L I F E S TA G E S &
TRIPLE BURDE N OF
DISEASE
UNIVERSAL
H E A LT H
INS UR A N C E
F inanc ial R i s k Prote c t ion
B etter Healt h O u t c o m e s
Re s p o n s i ve n e s s
R.A. 7160
LOCAL GOVERNMENT CODE OF 1991
HOMER CADSAWAN BALMES, RN MCD CSAS
Decentralization
• Decentralization is the transfer of
power, authority, function,
responsibilities and resources in public
planning, management and decision
making from national to sub-national
levels (e.g. Local health units).
Advantages of
Decentralization in LGU’s
• Greater responsibility for planning and budgeting,
for collecting user charges, and for determining
how collected funds and transfers from national
government will be spent
• Improving incentives for fee payment and
collection
• Accountability
• Choice reflects local needs
• Community development
• Minimizing administrative costs
(World Bank, 1990)
Advantages of
Decentralization (WHO)
• Improved local planning, management and faster
decision making
– There is greater involvement of local
communities in the management of their own
– Planners and implementer could take the
complexities and peculiarities more easily into
account.
– Planners are more responsive to local priorities.
– It is possible to organize a more rational and
unified health service. particularly for primary
levels of health.
Advantages of
Decentralization (WHO)
• Improved efficiency and costs
containment
• Inequalities can be reduced
• More effective integration of
government, nongovernmental and
private health organizations;
• Encourage greater involvement of
local communities.
• Better inter-sectoral coordination
Disadvantages of
Decentralization (WHO)
Green (2009)
• Increased geographical inequalities
– Resources of the Local Government
– Diversion of priorities in the national
level
• Increased practice variation between
geographical regions
Disadvantages of
Decentralization (WHO)
• Inappropriate implementation of
decentralization may result in:
– Hospital-based, hospital-led local health
system and increased influence of
particular local elite groups
– Declines of quality of services and
infrastructures
– Inefficient use of resources
Disadvantages of
Decentralization (WHO)
• Disruption of career path of health
personnel (Philippines – Grundy,
2003)
• Political intervention in staff selection,
priority setting
• Corruption
• Demoralization of health staff (lower
pay, benefits, etc.)
Disadvantages of
Decentralization (WHO)
• Inadequate planning and
management
– Fragmentation of health services
Disintegration of curative and
– Preventive services
Successful decentralization
requires:
• Strong regulatory and monitoring
capacity at the national level
• Sufficient management capacity and
necessary training at the local level
Inter-Local Health Zone
HOMER CADSAWAN BALMES, RN MCD CSAS
Inter-Local Health Zone
• It is a system of health care similar to a
district health system in which individuals,
communities and all other health care
providers in a well-defined geographical
area participate together in providing
quality, equitable and accessible health
care with Inter-LGU partnership as the
basic framework.
Inter-Local Health Zone
• any form or organized arrangement for
coordinating the operations of an array and
hierarchy of health providers and facilities,
which typically includes primary health
providers, core referral hospital and end-referral
hospital, jointly serving a common population
within a local geographic area under the
jurisdictions of more than one local government.
Inter-Local Health Zone
• ILHZ, as a form of inter-LGU cooperation is
established in order to better protect the public
or collective health of their community, assure
the constituents access to a range of services
necessary to meet health care needs of
individuals, and to manage their limited
resources for health more efficiently and
equitably.
Expected Achievement in ILHZ
• Universal coverage of health insurance
• Improved quality of hospital and Rural
Health Unit (RHU) services
• Effective referral system
• Integrated planning
• Appropriate health information system
• Improved Drug Management System
Expected Achievement in ILHZ
• Developed human resources
• Effective leadership through inter-LGU
cooperation
• Financially viable or self-sustaining hospitals
• Integration of public health and curative
hospital care
• Strengthened cooperation between LGUs
and the health sector
Composition of ILHZ
• People
– Ideal pop. Of 100,000 – 500,000 for optimum
efficiency (WHO)
• Boundaries
• Health Facilities
• Health Workers
Composition of ILHZ
• People
– Ideal pop. Of 100,000 – 500,000 for optimum
efficiency (WHO)
• Boundaries
• Health Facilities
• Health Workers
ILHZ
End