Module 2: The Health Care Delivery System PDF

**MODULE 2- The Health Care Delivery System** A. **World Health Organization -- a specialized** agency of the United Nations that provides global leadership on health matters. Head Office -- Geneva Switzerland 147 country offices / 6 world regional offices 6 World Regional Office...

**MODULE 2- The Health Care Delivery System** A. **World Health Organization -- a specialized** agency of the United Nations that provides global leadership on health matters. Head Office -- Geneva Switzerland 147 country offices / 6 world regional offices 6 World Regional Offices: a. Africa b. The Americas Eastern Mediterranean c. Europe d. Southeast Asia e. Western Pacific 1. Millennium Development Goals Goal 1: Eradicate extreme poverty and hunger Goal 2: Achieve universal primary education Goal 3: Promote gender equality and empower women Goal 4: Reduce child mortality Goal 5: Improve maternal health 6: Combat HIV/AIDS, malaria and other diseases 7: Ensure environmental sustainability Goal 8: Develop a global partnership for development 2. Sustainable Development Goals B. **Philippine Department of Health** -- the national agency mandated to lead the health sector towards assuring quality health care for all Filipino. The main governing body of health services in the country. 1. Vision: To be a global leader for attaining better health outcomes, competitive and responsive health care system, and equitable financing. 2. Mission: To guarantee equitable, sustainable and quality health for all Filipinos, especially the poor, and to lead the quest for excellence in health. 3. Historical Background 4. Local Health System and Devolution of Health Services -- Local Government Code -- this means that the LGU's have the autonomy and responsibility to plan and implement basic health services (primary care) on behalf of their constituents. 5. Major Roles of DOH a. Leader in Health b. Enabler and Capacity Builder c. Administrator of Specific Services 6. Classification of Health Facilities AO 2012-0012 Category A -- *Primary Health Care* -- a first contact health care facility that offers basic services including emergency services and provision for normal deliveries. Category B -- *Custodial Care Facility* -- a health facility that provides long term care, including basic services like food and shelter, to patients with chronic conditions requiring ongoing health and nursing are due to impairment and a reduced degree of independence in activities of daily living, and patients in need of rehabilitation. Example: drug abuse treatment and rehabilitation centers, sanitaria/leprosaria, and nursing homes. Category C -- *Diagnostic/ therapeutic Facility* -- a facility for the examination of the human body, specimens from the human body for diagnosis, sometimes treatment of disease, or water for drinking analysis. The test covers the preanalytical, analytical,and post analytical phases of examination. a. Laboratory Facility b. Radiologic Facility c. Nuclear Medicine Facility Category D -- *Specialized Outpatient Facility* -- a facility that performs highly specialized procedures on an outpatient basis. Examples are dialysis clinic, ambulatory surgical clinic, cancer chemotherapeutic center/clinic, cancer radiation facility and physical medicine and rehabilitation center / clinic.  7. **Philippine Health Agenda 2010 -- 2022 / Healthy Philippines 2022** *Motto*: All for Health towards Health for All -- Lahat Para sa Kalusugan! Tungo sa Kalusugan Para sa Lahat *Goals*: The Health System Aspire For: - FINANCIAL PROTECTION - Filipinos, especially the poor, marginalized, and vulnerable are protected from high cost of health care - BETTER HEALTH OUTCOMES - Filipinos attain the best possible health outcomes with no disparity - RESPONSIVENESS GOALS - Filipinos feel respected, valued, and empowered in all of their interaction with the health system - EQUITABLE & INCLUSIVE TO ALL - PROVIDES HIGH QUALITY SERVICES - USES RESOURCES EFFICIENTLY - TRANSPARENT & ACCOUNTABLE - Devolution - Use of Generics - Milk Code - PhilHealth (1995) - DOH resources to promote local health system development Milestones - Fiscal autonomy for government hospitals - Good Governance Programs (ISO, IMC, PGS) - Funding for UHC - - - - Every year 1.5 million families are pushed to poverty due to health care expenditures - Filipinos forego or delay care due to prohibitive and unpredictable user fees or co- payments (Tiisin ko na lang ito) - Php 4,000/month healthcare expenses considered catastrophic for single income families - Long wait times - Less than hygienic restrooms, lacking amenities - Poor record-keeping - Overcrowding & under-provision of care - Privacy and confidentiality taken lightly - Limited autonomy to choose provider a. Investing in People b. Protection Against Instability - UNIVERSAL HEALTH COVERAGE - STRENGTHEN IMPLEMENTATION OF RPRH LAW - WAR AGAINST DRUGS - ADDITIONAL FUNDS FROM PAGCOR PHILIPPINE HEALTH AGENDA FRAMEWORK Goals: - Attain Health-Related SDG Targets - Financial Risk Protection, - Better Health Outcomes - Responsiveness - Equity - Efficiency - Quality - Transparency STRATEGY: ACHIEVE - **A**dvance health promotion, primary care and quality - **C**over all Filipinos against financial health risk - **H**arness the power of strategic HRH (Human Resource for Health) - **I**nvest in eHealth and data for decision-making - **E**nforce standards, accountability and transparency - **V**alue clients and patients - **E**licit multi-sectoral and multi-stakeholder support for health 3 GUARANTEES: \#1 ALL LIFE STAGES & TRIPLE BURDEN OF DISEASE GUARANTEE (Services for Both the Well & the Sick) \#2 SERVICE DELIVERY NETWORK GUARANTEE (Functional Network of Health Facilities) \#3 UNIVERSAL HEALTH INSURANCE GUARANTEE (Financial Freedom when Accessing Services) C. **Primary Health Care Approach** 1. 2. 3. 4. 5. - - - - - - - - 6. *Education for Health* - - This program exists to control the occurrence of preventable illnesses especially of children below 6 years old. - - - - - *Supply of Essential Drugs* - - - - - 7. - a. Intrasectoral linkages - - b. Intersectoral linkages - a. Identify problem b. Identify solution c. Mobilizing resources d. Barriers - a. effectiveness and safety b. less complex c. less costly d. broader scope of technology e. acceptability to local culture f. feasibility - a. Individual b. Family-monitor growth and development of child and able to address to problems in government c. Community- organizations formed to promote health development 8. - a. b. c. d. - a. Community needs and priorities are basic for planning health services and activities b. Training curriculum of community health workers based on community health problems and task analysis of community health workers c. Regular supervision and periodic evaluation of community health workers' performance by health staff to community d. Development of promotive, preventive, curative and rehabilitative care e. Recognition of role and traditional healers in delivery of health services - a. b. c. d. e. f. g. h. - a. Community generates support for health care b. Mobilization of health resources c. Training of community leaders on leadership and managerial skills d. Income-generating projects - a. Convergence of health, food, nutrition, water, sanitation and population services b. Integration of PHC into national, provincial, municipal and barangay development plan - a. Establishment of effective health referral system b. Multi-sectoral and inter-disciplinary linkages c. Integration, Education, Communication (IEC) support using multimedia channels - - a. Reallocation of budgetary resources b. Advocacy for political will and support c. Re-orientation of health profession d. Establishment of community health organizations e. Mass health campaigns and community mobilization - a. Community generates support for health care b. Mobilization of health resources D. **Levels of Health Care and Levels of Prevention** - Primary care level - Secondary care level - Tertiary care level **Primary care level: **is the usual entry point for clients of the health care delivery system. It is oriented towards the promotion and maintenance of health, the prevention of disease, the management of common episodic disease and the monitoring of stable or chronic conditions. Primary care ordinarily occurs, in ambulatory settings. The client or the family manages treatment with health professionals providing diagnostic expertise and guidance. **Levels of prevention** ------------------------ - Health promotion - Protection against illness - Eating well balanced diet - Regular exercise program - Maintaining weight - No smoking - Moderation of alcohol - Information on alcohol substance - Nutritional counseling - Environmental control - Safe water Supply - Good food hygiene - Safe waste management - Vector and animal reservoir control - Good living and working condition - Stress management etc 1. early detection (diagnosis) of disease 2. prompt treatment - - - - - - - - - - Rehabilitation after stroke - Smoking cessation program for clients with emphysema E. **UNIVERSAL HEALTH CARE -** *Legal basis:* RA 11223 Universal health Care Act -- This is an Act instituting Universal Health Care for all Filipinos prescribing Reforms in the Health Care System and Appropriating Funds *8 Things to Know:* 1. **ALL Filipinos are covered** - Every single Filipino citizen is automatically enrolled into the newly-created National Health Insurance Program (NHIP). The program classified membership into two types: - - - All Filipinos will be granted "immediate eligibility" and access to the full spectrum of health care which includes preventive, promotive, curative, rehabilitative, and palliative care. This can be expected for medical, dental, mental, and emergency health services. - Filipinos will also be enrolled with a primary health care provider of their choice. The primary care provider is the health worker they can go and seek treatment from for health concerns. They will also serve as the person in charge of referring and coordinating with other health centers if patients need further treatment. - Citizens will not need to present any PhilHealth ID to avail of these benefits. Meanwhile, poor Filipinos or those who are located in geographically isolated areas will also be given priority when ensuring access to health services. 2. **It is not completely free** - Contrary to what some people may think, UHC does not mean every single health expense will be made free. - The law outlines those basic services accommodations will be covered by PhilHealth. - As a patient, that means that if you're admitted in a hospital you can expect regular meals, a bed in a shared room with fan ventilation, and a shared toilet and bath to be covered. - All are also entitled to an "essential health benefit package," which includes primary care, medicines, diagnostic, and laboratory tests. It also includes preventive, curative, and rehabilitative services. - It will no longer be free when one wants to stay in a hospital room offering private accommodation, air conditioning, telephone, television, and meal choices, among others. - Meanwhile, public and private hospitals are expected to allocate a certain portion of their beds as basic accommodations in the following amounts: - - - - As long as a patient avails of these basic accommodations, it will be covered by PhilHealth whether in a public or private hospital. - The law also states that if patients need to pay for extra expenses, their "co-payment" -- or what is paid on top of basic services -- should be regulated by the DOH in public hospitals. This means that you should know what to expect in terms of bills, as opposed to being shocked after treatment. Aside from this, current case rates or packages PhilHealth has crafted for certain diseases will remain. But together with the DOH, PhilHealth is expected to work towards including more - needs a person may have for a disease in its case rates. - The two agencies are also expected to craft and implement outpatient benefit services to be covered by the National Health Insurance Programs within 2 years after the law takes effect. **3. PhilHealth will become the "national purchaser" of health goods and services** - This means that PhilHealth will be in charge of paying health care providers like hospitals and clinics for services given to Filipinos. This is already a job PhilHealth carries out but the universal health care law wants to pool more funds so it can cover all Filipinos and eventually, more services. - Allocating more funds to PhilHealth will also strengthen its negotiating power with health care providers, which will foreseeably improve the quality of services and lower health costs. - Funds for PhilHealth will be sourced from the following: - - - - - With multiple fund sources for PhilHealth, Filipinos will no longer need to [[troop to various government offices]](https://www.rappler.com/newsbreak/in-depth/208496-what-subsidies-can-do-philippine-general-hospital-patients) to secure funds to pay for health expenses. It will also make them less dependent on politicians to help pay for health services. - By giving PhilHealth more funds, a goal of the UHC is to make PhilHealth the national purchaser of medicines. This can lower the cost of medicines as these will be bought in bulk. - Another goals is to have quality of health services improve as PhilHealth can set as a requirement for payment and contracting, standards for health care providers. **4. DOH will still be in charge of "population-based" health services** - While PhilHealth, along with other private health insurance companies, is expected to cover services for individuals, the DOH is still in charge of delivering health services that cover entire populations. - Think of these as programs for disease surveillance, health promotion campaigns, and mass immunization campaigns. - The DOH will do this by contracting public health care providers in cities and provinces. **5. Health systems will become city-wide and province-wide** - Provinces and highly urbanized cities will now be in charge of overseeing health services in areas as opposed to the current set-up where municipalities are tasked with managing their own health centers. - The DOH will need to work with the Department of the Interior and Local Government (DILG) to have province- and city-wide health systems or networks in about two years after the law takes affect. - For this, one can imagine as an example, Rizal overseeing its province-wide health care network of clinics and hospitals compared to each municipality in Rizal taking care of its own health center alone. Similarly, highly urbanized cities like Cebu or Makati will oversee their own health care network compared to single barangays being in charge of a health center. - Having access to health networks province-wide can address the problem of inadequate access to health services due to lack of funds in barangays or municipalities. - Provincial and city health boards will be in charge of pooling and managing a special health fund to finance and improve health services for residents. PhilHealth's income will also be channeled to this special health fund. **6. Return service in the public health sector** - Graduates of health and health-related courses who received government-funded scholarships will be required to work in the public health sector for at least 3 full years. This will address the need for health workers across the country. - They will be paid by and under the supervision of the DOH. Those who serve for an extra two years will also be given incentives, which will be determined by the DOH. - Meanwhile, graduates of health courses in state universities and colleges and private schools are encouraged to work in the public sector. **7. A "Health Technology and Assessment Council" (HTAC) will be created** - Another important feature of the law is the creation of the HTAC -- a group of health experts who will be responsible for evaluating latest health developments and recommending their use to DOH and PhilHealth. - The HTAC will be responsible for assessing the safety and effectiveness of health technology, devices, medicines, vaccines, health procedures, and other health-related advances developed to solve health problems. - Reviewing the social, economic, and ethical issues when using these technologies or programs is also required. - The HTAC will be attached to the DOH for the first 5 years after the law is implemented. After this, it will become an independent body attached to the Department of Science and Technology. **8. Health information will be collected** - Both public and private hospitals and health insurers will be required to maintain a health information system that will contain electronic health records, prescription logs, and "human resource information." This system will be developed and funded by DOH and PhilHealth. It will also be subject to patient confidentiality rules and data privacy laws.