Philippine Healthcare System Overview

Philippine Healthcare System Overview

• The Philippines is an archipelago in Southeast Asia, with a population of approximately 119 million in 2024.
• 92.2% of the population is Christian Malay, and 5.6% is Muslim, primarily concentrated in Mindanao.
• The adult literacy rate is 96.5%.
• Life expectancy has improved from 62.2 years in 1980 to 69.1 years in 2016, reflecting better living conditions.
• The country is transitioning from an agricultural to industrialized economy.
• Healthcare faces challenges such as Tuberculosis (TB), pneumonia, increasing Non-Communicable Diseases (NCDs), high disaster risk (ranking 3rd in exposure), and health inequities.

Political Context

• The Philippines is a democratic, republican state with a presidential form of government.
• The president serves as both head of state and head of government.
• Power is divided among three branches of government.

Executive Power

• Vested in the president, who is elected by popular vote.
• Assisted by the Vice President and 22 departments (including CHED and NEDA).
• Cabinet secretaries act as the president's representatives.
• Local Government Units (LGUs) have administrative and regulatory authority over the local health system.

Legislative Power

• Held by the bicameral Congress of the Philippines, consisting of the Senate and House of Representatives.
• The Congress passes laws that influence healthcare financing, delivery, and regulation.
• They approve the budget for the Department of Health (DOH) and health facilities.

Judicial Power

• Vested in the Supreme Court and lower courts, including the Court of Appeals, Regional Trial Courts (RTCs), Municipal Trial Courts, Shari'a district courts, and Municipal/Shari'a circuit trial courts.

Collaboration & Example

• Effective collaboration between the branches of government is crucial for enacting key healthcare legislation.
• For example, the Sin Tax Law, implemented in 2012 after 15 years of deliberation, was a result of presidential advocacy, gaining House support and Senate endorsement.

Health Status

• Life expectancy is increasing (62 years in 1980 to 69 years in 2016).
• Mortality rates from communicable diseases are declining.
• Leading causes of death are heart attacks (increasing from 61 per 100,000 population to 133 per 100,000 population between 1980 and 2014), followed by vascular diseases, and neoplasms.
• Data on major causes of death (1980-2014) is provided in a table.
• A shift from communicable to non-communicable diseases as the leading cause of death is noted.

Health System

• The Philippines has a dual health system with public and private sectors.
• The public sector is largely funded by taxes and services are provided by government facilities managed by LGUs and national offices.
• The private sector includes for-profit and non-profit providers, often utilizing user fees at the point of service.
• This private sector is extensive but fragmented, consisting of clinics, infirmaries, laboratories, hospitals, drugstores, pharmaceuticals, medical supply companies, and health insurance companies, as well as academic and research institutions.
• A distinction between private for-profit, and private non-profit organizations, is made.

Historical Background

• The Philippine health system's formal beginning is traced to 1565 with the establishment of the first hospital.
• The Spanish government later handled health concerns, including disease control.
• In 1578, Spanish clergy established medical institutions like San Juan De Dios Hospital (for the poor and disabled) and San Lazaro Hospital (for lepers).
• Later, in the 1800's small pox vaccines were introduced and further public health measures were introduced to address Cholera and Beri Beri outbreaks.
• After the Philippine Revolution and American Colonial period, policies and the health system was reorganized and improved (more hospitals were built, public health measures were implemented, and medical education was introduced).
• The Department of Health and Public Welfare was formed in 1939.
• The World War II impacted the health system significantly.
• The establishment of the DOH occurred on October 4th, 1947.
• Post war rebuilding and the Rural Health Act of 1954 led to expansion of the health system structure.

Martial Law & People Power Revolution

• The declaration of Martial Law in 1972 led to a shift to a parliamentary form of government in 1978.
• The Department of Health was transformed into the Ministry of Health.
• Primary health care became a national policy in the late 1970s inspired by the Alma Ata Declaration.
• The People Power Revolution in 1986 marked a return to a presidential form of government, reorganizing the Ministry of Health back into the Department of Health (January 30, 1987).
• The Local Government Code of 1991 devolved certain health functions to the LGUs, while the DOH maintained national policies.
• PhilHealth, the national health insurance entity, was established in 1995.

Novel Times

• The Department of Health (DOH) implemented the Health Sector Reform Agenda in 1999, based on previous legislative challenges and deficiencies.
• Executive Order 102 (approved in 1999), further restructured DOH functions and operations.
• The FOURmula One for Health (2005) was launched, outlining the framework for achieving the healthcare reform agenda's objectives, focusing on health financing, regulation, service delivery, and good governance.

Decentralization & Centralization

• The 1991 Local Government Code decentralized some health services from the national government to the LGU level.
• However, the DOH still plays a central role by maintaining national standards, guidelines, plans, and regulations.

Intersectorality

• The concept of "health in all policies" emphasizes the need for all sectors to consider healthcare implications when making policies and decisions.

DOH Priorities

• The DOH's priorities include addressing environmental/climate change, tobacco control, poverty alleviation, and HIV/AIDS.

Health System Issues

• A small country might experience issues like overcrowding, staff shortages, lack of supplies, or poor information systems in a single hospital.
• The health sector has a complex organization with many stakeholders and non-linear interactions/interdependencies.
• Systems thinking, as applied, can analyze the components of the healthcare system.

Goals of the Health System

• Improving the health of the population, providing financial risk protection, and responding to people's expectations are identified as health system goals.

Improving Health Measures

• Measures to improve health include reducing morbidity and disability, increasing life expectancy, improving nutritional status, and reducing the burden of disease and non-fatal outcomes.

Responding to Expectations

• Customer satisfaction is measured through population satisfaction surveys and customer exit surveys.

Financial Risk Protection

• Protecting the population from unexpected healthcare costs, as well as helping to prevent people from falling into poverty, is a priority.
• Measures for this include collecting proportions of out of pocket expenditures, and prepaid financing.