philippine health care system essay

Essay on Health Care System In The Philippines

Students are often asked to write an essay on Health Care System In The Philippines in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

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100 Words Essay on Health Care System In The Philippines

The basics of health care in the philippines.

The Philippines’ health care system is a set of health services provided by public and private providers. Public health care is managed by the Department of Health (DOH), while private health services are offered by various hospitals and clinics.

Public Health Care

Private health care.

Private health care is offered by private hospitals and clinics. It’s usually more expensive than public health care. People who can afford it often choose private care for more personalized service and shorter waiting times.

Challenges in the Health Care System

The health care system in the Philippines faces many challenges. These include a lack of resources, unequal access to health services, and a high cost of care. The government is working on these issues to improve the health care system.

Future of Health Care in the Philippines

250 words essay on health care system in the philippines, introduction.

The health care system in the Philippines is a mix of public and private providers. It aims to give medical help to all its citizens. The Department of Health (DOH) is the main body in charge of health care.

The government provides health care through public hospitals and clinics. These are usually free or cost very little. The Philippine Health Insurance Corporation (PhilHealth) is the national health insurance program. It helps people pay for medical services.

There are also private hospitals and clinics. These usually offer better facilities and shorter waiting times. But, they are more expensive. Many people have private health insurance to help cover these costs.

The health care system in the Philippines faces some issues. There are not enough doctors and nurses, especially in rural areas. Also, the quality of care can vary greatly. Some people can’t afford the cost of private health care but need it due to the lack of public facilities.

Improvements

The government is working to improve the health care system. One step is the Universal Health Care Act. This law aims to give all Filipinos access to quality health care, without causing financial hardship.

500 Words Essay on Health Care System In The Philippines

The basics of the health care system in the philippines.

The health care system in the Philippines is a mix of public and private providers. The Department of Health (DOH) is the main public health agency. It sets policies, plans, and programs for health services. It also runs special health programs and research.

The Philippine Health Insurance Corporation (PhilHealth) is another important part of the public health system. It provides health insurance for Filipinos. This helps to make health care more affordable.

Public and Private Health Providers

There are both public and private health care providers in the Philippines. Public providers include hospitals, clinics, and health centers run by the government. These offer free or low-cost services. But sometimes, they may not have enough resources or staff.

Private providers include doctors, clinics, and hospitals that are not run by the government. They usually offer more services and shorter waiting times. But, their services cost more.

Health Care Challenges

The health care system in the Philippines faces several challenges. One is the uneven distribution of health services. More health services are available in urban areas than in rural areas. This means people living in rural areas may have to travel far to get health care.

Efforts to Improve Health Care

The government is working to improve the health care system. In 2019, it passed the Universal Health Care Law. This law aims to give all Filipinos access to quality health care. It also aims to make health care more affordable.

The government is also investing in health technology. This includes telemedicine, which allows people to consult with doctors online. This can help people in rural areas get health care more easily.

The health care system in the Philippines is a mix of public and private providers. It faces challenges like uneven distribution of services and high costs. But, the government is taking steps to improve it. It is working to provide universal health care and make health care more affordable. It is also investing in health technology to reach more people. Despite the challenges, the future of health care in the Philippines looks hopeful.

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Developmental Changes in the Philippine Health System: Accomplishments, Successes and Challenges

Xerxes seposo.

1 School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki 852-8523, Japan; [email protected]

2 Faculty of Management and Development Studies, University of the Philippines Open University, Los Banos, Laguna 4031, Philippines

Associated Data

The Philippine health system has undergone various changes which addressed the needs of the time. These changes were reflected in the benchmarks and indicators of performance of the whole health system. To understand how these changes affected the health system (HS), this study determined the changes in the Philippine health system in relation to different health domains (health determinants, financing, and management/development). Two HS periods were identified, namely, health system period 1 (HS 1) from 1997–2007 and health system period 2 (HS 2) from 2008–2017. Each HS period was assessed based on three domains. The first two domains were quantitatively assessed based on an interrupted time-series method, while the third one underwent a comparative analysis using two Health Systems in Transition reports (2011 and 2018). This study was able to assess the developmental changes in the Philippine health system. Specifically, the (health determinant) maternal mortality rate (MMR) significantly decreased by three maternal deaths per 100,000 live births, the (health financing) tobacco excise tax increased by 13,855 (in Million PhP) in HS 2, and there was (health management/development) an improvement in access to health facilities. However, there was an indication of retrogressive progress with some challenges in HS 1 which remained unaddressed in HS 2. While it seems promising that the health system has progressed with improvements apparent in both health outcomes (e.g., MMR) and health financing (e.g., tobacco excise tax), such improvements were overshadowed by the inefficiencies, which were not addressed by the current health system (HS 2), thus making it more retrogressive than progressive.

1. Introduction

Health systems are structurally complex frameworks of intertwined operations which serve as a means in achieving pre-defined health goals set by an institution [ 1 ]. Health systems exist to complement other sectoral systems but are primarily dedicated in addressing the need of health care. Earlier records of existing health care systems were from the 600 BC where Charodes ordered that all citizens of Athens will have the right to access free medical care [ 2 ]. These so-called health care systems were not entirely “structurally systematic”, instead, these were unorganized and selective efforts to highlight the importance of (individual) health. Since then, various governments have engineered to create health systems which would go beyond personal/individual health to a broader societal breadth. Decades and centuries of development led to major health care system movements centered in Europe (UK), Asia (China), and North America (United States).

The National Health Service (NHS) of the UK was established in 1948 to render health care services at the national level coverage [ 3 ]. Its primary focus from 1950 to 1970 was on the modernization of facilities and technologies for improved health care delivery services. On the other side of the world, in China, since the founding of the People’s Republic in 1949, Meng et al. [ 4 ] emphasized that the “formation and development of the health system, especially the organization and governance structure, have been closely related to political, economic and administrative reforms”. The main mover in the changes in China’s health system was mainly due to the country’s economic pursuits which lasted for more than 30 years [ 4 ]. In the 1980s, the implementation of China’s Open Door Policy has allowed an influx of foreign investments, which then allowed the country to bolster its health financing schemes, which are linked to the economic developments brought forth by the policy [ 5 ]. Then there is the US health system, which began in the private sector and took flight in the 1960s as a state-regulated program [ 6 ]. The health system founded from the private sector’s perspective had a domino effect on the rise of the private insurance system. Private health insurance in the United States had its beginnings around the early 1930s, with the establishment of non-profit Blue Cross plans for hospital care and soon after Blue Shield plans for physician care [ 6 , 7 ]. Whereas in the Philippines, the earliest concept of public health was introduced by the Franciscan Friars in 1577 [ 8 ]. Various developments with respect to health have been fostered by the previous colonizers. The Spaniards instituted the Superior Board of Health and Charity in 1888, whereas the Americans helped in the installation of a more formal health administration through the (1) Act 1507 of the Philippine Commission in 1901 setting up the Board of Health of the Philippine Islands, and (2) Act 307 through 309, which provided provincial and municipal boards for health [ 8 ]. Forty years later, the Philippines independently created its own health system in 1941, where the Department of Health was separated from the Department of Health and Public Welfare and was established as a separate entity [ 9 ]. The Philippine health system operates in a devolved manner owing to the local government code of 1991, whereby services were mostly under the jurisdiction of the local governments, with supplementary services such as major national programs, which include but are not limited to immunization, tuberculosis, nutrition, etc. Decentralization of health services became a center piece of the Philippine health system.

Each of these health systems have been tailor-fitted for the specific situation for each country. The Philippines’, in particular, is unique from other major countries’ health systems as it is one of the few archipelagic country health systems. The Philippines’ health system provides an opportunity for examining the pertinent health system challenges geographically diversified countries experience. Likewise, as health systems change through time, temporal developmental changes though apparent, have not been elucidated and their assessment remains a challenge. While there have been numerous legislations which introduced changes in the Philippine health system [ 10 ], most of the major changes happened from or took effect relatively near to 2008. These health system-related changes included the universal access to cheaper and quality medicines (in 2008), FOURmula One for Health, an operational framework for health reform agenda which started from 2005 but gained momentum in 2007, and inception of the Philippine Facility Enhancement Program in 2008, among others [ 10 ]. With these major developments, it is thus important to understand the developmental changes in the Philippine health system, particularly focusing on the past decades’ health systems’ (Health System 1: 1997–2007 versus Health System 2: 2008–2017) accomplishments, successes, and challenges. Specific assessment of the developmental changes between Health System 1 (HS 1) and Health System 2 (HS 2) in terms of three domains—namely, (a) health determinant, (b) health financing, and (c) health development/management—were carried out.

2. Materials and Methods

The health system goals highlighted in the WHO Framework for Health System Performance Assessment [ 11 ]—namely, (a) health, (b) fair financing and financial risk protection, and (c) responsiveness—were operationalized into the three domains in this study, which were (1) health determinant, (2) health financing, and (3) health management/development. Murray, et al. [ 11 ] emphasize the monitoring of these three intrinsic goals as a main basis for health system performance. In brief, the first goal regarding health anchors to the prime motivation of a health system, and that is to improve the health of the population. This can be represented by a non-exhaustive list of health determinants, which include the incidence of a disease in the population, life expectancy, and mortality rates. The second goal focuses on the financial aspect of the health system, both in the household and society levels. This can be represented by the household level contribution to the health system or funding streams coming from either internal tax revenues or external donor aids. Lastly, responsiveness tackles the expectations of the population regarding the health system catering to the population’s needs. The health system responds to the population’s needs via provision of services and is closely linked to health administration/management. Addressing previously encountered health system related issues, through improved health management and administration, constitute health system responsiveness. In this study, the variables representing the health determinants and health financing were selected based on whether they satisfy the conceptual definitions of health system goals of “health” and “fair financing and financial risk protection” as highlighted in the WHO Framework for Health System Performance Assessment, and if they have existing annual data.

Each of the domains were analyzed separately with the respective data and methods to be used, as shown in Figure 1 . A mixed method was utilized to analyze each domain, quantitative for health determinant and health financing, whereas qualitative for health management/development. Data used in the respective analyses are summarized in Supplementary Materials Table S1 .

Health system analysis methodological framework.

2.1. Data Description

2.1.1. health determinant domain.

Health determinant data, such as life expectancy at birth, maternal mortality rate, infant mortality rate, HIV incidence, TB incidence, severe wasting, and overweight, were obtained from online data sources, as shown in Table S1 with the corresponding variable description and source summarized in Table S2 . While there are numerous candidates for health determinants (e.g., cancer and other chronic diseases), due to the annual data unavailability which could match the time periods, only the aforementioned health determinant data were analyzed.

2.1.2. Health Financing Domain

Data for health financing were obtained from the World Bank (WB) database. Total health expenditure in terms of percentage of GDP (%GDP) was extracted from the WB world development indicators database [ 12 ]. While there may be other variables which could represent total health expenditure, Mcintyre, et al. [ 13 ] argue that the “percentage of GDP provides a basis in advocating an in increase in both government resource mobilization and spending on the full range of human rights and social determinants of health in situations where governments are not presently providing maximum available resources”.

2.1.3. Health System Management/Development Domain

Main data source for analyses included the grey literature of the Health Systems in Transition (HIT) reports (2011 and 2018 versions) of the Philippine Health System. In support to the HIT reports are the NHA reports, as well as Philippine Institute of Development Studies (PIDS) reports, together with some relevant legal statutes (republic act and implementing rules and regulations) passed or took effect during the specific periods.

3. Analyses

3.1. interrupted time series.

Data from the health determinant and health financing domains were analyzed using an interrupted time-series (ITS) technique. This is a quasi-experimental design, which aims to evaluate the impact of interventions in a longitudinal framework of observations [ 14 , 15 ]. Interrupted time series has been gaining traction and has been implemented in health care studies which assess the attribution of the changes an intervention has introduced compared to a no-intervention scenario [ 14 , 15 , 16 ]. It is characterized by the temporal, time-related changes through the difference in the trend of pre- and post-periods of interest. In this case, the pre-period was the 1997–2007 health system, while the post-period was 2008–2017. The selection of the division of the periods was based on the major changes which occurred starting from or relatively near to 2008, as highlighted in Dayrit et al. [ 10 ]. In this study, 2008 was assumed as a pivotal point where major changes after 1991 were introduced to the health system. The proposition is, if the changes implemented in or relatively near to 2008 had not happened, would the health system, in terms of the health determinant, health financing, and health management components, remain the same? In effect, there were two health system periods, before and after the major changes. We then used this division to assess progress in the health system.

The ITS was parameterized as in Equation (1) below:

whereby, y is the parameter of interest (either health determinant or health financing domain variables), T is the time component, whereas par is the binary variable indicating the 1997–2007 (valued to be 0) and 2008–2017 (valued to be 1) health systems; ε is the error term representing the uncertainty in the model [ 17 ]. The cut off period for the ITS was set at 1997/1998–2007 and 2008–2017/2018. At least five continuous annual data points should be available for the ITS analysis. If the number of continuous data points for each period was less than five or if the data points were not continuous, the mean of the data points was utilized instead; as shown in Figure 2 below.

Analysis strategies subject to the availability of the data points for each variable. ITS = interrupted time-series.

While the minimum number of observations to carry out ITS was 3 [ 18 ], in this study, variables with at least 5 temporally consecutive observations before and after 2008 were analyzed (for ITS). On the other hand, the mean was taken for variables which were either (a) non-consecutive 5 observations or (b) less than 5 observations.

The variables/parameters subject to ITS analyses were:

• (a) Life expectancy;
• (b) Maternal mortality rate;
• (c) Infant mortality rate;
• (d) HIV prevalence;
• (e) TB prevalence;
• (f) Total health expenditure;
• (g) Tobacco excise taxes.

While the following variables were averaged for each health system:

• (a) Malnutrition (wasting);
• (b) Overweight;
• (c) HIV expenditure.

3.2. Comparative Analysis

To facilitate the health system management/development analysis, a comparative analysis was conducted utilizing the papers of Romualdez et al. [ 9 ] and Dayrit et al. [ 10 ], which represented health system period 1 (HS 1) from 1997–2007 and health system period 2 (HS 2) from 2008–2017, respectively. Each of the reports were summarized into four components, namely, (a) Feature, (b) Challenges, (c) Reforms, and (d) Laws/Statutes passed/enforced (during the said period). “Feature” reflects the characteristics inherent to the health system, with ample focus on the strengths. “Challenge” are the health issues or problems arising under the HS period. “Reforms” are the innovations introduced in the said HS, and “Laws” are landmark statutes passed/enforced.

After summarizing the report into these four components, only the “Feature” and “Challenge” components were utilized to represent health system development. In this study, HS development was defined in terms of being (a) Progressive or (b) Retrogressive using matched variables from the HS 1 and HS 2. Progressive classification was defined in terms of two aspects: (a) Challenge changed to Feature; (b) Feature retained as Feature. When a challenge in HS 1 becomes a feature of HS 2, it means that HS 2 was able to progressively address the challenge. While, if the feature remains the same between two health systems, it only signifies that HS 2 was able to maintain that current feature. The HS 2 was retrogressive if a feature in HS 1 became a challenge in HS 2. Similarly, if a challenge in HS 1 remained to be a challenge in HS 2, it only indicated that there was not much progress in addressing such a challenge. A graphical summary is shown in Figure 3 .

Graphical summary of health system development.

From the health determinants, only TB prevalence had an apparent distinction among the two health system periods, with an apparent decrease in the previous one and a subsequent increase in TB cases in the succeeding health system period. There was no distinct trend for maternal mortality rate, while there was decreasing and increasing trends for infant mortality rate and HIV prevalence, respectively. All the data utilized in this study are reflected in Table S1 .

All three health financing parameters increased with time, with an apparent and extensive increase with the excise tax from tobacco, representing the tobacco excise tax measures.

In Table 1 , there was no significant change in life expectancy in either of the HS. While we observed relatively positive changes in HS 2, such as a statistically significant decrease in Maternal Mortality Rate (MMR) (a decrease of approximately three maternal deaths per 100,000 live births) and an increase in excise tax funds, a majority of health determinants such as infant mortality rate, HIV incidence, and TB incidence increased coupled with a decreased THE.

Interrupted time series results for each variable of interest.

p -value: *** p < 0.001; ** 0.001 < p ≤ 0.05; - statistically not significant.

In Figure 4 , we can observe that both malnutrition and overweight population increased by 37.5% and 91.9%, respectively. Both of which signify that non-communicable diseases have been on the rise in the Philippines, which may indicate some levels of underperformance in HS 2. We can find a rather interesting trend, in which though HIV expenditure, through both the local funds and foreign aids, increased significantly in HS 2, we still see an increasing trend of HIV incidence in the same period—a possible indication of either underperformance in disease prevention or an increase in detection rate.

Malnutrition: Prevalence of severe wasting, weight for height (% of children under 5); overweight: prevalence of overweight, weight for height (% of children under 5); HIV expenditure: inflation-adjusted HIV expenditure (in USD millions); mean representation of the selected health determinant (malnutrition and overweight), and health financing (inflation-adjusted HIV expenditure) variables.

5. Discussion

This study was able to assess the developmental changes in the Philippine health system in the past decade. While there was progress in different health system components from the HS 1 to HS 2, the overall health system performance was retrogressive with major challenges still being carried over to HS 2.

In Table 1 , there was a significant decrease in the number maternal deaths in HS 2 than in HS 1. However, all other health determinants were found to be retrogressive. In the case of health financing, while THE decreased in HS 2, other health financing variables increased. The tobacco excise tax significantly increased coupled with the doubling of HIV expenditure in the past decade. As for the health system management/development, though there were some progressive changes in the health systems (increase in health financing, increase in health facility access, increase in social health insurance coverage, and improved waiting time). Taking all developmental changes into account, overall, the health system is still facing the challenge of retrogressive progress.

While it seems promising that the health system has progressed with improvements apparent in both health outcome (i.e., MMR) and health financing aspect (i.e., tobacco excise tax), such improvements were overshadowed by the overwhelming inefficiencies which were not addressed by the current health system, thus leading it to be retrogressive rather than progressive.

The Philippine health system has progressed in one way or another, but there are some developmental aspects which remained unaddressed. Utilizing the whole period data, we can observe only a few variables which indicate a definite trend. In Figure 5 , IMR is gradually decreasing, whereas HIV incidence has increased rapidly through the years. In health financing, as shown in Figure 6 , all variables increased through the years. However, Figure 4 and Figure 5 may not be enough to understand how the health system progressed amidst the various changes it had undergone through time, particularly with the major changes in 2008. The succeeding sub-headings focus on how the health system changed (comparing HS 1 and HS 2) based on the premises of: (a) health determinants, (b) health economics/financing, and (c) health system management/development.

Health determinants in various health systems.

Health financing parameters (total health expenditure, HIV expenditure, tobacco excise tax) in either of the health system periods.

5.1. On Health Determinants

Among the health determinants, only MMR significantly progressed in HS 2 compared to HS 1. The progress in MMR can be attributed to the improvement in the health service facilities as well as the increase in access to health services highlighted in Table 2 (HS 2: Feature 9). Reforms such as the HFEP and the DOH deployment program (in HS 2) are essential components in health service accessibility in the rural areas. All other health determinants increased in HS 2. The IMR increased, with approximately three infant deaths per 10,000 live births, there were 965 new HIV positive cases, and 14 new TB cases in HS 2 (shown in Table 1 ).

Summary table of the Features, Challenges, Reforms, and the pertinent Laws/Statutes passed and enforced during the respective health systems.

NCR = National Capital Region.

The summary table from the health systems in transition reports of Romualdez et al. [ 9 ] and Dayrit et al. [ 10 ] were outlined in four aspects, namely, (a) Features, (b) Challenges, (c) Reforms, and (d) health-related Laws accompanying or independent of the reforms. Changes in the health system were more apparent in HS 2 with major features of health insurance and health facility reforms. However, such features were also accompanied with challenges related to OOP and NCD-related health problems.

While there were health reforms in the past HS, IMR progress may have stagnated due to the presence of socioeconomic factors in relation to within-country inequalities in child health outcomes [ 19 ]. Kraft et al. [ 19 ] noted that child mortality in the Philippines may vary in terms of the rural–urban divide, by province and wealth status. Implementation of these reforms toward the grassroots level may have been trickling down at a different pace, thus an inequality in terms of the health outcomes in the provinces exists. This would have later impacts on the national level progress in IMR. This is further supported by the “Challenges” observed in HS 2 in Table 2 , whereby there was an uneven distribution of health facilities and personnel across the country.

The increasing TB incidence in the country may be related to either (a) the inefficiency of health interventions in reaching the risk populations or (b) the detection of cases was enhanced. According to the GBD Tuberculosis Collaboration Group [ 20 ], the little or non-improvement in the TB situation in the Philippines has been linked to the inadequacy of the diagnostic test and its use in the risk populations (prison inmates and indigenous populations). This is further worsened by the increasing prevalence of multidrug-resistant TB and extensively drug-resistant TB in the country [ 21 ] as well as the increasing HIV incidence. The link between TB and HIV has been well established, with HIV infection increasing the risk by 20 times compared to HIV-seronegative individuals in highly prevalent countries [ 22 ]. From 1990 to 2003, HIV infection is one of the key underlying factors for the 1% increase in annual global TB incidence [ 23 ]. On the other hand, the increase in TB incidence may also be explained by the increase in the detection capacity. Vianzon et al. [ 24 ] highlighted that the increase in TB incidence can be attributed to the initiatives of the National TB Program in improving access to diagnostic and treatment services. Public–private partnerships have also contributed to the increase in the detection rate of TB incidence [ 25 ].

Also, HIV was observed to have increased in HS 2, similar to TB. This may be viewed as an inefficiency of the health services in reaching at risk populations, otherwise, it may be an efficiency in the detection rate. There was a significant increase in HIV incidence, with 965 new cases higher—than in HS 1. Some attributed the increase of HIV incidence to the drug-resistant subtype of HIV, specifically the change in the typically observed Western subtype B to a more aggressive HIV subtype, AE [ 26 ]. However, from the health management side, Farr and Wilson [ 27 ] identified that low rates of condom use, increased casual sex activities, and the widespread misconception about HIV/AIDS has driven the disease into becoming an epidemic. The stigma regarding HIV/AIDS has been acknowledged in HS 2 ( Table 2 : Challenge 11) but has not been fully addressed in HS 1. Though there were problems regarding HIV/AIDS in HS 1, there was no explicit mention of the stigma problems faced by the key populations. The lack of acknowledgement about the stigma may be due to the less attention it gained during HS 1, and when the epidemic exponentially increased after 2008, it gained more attention. On the other hand, the increasing HIV incidence may be related to the increase in the awareness and access to health services [ 28 ]. While this is plausible, the continuous and rapidly increasing rate of HIV incidence may prove to be more than just the increase in access/awareness; rather, this may be rooted in a more complex interaction of the previously highlighted molecular and management factors.

Aside from IMR, TB, and HIV increases, malnutrition and overweight increased by 37.5% and 91.9%, respectively (shown in Figure 4 ; leftmost and center panels). Nutrition-related problems are precursors to even bigger problems in the Philippines—non-communicable diseases (NCDs). These constitute 57% of annual deaths in the country, and had been increasing over the last decades [ 29 ]. Adair [ 30 ] noted that there was a six-fold increase of overweight and obese women from a 6% in 1983–1984 to a 35% in 1998–1999. The increase in these nutrition-related problems, particularly overweight, can be explained by the change in food regimens, whereby there is greater consumption of high caloric and less essential nutrient food sources and is further worsened by the sedentary life style [ 30 ].

5.2. On Health Financing

An efficient health financing would promote overall health and improve health status. While the tobacco excise tax was statistically higher in HS 2, at 13,855 (in Million PhP) and THE decreased by 0.135. The increase in the tobacco excise tax has been linked to improvements in personal health and eventually for the health system as a whole in the long run. In Lebanon, Salti et al. [ 31 ] observed that the tobacco tax resulted in an estimated 65,000 averted premature deaths, 300 million USD additional tax revenues, and 23 million USD out-of-pocket spending on health care averted. Both the financial and health benefits of increasing tobacco taxes result in health gains and savings in health care, which could influence later on improvement in the health system. In China, Verguet et al. [ 32 ] had similar findings wherein an increase in tobacco tax resulted in a pro-poor policy instrument bringing health and financial benefits to households and substantial revenues to society. The HIV expenditure ( Figure 4 ; rightmost panel) paired with the findings about increased incidence can be interpreted in two ways: (a) inefficient resource use and (b) increase in detection. Though it increased by 82.3% in HS 2, new HIV cases surged in HS 2, which is quite counterintuitive. This may be linked to inefficient resource use, particularly in using the current resources to decrease the incidence. On the other hand, it could mean that resources may have been used to increase detection of new cases. If it is the first one, then this seemingly increasing resource allocation to the HIV agenda can be an opportunity to look back and reevaluate resource efficiency subject to the targets and goals set. There were various factors linked to the worsening HIV epidemic, highlighted previously, and these factors can be candidate starting points, which can be utilized in re-strategizing how to maximize the use of resources in achieving the desirable output, outcome, and impact of interest. While if it is the other way around, there is a need to assess the scale of the operations in what could be the most efficient way to improve current practice.

5.3. On Health Management/Development

The aim of assessing the health management/development was not to judge which health system is better, rather, if the health system, divided into two periods, was able to progress amidst the challenges and reforms it has undergone. Both HS 1 and HS 2 had their unique features setting them apart (as summarized in Table 2 ). The HS 1 was the precursor of primary health care and social protection, and these features were further carried over to HS 2, with improvements in health facilities and health care benefits. In this study, progress was defined in terms of (a) when a feature in HS 1 was still existing in HS 2 (meaning it was sustained) and (b) when a challenge in HS 1 became a feature in HS 2 (means the problem was resolved and became an asset in HS 2). On the other hand, retrogression was defined as (a) when challenges in HS 1 were still existing in HS 2 (unresolved previous problems) and (b) when features in HS 1 became a challenge in HS 2 (an asset becoming a problem). Although there were numerous challenges and features (in Table 2 ), only those matched ones were included in the assessment in Table 3 . Progressive aspects of the health system were apparent with the increased health financing, social protection, improved waiting time, and improved access to services and data gathering. However, a big portion of these developments were retrogressive, such as high OOP, uneven distribution of health facilities and personnel, and restrictions to health data access, among others. The retrogressive nature of development of the Philippine health system is related to the unresolved previous problems, partly due to the increasing challenges and limited resources to resolve existing ones. Even though investments in health are increasing, so too are the problems, thus these resources are spread thinly creating relatively small impacts on massive problems, resulting in these problems being unresolved. Constant evaluation of these programs and projects is needed to determine the evolving problem, and how to provide a way which adapts with the evolving problem. This is where information and data play a big role. This challenge has been acknowledged in both HS 1 and HS 2. The private health sector constitutes a large proportion of the health system and yet there is no access to the information they hold. Similarly, the public health sector has a weak data gathering, updating, and validation system, which makes health policy stationary and creates non-adapting solutions to evolving problems. If we have access to this information, we would have a clearer picture of where we are now, and how to move forward in the health system.

Highlighting the health system development from HS 1 to HS 2 using matched variables.

Green = Feature; Orange = Challenge; Progressive classification: (a) Challenge changed to Feature; (b) Feature retained as Feature; Retrogressive classification: (a) Feature changed to Challenge; (b) Challenge retained as Challenge. NCR = National Capital Region.

Progressive classification was defined in terms of two aspects: (a) Challenge changed to Feature; (b) Feature retained as Feature. When a challenge in HS 1 becomes a feature of HS 2, it meant that HS 2 was able to progressively address the challenge. While, if the feature remained the same among the two health systems, it only signified that HS 2 was able to maintain that current feature. The HS 2 was retrogressive if a feature in HS 1 became a challenge in HS 2. Similarly, if a challenge in HS 1 remained a challenge in HS 2, it only indicated that there was not much progress in addressing such a challenge. While there were important aspects of progress in the health system, it was still overwhelmed with challenges which were yet to be addressed. Health financing seemed to have improved; however, health insurance claims were stagnating and was worsened with the increase in or reliance on OOPs for health services.

6. Limitations

The study had a few limitations, namely, (a) availability of current data, (b) the number of observations for ITS, and (c) qualitative analysis.

There are various variables which can represent the health determinants, health financing, and health management/development domains; however, due to the data limitations, variables which were readily available or could be extracted were only used. Other health determinants data such as cancer rates and chronic health outcomes, as well as health financing data (e.g., catastrophic health spending), could also provide insights in regard to the performance of the health system. Future studies are encouraged to include these variables if available.

For health management/development, there may be other features and challenges not fully captured in the summary; however, if such information becomes available in the near future, there is a need to run a re-analysis. While the current number of observations before and after 2008 were beyond the minimum number of observations required to do an ITS [ 18 ], extending the number of observations may provide a more robust insight on the estimates. In this study, the quantitative analyses relied on the available data sources as well as grey literature in assessing the progress of the Philippine Health System. While the results of the quantitative techniques complemented the observations from the health transition reports, more detailed insights could have been gained from in-depth qualitative analyses through focus group discussions (FGDs) and key informant interviews (KIIs).Focus group discussions and KIIs would be able to provide a grassroots perspective of how the progress affected the beneficiaries, the people, as well as various insights on how progress was optimized and the challenges were resolved from a health manager’s perspective. Aside from FGDs and KIIs, the assessment of quality of life as well as patient satisfaction would provide additional qualitative evidence in support of the performance of the health system [ 33 ]. Further studies including qualitative analyses are needed to gain more insight into how health system progress is appraised from a community level perspective.

7. Conclusions

This study assessed the developmental changes in the Philippine health system, particularly focusing on the past decades’ accomplishments, successes, and challenges. The health system has progressed, particularly in the improvement of health outcomes (i.e., MMR), increased health financing, and increase in access to health services. However, there are indications that the overall health system is retrogressive. There are a multitude of factors which led to a retrogressive status. Similarly, there are different ways to address these issues, one of which is to constantly monitor and evaluate under the premise that data should be shared across stakeholders sanctioned by equivalently strict and secure data sharing/privacy agreements.

Supplementary Materials

The following are available online at https://www.mdpi.com/2227-9032/7/4/116/s1 , Table S1: Master dataset of the annual health system performance-related variables, Table S2: Variable description and related source.

This research received no external funding.

Conflicts of Interest

The author declares no conflict of interest.

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The health status of Filipinos has improved dramatically over the last 40 years, with a two-thirds drop in infant mortality, lower prevalence of communicable diseases and life expectancy to over 70 years. However, the country is grappling with considerable inequities in access to health care. Despite the creation of a national health insurance agency, PhilHealth, in 1995, out of pocket payment levels are high.

A major reform was introduced in 2010 to increase the number of poor families covered by PhilHealth and to reduce or eliminate co-payments. Current and future challenges for the health care system include staff retention, service delivery inefficiencies, the rise in noncommunicable diseases and the challenge of reaching populations in remote areas.

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Healthcare in the Philippines

An overview of the philippine healthcare system.

The Philippines has accredited hospitals and well-trained medical providers. In most cities, healthcare in the Philippines will be just as good, if not better, than in your home country.

However, the Philippines is made up of more than 7,500 islands, and the country has more than 20,000 miles of coastline. There are many remote areas within this geography. Remote locations may not have up-to-date equipment or adequate staffing levels, though the quality of health services will vary by facility and region.

Yet the healthcare system in the Philippines is steadily improving. The Philippine Health Insurance Corporation, known as PhilHealth, aims to provide universal coverage; expats and foreigners who legally reside in the Philippines can join this system for very low premiums. With a range of public and private options, you’ll find that every kind of healthcare need can be met in the Philippines.

PhilHealth and Healthcare in the Philippines

The PhilHealth program was set up in 1995 to provide affordable universal coverage. In 2019, the country reached a major milestone with the Universal Health Care (UHC) Law. PhilHealth covers all kinds of medical care, including preventive, curative, and rehabilitative services. Thanks to the UHC Law, medical consultations and diagnostic testing, including lab tests, began to be covered.

PhilHealth counts about 90% of the country’s population as members. Much of the funding for the Philippines’ healthcare comes from “sin taxes” on alcohol and tobacco. The first of these went into effect in 2012; its success resulted in additional such taxes in later years. Many workers and employers also pay premiums that help support PhilHealth.

PhilHealth has different membership categories that vary based on work status, income, and age. The six major groups are:

• Formal Sector: Workers employed by public and private companies
• Indigents: Impoverished people subsidized by the national government
• Sponsored Members: People subsidized by their local governments
• Lifetime Members: Retirees and pensioners who previously paid 120 months of premiums
• Senior Citizens: A category open to those who are 60 years of age or older, and who do not qualify as Lifetime Members
• The Informal Economy: Self-employed people, migrant workers, and overseas Filipino workers; expats who are legally living in the Philippines are eligible to join PhilHealth in this category

Private and Public Care in the Philippines

In general, public hospitals and other public facilities handle preventive and primary care in the Philippines. Private facilities provide specialized care in areas such as cardiovascular disease or orthopedics.

Private care in the Philippines usually means additional comfort for patients. With fewer people seeking care, it’s often faster to obtain treatment. Plus private facilities have more up-to-date equipment. However, it is not necessary to visit a private facility to be treated by an English-speaking doctor. If you seek care at a private facility, ensure you have the funds available to pay for your treatment or verify if your international medical insurance provider covers your costs.

Barangay (village) health stations and local health centers meet much of the country’s primary care needs. Public hospitals have sometimes struggled with staffing levels, as care providers can often find better-paying jobs in the private sector or by moving overseas. Due to the issues with staffing and the fact that more patients seek care at these facilities, treatment delays are not uncommon at public hospitals. Those who can afford it often turn to private settings.

Source: http://asiahealthcaremarketresearch.com/philippines.html

Healthcare Options for Expats and Foreigners

International citizens who are legal residents in the Philippines are eligible to join PhilHealth. Your membership could fall under the Formal Sector if a local business employs you. However, if you are self-employed or a freelancer, you can join PhilHealth as part of the Informal membership category.

PhilHealth benefits include inpatient and outpatient care, diagnostic testing, prescription drugs, rehabilitation, and preventive services. Annual premium costs range from less than USD$100 to over $700, depending on your income. To sign up for PhilHealth, visit a local PhilHealth office or check if the online registration system is accepting applications.

The Philippine healthcare system includes private medical facilities and care providers. Many Filipinos join Health Maintenance Organizations (HMOs) via their workplace to help with the costs of private healthcare. You may wish to look for an HMO or sign up for international health insurance so you can visit private facilities without having to worry about paying for everything out of pocket. Remember, visiting a private hospital can be necessary to receive specialty care. In addition, you might wish to avoid wait times!

Short-term visitors such as tourists will not be covered by PhilHealth. As such, they should carry their own travel medical coverage .

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How to Access and Receive Healthcare in the Philippines

In urban areas, you will find both public and private hospitals that meet high standards of care. We have compiled a list of the best international hospitals in the Philippines for expatriates . You can also visit Joint Commission International , a site that offers accreditation for international hospitals, to see if any facilities near you have received their stamp of approval. You can also turn to local friends, colleagues, and fellow expats for recommendations about which hospitals and clinics to visit in your area. Fortunately, most healthcare providers speak English, so you shouldn’t worry about communication difficulties.

Access to medical care can be limited in remote locations. It may take time to receive emergency treatment or such care may be completely unavailable. If you have a medical condition that requires regular care, you may want to stick to more urban areas during your stay in the Philippines. If you visit a remote area and start to feel unwell, consider heading to the closest city in case your condition worsens.

Make sure to plan for how to pay for any medical care you receive. Without health insurance, you may need to pay a substantial bill if you’re treated in a private hospital.

Out-of-Pocket Costs in the Philippine Healthcare System

Though the Philippines has high-quality public health facilities and hospitals, many people seek care in private settings. Private facilities not only have the latest equipment and shorter wait times, but private hospitals also often specialize in different areas of care. Someone with diabetes or cancer may only be able to receive necessary care at a private hospital. However, if you get private treatment, you may have high out-of-pocket costs. In addition, drugs are often imported into the Philippines, so some medications are only available at high prices.

HMOs are one way to deal with out-of-pocket healthcare costs in the Philippines. HMOs maintain a network of providers who members can see for care. Many regular employees in the Philippines are able to enroll in an HMO through their employer’s benefits package. If you don’t want to be limited to an HMO network, you can also sign up for a private health insurance plan that should allow you to visit private healthcare facilities without being overwhelmed by costs.

Reproductive Care in the Philippines

Catholic leaders (the Philippines is a majority-Catholic country) previously challenged the legality of female hormonal contraceptives, but today this kind of contraception is available in the Philippines. Birth control options now include long-acting reversible contraceptives such as subdermal implants and IUDs, as well as oral contraceptive pills and contraceptive hormonal injections.

Emergency contraception is not available in the Philippines, and abortion is illegal in the country. There are no exceptions for pregnancies that are the result of rape or incest. Termination of pregnancies that endanger the life of the pregnant person is of questionable legality and in general, are not accessible.

Mental Health and Addiction Treatment

Treatment for mental health issues is relatively easy to obtain in Philippine cities. Hospitals provide mental health services, and there are also private psychiatrists and clinics to visit. Unfortunately, this type of care is not available in rural areas.

A violent war on drugs in the Philippines has resulted in the deaths of thousands of drug users. But drug use has continued, while efforts to rehabilitate addicts have been underfunded and disorganized.

Confronting Healthcare Challenges in the Philippines

The lack of benefits and low wages in public facilities has long led doctors and nurses to leave the Philippines for work overseas. This “brain drain” of healthcare workers is a serious problem for the Philippine healthcare system. In 2019, the country had approximately one doctor or nurse per 20,000 residents, which is not considered adequate to a population’s needs. The UHC Law seeks to transition Philippine healthcare workers from contractual positions to regular staff members in the public sector as a way to incentivize more healthcare workers to remain in the country.

The country is taking steps to send healthcare workers to areas that need more providers. One was to award scholarships to doctors from different municipalities. These doctors would then spend at least four years working in their home regions.

In 2018, the World Health Organization published The Philippines Health System Review , which noted that available beds in Philippine hospitals were very low: 23 beds per 10,000 individuals in the National Capital Region; outside the capital region, there were fewer than ten beds per 10,000 individuals. Both large and small hospitals are working to improve their facilities.

Today the Philippine healthcare system can turn to its Drug Price Reference Index (DPRI) for pricing information. Drug prices may be higher than in the index, as preparation and storage fees can be added to the final cost, but the reference helps guard against unnecessarily high drug prices. Another cost-saving measure is a mandate that public facilities prescribe generic drugs when possible.

COVID-19 and Healthcare

The Philippines suffered greatly during the COVID-19 pandemic, and Filipinos have not rushed to get vaccinated. In 2017, an immunization scandal arose when a new vaccine for dengue fever was administered to children, then was found to increase the risk of severe illness for people who caught dengue if they had never had it before. Although the vaccine was not directly linked to any illnesses or deaths, the controversy increased vaccine hesitancy in the country, which the healthcare system is still trying to combat.

Though healthcare in the Philippines isn’t perfect, the country has a system that provides high-quality care to citizens and visitors alike. As a knowledgeable visitor, you’ll have the peace of mind that comes with knowing how to access excellent care should you need it.

• Hospitals in the Philippines for Expatriates
• Philippines: Safety and Travel Insurance
• Health Insurance in the Philippines

Author: Joe Cronin , Founder and President of International Citizens Insurance . Mr. Cronin, a former expat, is an authority in the areas of international travel, and global health, life, and travel insurance, with expertise in advising individuals and groups on benefits for today's global workforce. Follow him on LinkedIn or Twitter .

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[OPINION] 5 thoughts about the Philippine healthcare system

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This is AI generated summarization, which may have errors. For context, always refer to the full article.

A two-week confinement recently and a longer one last year for COVID-19 got me thinking about the Philippine healthcare system and hospitalization costs, in particular. As I lay in bed waiting to heal, I had five thoughts about the medical system.

• One, it is expensive to get sick in this country and to be hospitalized – too expensive for many Filipinos of lower middle income and below.
• Two, doctors have their own specializations and coordination of multiple doctors with one patient is often not seamless and even fragmented.
• Three, nurses and nursing assistants are underpaid.
• Four, nurses are well trained but nursing assistants could receive better training.
• Five, the pricing of medicines based on the hospital room used is wrong.

The five thoughts discussed

One, confinement in hospital can add up in cost very quickly especially if lab work, procedures and operations need to be done. Such a situation can put many Filipino families in a huge financial dilemma.

Membership in HMOs (Health Maintenance Organizations) is advised to help manage the extraordinary cost that goes with hospitalization but this stops after 65 years of age, a time when seniors will need more health care, not less. PhilHealth is useful but limited. The senior discount was helpful in my case. Yet after all these deductions, the out-of-pocket was still substantial. Personal debt is resorted to and if through informal sources, could carry with it high if not exorbitant rates of interest. Many hospitals offer a deferred payment plan but this can affect a hospital’s cash flow position which could have an impact on its medical service.

In the last year, two individuals from working class families known to me have seen family members pass away from disease that crept up on them (non-COVID-19) that required hospital care but which they kept ignoring or postponing because of the cost until it was too late. No health insurance, no savings in their cases, and despite help from a call to friends, it was too late. This is a story oft-repeated among those with lesser means in life.

Two, in my confinement for over a month with COVID-19 in 2021, a number of doctor-specialists were assigned to me upon my check-in in the emergency unit – a cardiologist, a pulmonologist, an infectious disease specialist, on top of my nephrologist, endocrinologist, and neurologist, the last three from my previous history of diabetes, renal failure, and a stroke. I got the sense that they were not coordinating on my treatment given the conflicting instructions given to nurses on medications and procedures. I found myself having to call doctors to clarify these things before things were clarified and/or changed.

In a recent two-week confinement (non-COVID-19), the experience had thankfully improved for me. The 7 doctors – four from my COVID-19 confinement previously – were speaking to each other and sharing updates. A lead doctor – in this case the infectious disease specialist – set up a Viber group so that the 7 of them could share notes on a daily basis. This helped the nurses explain medications and procedures more clearly. The only issue was the process of getting clearance from each of them when it became clear that my blood infection had been arrested. Chasing all seven doctors to get their clearances for my discharge took numerous follow up calls by my wife (mostly) and myself until it was finally done. The longer wait, however, added an additional day in hospital including a long wait for accounting to itemize the final bill for payment. The additional waiting time comes with its concomitant costs.

Three, from my conversations with nurses and nursing assistants (caregivers), I came to find out that they are grossly underpaid. Nurses in the private hospital were paid a monthly salary of P22,000. They told me that nurses in government hospitals had a higher monthly salary of P36,000. When asked why they did not transfer, the answer was generally one of two: Government hospital working conditions were more difficult (more patients to look after per shift, little time to rest, poorer facilities), or the private hospital was JCI-accredited and this meant that nurses there had a better chance of working abroad (US, Canada, UK, Australia) when applying for overseas placement. A number of nurses had worked previously in Saudi Arabia and had experienced better pay and working conditions but were now looking for an immigration opportunity for a more permanent move.

Nursing assistants (caregivers) in this private hospital were in an even more precarious position. Their monthly salary was P12,000 and they were on 6-month contracts with no security of tenure.

In another private hospital, a dialysis nurse there who had a monthly salary of P14,000 said she chose to return after a two-year stint in Saudi Arabia to be with an 8-year old daughter. She has a second job for a second income to help her husband and family.

There was a also pattern I observed which I hope is not the normal thinking. In my hospital stay, I met two nurses who had been community nurses but who shifted to hospitals because of the better pay. Then, I met nurses in that private hospital looking to migrate in search of better opportunities.

This is an often-heard refrain: Nurses looking or actually migrating to greener pastures. In my dialysis center, four dialysis nurses have migrated to Canada, the US and Germany in the last two years. These are highly trained medical professionals that we lose to other countries. And there are more are in that pipeline.

Four, nurses are well trained but nursing assistants could receive better training. This is the difference between a four-year degree and a short certificate course. Caregivers take a short course TESDA (Technical Education And Skills Development Authority) training with certification but it perhaps could benefit from more hands-on medical training.

Five, the pricing of medicines based on the hospital room used is wrong. In my first hospital stay, all the medicines were given by the hospital. I was not allowed to use my available supply of maintenance medication including insulin. The price differential between the drugs I purchased myself versus the hospital-administered medication was higher by a factor of 2-4 adding significantly to my hospital bill.

A business school colleague now managing a hospital consulting group revealed that private hospitals follow differential pricing on services and supplies charged based on the room contracted. In the case of medicines which has a retail price in the publicly available drug stores and pharmacies, this pricing differential is akin to price-gouging.

What to do?

There is a lot that needs to be done with regard to our healthcare system. As a senior, I am increasingly having to use it more frequently, so I begin to see certain inefficiencies in the system that can lead to high healthcare and hospitalization costs.

The Universal Health Care Act (2019) was enacted “to realize universal coverage through a systematic approach and clear delineation of roles of key stakeholders towards better performance of key agencies and stakeholders in the healthcare system.”

Alvln Manalansan, a non-resident fellow of Stratbase CADR Institute and a convenor of CitizenWatch Philippines wrote an article in March 2021 whose title summed up the cause: “Urgency to transform fragmented health system.”

“Like any other health care system,” he wrote, “the vision of the UHC Act is remarkably outstanding, however, the main challenge is in its implementation. If the UHC Law is fully implemented, it will provide equitable access to quality and affordable healthcare services while protecting against financial risk for every Filipino. However, as frequently mentioned by the DOH, the law cannot be implemented instantly, but only progressively, mainly due to its high resource requirements at all levels.”

What can be done to bring more efficiency into the health care system?

We could start by appointing a secretary of health well-respected by the medical and health care establishment with knowledge ranging from community health care to hospital care, from pre-natal and maternal health care to gerontology (care for the elderly), and everything in between. The secretary need not be expert in all areas; he or she just needs to know the leading players in the each field and can assemble a first-rate team to look after and manage the system’s different parts.

In his column for the Philippine Daily Inquirer, business consultant Peter Wallace wrote , “In 2020, the country’s total health expenditure reached P1 trillion, 5.6% of GDP in that year. So, it should be the most important department in government, with the most competent, most highly experienced leader that can be found. From what we’ve heard, there are such leaders. The President only has to choose which one. Now.”

Let’s assemble the finest group of health economists, business managers, and public policy analysts to sit with the Department of Health leadership team and key medical practitioners to take apart the Universal Health Care Act to see how the entire system can be more integrated, more seamless, more efficient, and less costly to all Filipinos. Studying how certain countries have set up their national health programs (I.e. Canada, Europe) would be instructive. Congress has created an Education Commission II to overhaul the basic education system to improve system performance; a similar Health Commission should be considered.

A consolidation of small private hospitals with larger hospital groups will bring needed investment into this sub-sector, help modernize it, and generate the economies of scale that could drive costs down.

Health insurance should be made available to all with substantial benefits and a variant for senior citizens should be designed and implemented, including home care for the elderly and even hospice care for those nearing death. Incentives and tax breaks should be available to private health insurers providing health insurance and HMO coverage to seniors above age 65.

Most important, investment by Government in community health and preventive medicine should be increased. As in many cases in other fields, investing in prevention minimizes future risk and is less costly than clinical care.

Lastly, let’s pay our nurses and non-doctor medical personnel better wages. We need to provide better economic benefits to encourage them to stay in the country. – Rappler.com

Juan Miguel Luz was former Dean and Head of the School of Development Management at the Asian Institute of Management, and former Undersecretary, Department of Education.

Please abide by Rappler's commenting guidelines .

Totally agree with the writer. I am one of the Filipino nurses who migrated to the USA, 50 years ago. It saddens me that the conditions Mr. Luz describes was true back then, and that the system has not improved. Granted, the healthcare system is a complicated one. But all the suggestions for improvement that Mr. Luz proposes have been known even 50 years ago. The problem has always been in the implementation. That phase seems to be the thorniest of all phases. We have excellent thinkers, but the implementation phase is plagued by lack of resources, politics, lack of will, etc. Good luck to the next generation. May they get better at solving this great social need.

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An Evaluation of the Philippine Healthcare System: Preparing for a Robust Public Health in the Future

Affiliation.

• 1 Department of Theology and Religious Education (DTRE), De La Salle University, Manila, Philippines.
• PMID: 35678007
• PMCID: PMC9201087
• DOI: 10.3961/jpmph.22.154

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Conflict of interest statement

CONFLICT OF INTEREST

The author has no conflicts of interest associated with the material presented in this paper.

• Challenges to Achieving Universal Health Coverage Throughout the World: A Systematic Review. Darrudi A, Ketabchi Khoonsari MH, Tajvar M. Darrudi A, et al. J Prev Med Public Health. 2022 Mar;55(2):125-133. doi: 10.3961/jpmph.21.542. Epub 2022 Mar 8. J Prev Med Public Health. 2022. PMID: 35391524 Free PMC article.

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• Department of Health Republic of Philippines UHC Implementing Rules and Regulations of the Universal Health Care Act (Republic Act (11223) [cited 2022 Mar 29]. Available from: https://doh.gov.ph/sites/default/files/health_magazine/UHC-IRR-signed.pdf .
• Varcas M. Pandemic response still a budget priority. BusinessWorld. 2021. Aug 18, [cited 2022 Mar 30]. Available from: https://www.bworldonline.com/pandemic-response-still-a-budget-priority/
• Tomacruz S. What prevents swift COVID-19 vaccine deliveries to Philippines’ provinces? Rappler. 2022. Feb 1, [cited 2022 Mar 30]. Available from: https://www.rappler.com/newsbreak/investigative/what-prevents-swift-deli...

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Health Care Delivery System in the Philippines

Health Service Delivery Profile

Philippines 2012

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Philippines health service delivery profile Demographics and health situation Positioned on the western edge of the Pacific Ocean, on the south-eastern rim of Asia, the Philippines is the second-largest archipelago on the planet, with over 7,107 islands In 2010, the population of the Philippines was 92.3 million, with a growth rate of 1.9% per year. There are 80 provinces, 138 cities and 1,496 municipalities and half the population (50.3%) live in urban areas, and of that, 44% live in slums. Both urban and rural poverty are high but steadily decreasing. The population is highly fragmented across the islands and with 180 ethnic groups. Malays make up the majority and there are tribes of indigenous peoples in mountainous areas throughout the country. The majority of the population is Christian and there is a Muslim minority concentrated in the south. Table 1. Key development indicators in the Philippines

Key development indicators Human development index Gini coefficient Total health expenditure GDP per capita Proportion of population below poverty line Literacy rate (male/female) (%) Life expectancy at birth Infant mortality rate Maternal mortality rate

Measure 0.644 44.0 3.8% GDP USD$2,370 26.1% 84.20/88.70 68.7 years 22 per 1,000 live births 221 per 100,000 live births

Year 2011 2000-2011 2009 2011 2009 2008 2011 2011 2011

Health service delivery is based on a Western biomedical model of health initially introduced during the Spanish colonial era and strengthened during American colonization. This Western system is superimposed on a pre-existing alternative model of health care based on a mix of folk and herbal medicines, religious beliefs, and traditional practices that has persisted throughout the country. Indicators of health status have steadily improved since the 1970s. However, there is a high inequality in many health outcomes between socio-economic classes and disparities between geographical regions. The top five causes of death include heart and cerebrovascular diseases, malignant neoplasm, pneumonia, and tuberculosis. . The top five causes of morbidity include acute respiratory infection, ALRTI and pneumonia, bronchitis, hypertension and acute watery diarrhoea.

Health system strategies, objectives and legislation Health Functions are largely devolved to provinces and municipalities. The Local Government Code (1991) outlines the roles of different levels in health care, including barangay (village), municipality and province. The Aquino Health Agenda: Achieving Universal Health Care for All Filipinos is the Philippines Government’s continuing commitment to health sector reform and achieving the Millennium Development Goals (MDGs).

The National Objectives for Health (2011-2016) sets all the health program goals, strategies, performance indicators and targets that lead the health sector towards achieving it’s primary goal of Kalusugan Pangkalahatan (KP), or universal health care. The overall goal is to achieved the health system goals of financial risk protection, better health outcomes and responsive health system and it includes three strategic thrusts: 1) financial risk protection through expansion of the National Health Insurance Program, enrolment and benefit delivery 2) improved access to quality hospitals and health care facilities and 3) Attainment of the health –related MDGs The Aquino Health Agenda’s six strategic instruments are health financing, service delivery, policy, standards and regulation, governance, human resources, and health information.

Philippines Health Service Delivery Profile, 2012

Legislation that forms the regulatory framework for health system functioning and public health in the Philippines includes the following: Organ Donation Act (1991); Hospital Licensure Act; Pharmacy Act, Dangerous Drugs Act (1972) and 2002, Generics Act of 1988; Republic Act No. 7600 – Rooming-in- and Breastfeeding Act of 1992; National Blood Services Act of 1994; Magna Carta for Disabled Persons; National Health Insurance Act of 1995; Traditional and Alternative Medicine Act (TAMA of 1997); HIV Prevention and Control of 1988 Philippine Food Fortification Act of 2000; Tobacco Regulation Act of 2003 ; Expanded Senior Citizens Act of 2003; Newborn Screening Act of 2004; the Universally Accessible Cheaper and Quality Medicines Act (2008), and the Food and Drug Administration Act (2009) (http://www.lexadin.nl/wlg/legis/nofr/oeur/lxwephi.htm) PhilHealth, the country’s national health insurance program, is governed by the National Health Insurance Act of 1995 or the Republic Act 7875 which replaced the Medicare Act of 1969. PhilHealth is mandated to provide health insurance coverage and ensure affordable, acceptable, available and accessible health care services for all citizens of the Philippines and is mandated to regulate public and private providers through accreditation in compliance with its quality guidelines, standards and procedures.

Service delivery model The Department of Health (DOH) is responsible for developing health policies and programmes, regulation, performance monitoring and standards for public and private sectors, as well as provision of specialized and tertiary level care. The DOH Centres for Health and Development (CHDs) are the implementing agencies in provinces, cities and municipalities, and link national programs to Local government units (LGUs). The CHDs are the DOH offices at the regional level. They assist the LGUs in the development of ordinances and localization of national policies, provide guidelines on the implementation of national programs at the LGU levels, monitor program implementation, and develop support system for the delivery of services by LGUs.

Health service delivery has evolved into dual delivery systems of public and private provision, covering the entire range of interventions with varying degrees of emphasis at different health care levels. Public services are mostly used by the poor and near-poor, including communities in isolated and deprived areas. Private services are used by approximately 30 % of the population that can afford fee-for-service payments. The service package that is supported by the government is outlined by PhilHealth. Coverage is reported by PhilHealth to be 74 million or 82% of the population at end December 2011. However, the services covered are not comprehensive, copayments are high and reimbursement procedures are difficult. The dominant private sector is made up of large health corporations and smaller providers. Health maintenance organisations are also present. Professional organizations contribute to continuing education, clinical practice guidelines development, advocacy, and influence policy and regulation. Opportunities for community participation in health are through the barangay health workers who come from the local community, and representatives from civil society and the private sector who participate in LGU policy-making local health boards.

The provider network In the public sector the Department of Health (DOH) delivers tertiary services, rehabilitative services and specialized healthcare, while the local government units (LGUs) deliver health promotion, disease prevention, primary, secondary, and long-term care. Primary health services are delivered in barangay (village) health stations, health centers, and at hospitals.

Table 2. Summary of health services and providers in the Philippines, 2012 Heath services

Public sector provision

Private sector provision

Health centres Barangay health stations National programs and agencies provide technical support Activities are highly variable and depend on the local government unit Community health teams provide education and information at family levels in the community. They also work with poor families to determine health needs, services available and receive PhilHealth benefits

Hospitals conduct multi media health promotion activities in their waiting areas, lobbies and OPDs Some LGU-operated birthing facilities Include: Pre-natal care for mothers, Iron Anti-rabies for animal bite centres UHC/KP focuses on the 5Million poorest

Family and community practitioners, paediatricians, obstetricians, physicians and some subspecialists Some organized NGOs initiate activities Large-scale programs are rarely provided by the private sector

Childhood immunization Tb, malaria, leprosy, filariasis, schistosomiasis, rabies, dengue fever, and SARS

Health centres Provincial hospital outpatient services and Animal Bite Treatment Centres National agencies provide technical support and supplies Support from the Global Fund for AIDS, Tuberculosis and Malaria Includes: Endemic areas are provided with antimalaria drugs, schisto and filarial drugs, including soil-transmitted helminthiasis

Paediatricians clinics and private hospital outpatient services provide immunizations Private Animal Bite treatment Centres as stand alone clinics and those in private hospitals. Pulmonary specialists and some general practitioners participate in the DOTS program for

HIV and other Sexually Transmitted Infections (STI)

Display of IEC materials in some rural health units/ social hygiene clinics/city health offices; video showing in waiting areas

NGOs and Key Populations at higher risk for HIV Support Groups for Sex workers/Men having Sex with Men and People who inject drugs, and the young key populations conduct outreach work and peer education activities Some private hospitals display IEC materials; video showing in waiting areas

Environmental health and sanitation

Local governments, water districts, national agencies provide assistance in terms of water supply systems; sanitation systems; solid waste, hazardous waste, health care waste management systems; sewage and wastewater collection and treatment facilities; water and wastewater laboratories. DOH Environmental and Occupational Health Office provides technical support to LGUs.

Water utilities (e.g. Manila Water, Maynilad), NGOs for water and sanitation; water refilling stations, bottled water companies; solid waste and hazardous waste treatment and disposal services; septic tanks desludging services (e.g. Malabanan companies); sewage and wastewater treatment facilities; water and wastewater laboratories

Health promotion Health education Family planning Maternity care Child care Nutrition and food safety Lifestyle-related or non-communicable diseases Communicable diseases Environmental Health and sanitation

Disease Prevention

Table 2. Summary of health services and providers in the Philippines, 2012 Heath services Diabetes, hypertension, cancer and mental health

Health facilities at LGU levels National NCD program of the DOH provides technical support to local government units Hospitals at municipal/city, provincial and regional levels also provide diseaseprevention related activities (e.g. smoking cessation advice, wellness clinic, etc.) The medicines program – Compack – for NCDs targets the 5 Million poorest as part of UHC/KP commodity support

Private general practitioners and Specialists in clinics and medical centres provide education and prevention programs. Some are linked to NGOs such as Diabetes Foundation, Philippine Heart Association, Philippine Coalition for the Prevention of NCDs, among others Private mental health facilities

Health centres Primary care hospitals other DOH-supported commodities – eg TB drugs, vaccines (DPT, OPB, measles, BCG, Hep B), also flu vaccines for indigent senior citizens

Clinics Hospitals

Primary services Outpatient, dental and laboratory services Disease programs like TB, Malaria, Dengue

Secondary and tertiary services Outpatient, Inpatient and hospital care Laboratory and special procedures

Secondary and tertiary care hospitals, including very specialized care

Acute and emergency care

Dental care

Some health centres and hospitals

Most dental care is by private practitioners in clinics and some hospitals

Mental Health

Hospitals, Clinic/halfway homes

Acute inpatient rehabilitation

Tertiary hospitals with specialist physicians and physical, occupational and speech therapists

Tertiary hospitals

Long term care for the elderly and disabled

A few tertiary hospitals provide house visits and palliative care Some community-based care

Some home-based care Several NGOs and foundations provide assistance

Programs for the disabled

National Commission Concerning Disabled Persons coordinates implementation and enforcement of legislation

This should be filled up. There are more of private partners doing work here.

Palliative care

A few tertiary hospitals Services are variable, highly dependent on the local government

Rehabilitative services

In total, there are approximately 1800 hospitals in the Philippines, of which 721 (40%) are public hospitals and 70 are DOH hospitals. In 2010, there were a total of 98,155 hospital beds; 50 percent or 49,372 were in government hospitals. Of the 17 regions, only 4 have sufficient numbers of beds per 1000 population.

The DOH has existing policy to provide services under the National Mental Health Policy, the National Policy on Oral Health, including the Minimum Essential Oral Health Package of the DOH for children 2-6 years, and to overseas Filipino workers. However there is also a very limited dental and rehabilitative services in the public sector. The 7.76 million overseas Filipino workers face a wide range of

occupational, mental, reproductive and sexual health-related problems, but currently receive almost no education or information and variable levels of insurance and support. Public facilities from both national and local governments provide free services including medicines and laboratory work up during outbreaks and other public health related events. Health Information system including surveillance of diseases and other public health events are recorded and reported from the local surveillance units and through the Philippine Integrated Disease Surveillance and response to the DOH national surveillance unit. This serves as the data bank for the analysis of the health status of the local community as well as the national data for the health profile of the country especially those that will need immediate notification to WHO as a commitment for the implementation of International Health Regulation (2005).

In 2012 the DOH released a new classification system of hospitals and other health facilities with specific guidelines for scope of services and functional capacity for each classification, and overall operating standards. There is also an ongoing effort to upgrade government health facilities in line with the goal to achieve universal coverage.

Table 3. Classification and characteristics of health facilities and services in the Philippines, 2012 Facility Hospitals General Hospitals

Level 1 General Hospitals Level 2 General Hospitals Level 3 General Hospitals DOH hospitals a. Specialty hospitals b. Other DOH hospitals

Characteristics

Most hospitals at all levels provide services for all kinds of illnesses, diseases, injuries or deformities. It has emergency and outpatient services primary care services, family medicine, pediatrics, internal medicine, obstetrics-gynecology, surgery including diagnostic and laboratory services, imaging facility and pharmacy. Level 1 general hospitals also include: isolation facilities, maternity, dental clinics, 1st level x-ray, secondary clinical laboratory with consulting pathologist, blood station, and pharmacy.

Level 2 hospitals include level 1 services and departmentalized clinical services, respiratory units, ICU, NICU and HRPU, high risk pregnancy unit, tertiary clinical laboratory, and 2nd level x-ray

Level 3 hospitals include level 2 services and teaching/training, physical medicine and rd rehabilitation, ambulatory surgery, dialysis, tertiary laboratory, blood bank, 3 level x-ray

A tertiary hospital which specializes in the treatment of patients suffering from a particular condition requiring a range of treatment (e.g. Phil. Orthopaedic Centre, National Centre for Mental Health); patients suffering from disease of a particular organ or groups of organ (e.g. Lung Centre of the Philippines, Phil. Heart Centre); or patients belonging to a particular group such as children, women, or elderly (National Children’s Hospital, Dr. Jose Fabella Memorial Medical Centre). Tertiary care facilities located all over the country serving as referral hospitals in the different regions of the country and providing anticipated range of tertiary services.

Other health facilities

Category A: Primary care facility Category B: Custodial care facility Category C: Diagnostic / Therapeutic facility Category D: Specialized outpatient facility

First contact facility offering basic services including emergency and normal delivery services. Includes: in-patient short-stay facilities, medical out-patients, overseas workers and seafarers facilities, and dental clinics.

Provides long-term care for those with chronic or mental illness, substance/drug abuse treatment and rehabilitation, sanatorium/leprosarium, and nursing home facilities. Laboratory facilities, radiology including x-ray, and nuclear medicine facilities

Including for dialysis, ambulatory surgery, in-vitro fertilization, stem cell services, oncology and chemotherapy, radiation oncology, and physical medicine and rehabilitation.

PNAC is a unit within the DOH responsible for promoting HIV/AIDs program and provides secretariat support to HIV/AIDs prevention and control, Diabetes Foundation, Heart Association and Philippine Coalition for the Prevention of NCDs are organizations with membership from the public and private sectors.

Health financing In the Philippines, health financing is fragmented with insufficient government investment, inappropriate incentives for providers, weak social protection and high inequity. Figures on coverage by PhilHealth vary, compounded by an inadequate information system on membership. In 2008 the Demographic Household Survey indicates a PhilHealth coverage rate of 38%.

%Total Health Expenditure

In 2007 expenditures on health services were paid for by the government (33%) and out-of-pocket payments (57.00%) and total health expenditure per capita was US$68. Government funding is a share from general taxation. Several earmarked taxes are also directed to PhilHealth; these include: value added tax, sin tax, stamp tax and excise

tax. A small proportion of funding comes Fig.1: Health Expenditure by Source of Funds from private insurance, HMOs, employment-based plans and private 100% 0.3% 1.2% 1.2% 1.1% 2.1% 11.5% 12.1% 10.4% 10.3% 10.5% schools. Foreign assisted projects 90% comprise only 1.7% of health finances. 80% 70% 46.6% Both public and private facilities operate Others 46.9% 49.2% 52.3% 54.3% 60% Other Private Sources on a fee-for-service basis, although 50% Out of pocket (OOP) public services receive greater subsidy 8.7% Social Insurance 40% from PhilHealth. The PhilHealth benefits 9.5% 9.7% Government 8.8% 8.5% 30% scheme pays for a defined set of 20% 40.0% services at predetermined rates, beyond 30.0% 29.5% 26.6% 26.2% 10% which patients pay out-of-pocket. 0% PhilHealth reimbursements are paid 2003 2004 2005 2006 2007 directly to service providers. Public Year hospital professional fees and stays are free of charge, but the cost of medicines, supplies, and diagnostics while in hospital are covered by PhilHealth within the predetermined rate. Public hospitals have private rooms and pay-wards that can be partly covered by PhilHealth. A few government agencies and charity organizations offer further subsidies or discounts for the poor and indigent, but no standard policy exists. Senior citizens and the disabled also have additional discounts. PhilHealth subsidizes direct medical costs up to a certain level in private hospitals through direct reimbursement to providers. Patients make out-of-pocket co-payments. Outpatient consultations and ongoing requirements for drugs are not yet included in the benefits package although additional benefits that include outpatient TB DOTS, outpatient care for sponsored program (SP) members, and maternity care are now provided.

PhilHealth contributions are compulsory for formally employed individuals, but there are difficulties in enrolling the informal sector. Poor households are progressively being enrolled and paid for through earmarked taxes. PhilHealth premium levels continue to be regressive since their low ceiling means that those in the upper salary brackets contribute proportionately less compared to those with lower income. The limited population and service coverage means that the high out-of-pocket payments is a major barrier to accessing health services. In general, the health financing system does not provide a safety net from the financial consequences of illness. People who get sick can easily slide into poverty since PhilHealth cannot provide full insurance coverage. During 2011, PHP34,885 million (approx USD840 million) was paid out by PhilHealth in benefits on 3,941,412 claims – an average of 1 claim for each 23 people and PHP8,197 (approx USD195) per claim. However it is likely that a smaller number of people have multiple claims. PhilHealth data does not seem to be available by income quintile for monitoring equity.

Human resources Over the last decade, the Philippines has experienced increasing migration of its health professionals, with a consequent shortage nationwide. There are insufficient doctors, dentists and therapists for the needs of the population, and many nurses and midwives train specifically to work overseas on a temporary basis. In 2011, the numbers of PhilHealth accredited professionals included: 10,773 general practitioners; 12,701 medical specialists; 201 dentists; and 522 midwives. DOH (2007) does have specified minimum numbers of workers required for hospitals to be licensed, however, it is not known if these minima are consistently and fully met. As data on private sector health workers is not readily

available, assurance of quality of care and long-term workforce planning are difficult. Government health workers are unevenly distributed throughout the country and are concentrated in urban and more developed areas. Three regions, NCR, Regions III and IV-A (which are relatively close to metropolitan Manila), have a higher proportion of government health workers than more remote regions such as Mindanao. To address the distribution of human resources, the DOH has deployment programs that are aimed to increase supply of health professionals to rural areas such as the Doctors to the Barrios (DTTB) and Specialist to the Province (STTP) programs. As well, Community Health Teams and registered nurses, through the Registered Nurse for Health Enhancement and Local Service (RNHEALS) program, will work with families to guide them to services and facilities and financing benefits. The master plan for human resources for health is currently being updated to take into account the strong private sector orientation and the objectives of the Aquino Health Agenda.

Medicines and therapeutic goods Prior to 2009, the cost of pharmaceuticals used to be among the highest in Asia. The Cheaper and Quality Medicines Act (2008) required maximum retail prices for selected drugs corresponding to a 50% reduction in the price of these listed medicines. Pharmaceuticals are dispensed in public hospitals, private hospitals and retail pharmacies, and prescription, by law, should mention the generic name of medicines but could also specify the branded medicines. PhilHealth reimburses inpatient medicines listed in the Philippine National Drugs Formulary up to a ceiling, and essential medicines may be provided free in government health services, although supply is a challenge with only 25% of essential medicines available in the public sector. Outpatient medicines are not covered by PhilHealth and the price is entirely shouldered by the patient. All these factors put significant constraints on access to essential medicines in the country. In 2007, medicine purchase was the highest source of out-of-pocket expenses for health, being around 50%. Ongoing PhilHealth reforms and moves towards case mix payment in hospitals as well as primary care benefit (including selected medicines) for outpatients, is expected to reduce part of this burden for the poorest.

DOH Complete Treatment Pack program is a medicines access program designed to reach the poorest of the poor with complete treatment regimens for the top most common diseases in the country which contribute to increasing morbidity and mortality and high out-of-pocket spending for medicines and health services to majority of Filipinos. The program distributes free complete treatment packs containing medicine, including for NCDs and anti-biotic, for one month to 10 million of the poorest families included in the National Household Targeting System.

Movement and linkages through the provider network Formal well-defined referral mechanisms among the different parts of the health system are weak, despite a referral system being set by the DOH in the early 2000s. Ideally, patients should enter health services at the barangay health centres and then be referred upwards. There is a district system of hospitals in each province to provide first level referral services for localities without hospitals, and to direct patients back to rural or barangay health services. Many cities and large municipalities also maintain their own system of referral hospitals.

However, self-referrals at any level are common practice and there is no proper gate-keeping mechanism. In private practice, patients may be referred by GPs or family physicians to specialists, then to subspecialists. Referrals are mostly done through referral letter. Both cost and access to services determine whether patients seek public or private sector care. Public providers may refer to the private sector when there is a need for specialized care or special facilities (e.g. ICU). Regular DOH public health programmes (e.g. immunizations, rabies and tuberculosis) have enhanced referrals from private to public providers, mainly for the benefit of acquiring free medicines or PhilHealth packages. However, with the exception of the DOTS program for TB that shares information, skills and supervision, there is very limited other interaction between public and private sectors. For some health promotion and disease prevention programs there is technical support and supervision provided from national level to lower levels and a sharing of vaccines and other supplies. Disease surveillance is communicated across levels.

Quality All health services are meant to be licensed and accredited by the DOH. In addition, PhilHealth is mandated to regulate quality of care, service delivery and health establishments through the accreditation of health care providers in seven areas: ethics and patient rights, quality of care, leadership, management of human resources and information, safety, and improving performance. Health professionals are regulated by the Professional Regulations Commission. The Food and Drug Administration regulates pharmaceutical products as well as food, cosmetics, vaccines, herbal supplements, health devices and equipment. In 2011, 1622 of 1781 hospitals were provisionally or fully accredited, 1,601 rural health units, 185 authorized hospitals, 69 ambulatory surgical clinics, 70 freestanding dialysis units, 1,090 TB-DOTS clinics, 1,070 maternity clinics, and 24,197 health professionals were accredited by PhilHealth. A number of program and essential care practice guidelines are available. Monitoring their use in the private sector is limited.

In general, quality of health services as measured by outcomes, population coverage, effectiveness, and safety and other indicators is highly variable depending on geographic location and social and economic factors. Highly urbanized metropolitan areas with higher income levels tend to and are perceived to have better quality health service than the mainly rural impoverished and often isolated communities where licensing standards are absent, and accreditation rates are very low. Most hospitals and professional practitioners meet the quality standards set by licensing requirements and PhilHealth accreditation standards. The PhilHealth Benchbook (2009) outlines all standards of quality processes and outcomes for hospitals. Data on quality outcomes are few and unreliable, but public facilities are generally perceived as poorer quality than private hospitals. Primary care facilities and lower level hospitals are bypassed because of similar perceptions of low quality.

Equity Inequity in health status and access to services is the single most important health problem in the Philippines. Population surveys, special studies and routine data collection consistently show the following: •

Financial barriers, negative perceptions about quality of care (in public providers) and lack of awareness of services and available benefits packages.

Key health outcomes and coverage for major programmes on child health, maternal care and infectious disease is lower in hard-to-reach areas, the poorest quintiles of the population (urban and rural), and families with uneducated mothers (urban and rural).

Life expectancy is more than ten years longer in richer provinces than in poorer ones.

NCDs lack systematic programmes, standards and service packages at first levels of care.

The prevalence of out-of-pocket payments as the main source of heath financing points to serious inequity in the health financing system since it forces the sick patient’s family to find money to pay for care at the point of need, i.e., at the time when they are most vulnerable. PhilHealth enrolment of the poorest households has not been sustained during the period of 2005–2010, despite two years of high enrolment in 2004 and 2006. Also, deficient targeting tools might have led to non-poor households that are being subsidized, while a big number of poor households have been excluded. The current payment system does not provide enough financial protection to members. Reforms of the health sector beginning in 2000 have continued to have little or no impact on a hospital network dominated by high-end for-profit private institutions. As a consequence, poor health outcomes for the poorest income groups and geographic areas persist. The prolonged inequity of outcomes can be traced to a historical trend of poor basic health services at primary and secondary level of care.

Demands and constraints on service delivery The decentralized system resulting from the Local Government Code (1991) has influenced the scope of implementation of health services and directing resources. Nationally, there is technical expertise in research, management and prioritization of population needs. Locally, LGUs are very powerful and

implementation of services depends on local funding and politics. Well-resourced areas with strong LGUs do provide comprehensive services through systems comparable to that in high middle income countries, but LGUs may opt not to prioritize health. PhilHealth programmes have provided incentives for local governments to enhance efficiency, management and implementation of their health services. Overall, the system can be described as fragmented.

As across Asia Pacific generally, the population is aging and becoming more urban with rises in noncommunicable diseases which will have significant impact on population health and service delivery capacity. It is anticipated that formal mechanisms to support NCD services at the local level will be implemented in the next few years to complement higher-level capacity and achieve the NCD-related targets in the universal health care program.

Indicators of progress The Department of Health has framework a Monitoring and Evaluation for Equity and Effectiveness (ME3). The system aims to determine whether the government’s health reforms are achieving the goals of equity and effectiveness.

Progress on the MDGs is regularly collated and monitored by the DOH and the National Statistics Office through government surveys, administrative records, annual routine data, and some international organization data. The Philippines is making good progress in reducing the poverty gap, lowering infant mortality, and reducing prevalence of malaria and tuberculosis. Slow progress is seen in reducing maternal mortality and halting HIV transmission. Hospital data and coverage rates for various promotive and preventive programs are also collected. Average utilization rate of PhilHealth programmes (service package benefits) remains low at 3.9% of total population. Utilization rate for health facilities in 2000 was 77%. Table 4. Selected Health Indicators Baseline Data and Targets Indicators

Life expectancy

2016 Targets

67.62 years (2000-2005)

71.59 years (2015-2020)

Infant mortality rate (per 1,000 live births)

Under 5 mortality rate (per 1,000 live births)

92-163 (2010)

20.6 (2008)

Malaria mortality rate (per 100,000 population)

0.03 (2009)

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Affordable Care Act: Access to Health Care Matters

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Healthcare System in The Philippines: An Overview

Philippines healthcare system is a mix of public and private sector with a long history, but changes have been made to improve it.

Introduction

The Philippines healthcare system is a complex and diverse system, with both public and private sectors playing a role in providing healthcare services to the population.

The healthcare system in the Philippines has a long history, dating back to the Spanish colonial period. Throughout the years, the system has undergone significant changes, with the introduction of new policies and programs aimed at improving access to and the quality of healthcare in the country.

Current State of the Healthcare System

Many people have trouble accessing healthcare, with low quality of healthcare many areas. There are problems like not enough healthcare workers, poor infrastructure and not enough budget.

Inadequate access to healthcare in the Philippines is a major concern, with many Filipinos living in rural areas facing challenges in accessing healthcare services. In rural areas, healthcare facilities may be scarce, and those existing may not have the necessary equipment or staff to provide comprehensive care. This can make it difficult receive treatments for serious illnesses or injuries.

Despite government efforts to increase access to health services , many Filipinos still struggle to receive the medical care they need.

The quality of healthcare in the Philippines varies widely, with some areas of the country having access to highly skilled medical professionals and advanced medical facilities, while others lack these resources.

Healthcare expenditure in the Philippines is relatively low compared to other countries, with government spending on healthcare accounting for only around 4% of GDP.

The Philippines healthcare system currently faces a number of challenges, including a shortage of healthcare workers, inadequate funding, and a lack of infrastructure.

Government Policies and Programs

The government created a program called PhilHealth to help people pay for medical care and some other programs to improve healthcare system.

The Universal Health Care Act, passed in 2019, aims to provide universal access to healthcare services for all Filipinos. This law establishes a national health insurance program, known as PhilHealth, which is designed to provide financial protection for Filipinos in case of illness or injury.

PhilHealth is the national health insurance program, which is designed to provide financial protection for Filipinos in case of illness or injury. Enrollment in PhilHealth is mandatory for all Filipinos, and it provides coverage for a wide range of healthcare services, including inpatient and outpatient care.

In addition to the Universal Health Care Act and PhilHealth, the government has also implemented other initiatives to improve healthcare in the Philippines, such as the Health for All program, which aims to increase access to healthcare for marginalized communities.

Private Sector Involvement in Healthcare

Private sector also plays a role in healthcare system, offering several medical services. But high costs is a challenge.

The private sector plays a significant role in providing healthcare services in the Philippines, with many private hospitals and clinics located throughout the country.

Private healthcare providers in the Philippines offer a wide range of medical services, including primary care, specialty care, and advanced medical treatments.

Private healthcare providers in the Philippines face a number of challenges, including high costs of medical equipment and supplies, and difficulty in recruiting and retaining healthcare workers.

FOURmula One for Health (F1)

In 2005, the Philippines healthcare system underwent a major reform known as FOURmula One for Health (F1). Its goal was to improve the efficiency, effectiveness, and equity of the healthcare system. The reform was organized into four main components: financing, regulation, service delivery, and governance.

Additionally, two laws were passed during this time, the Universally Accessible Cheaper and Quality Medicines Act of 200 8 and the Food and Drug Administration Act of 2009 . However, despite these efforts, the problem of inequality in healthcare access and outcomes remains a persistent issue in the Philippines.

The Philippines healthcare system is a complex and diverse system, with both public and private sectors playing a role in providing healthcare services to the population. Despite government efforts to improve access to and the quality of healthcare, many Filipinos still struggle to receive the medical care they need.

The future outlook for healthcare in the Philippines is uncertain, with a number of challenges facing the system, including a shortage of healthcare workers, inadequate funding, and a lack of infrastructure.

Recommendations for improving healthcare in the Philippines include increasing government spending on healthcare, strengthening the healthcare workforce, and expanding access to healthcare services in rural and marginalized communities.

The Philippines healthcare system is a mix of public and private sector, with government efforts to improve access and quality, however, many Filipinos still struggle to receive care, facing challenges like shortage of healthcare workers, inadequate funding and lack of infrastructure.

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