Innovation in Access to Healthcare The Social Contract

through Universal Health Care

Teodoro J. Herbosa, MD Undersecretary

Department of Health

Investing in Filipinos, especially the poor

Universal Health Care

Education HousingGood

Govern-ance

Strengthen Preventive

& Promotive Care

Governance Reforms for Hospital

Upgrade Health Facilities

Improve Policy, Regulation and

Sector Management

DOH

Expand Coverage Improve Benefits

5.2M to 14.7M families

UHC: synchronized reforms in DOH and PhilHealth

PhilHealth

UHC financing requirementsWhat we have (DBM Forward Estimates, in billion PHP)

What we need (DOH estimates, in billion PhP)

    2013 2014 2015 2016 TotalA Preventive & Promotive Health

Programs5.8 12.3 5.5 4.3 27.9

B PhilHealth Premiums 12.6 12.6 18.9 18.9 63.0C Hospital Operations 14.4 14.9 15.4 15.9 60.6D Health Facilities Enhancement Program 13.6 10.6 10.2 10.7 45.1E Policy and Regulation and Sector 7.6 7.9 8.2 8.6 32.3  TOTAL 54.0 58.3 58.2 58.4 228.9

    2013 2014 2015 2016 TotalA Preventive & Promotive Health

Programs21.1 21.9 22.8 23.7 89.5

B PhilHealth Premiums 25.9 25.9 38.9 38.9 129.6C Hospital Operations 14.4 14.9 15.4 15.9 60.6D Health Facilities Enhancement Program 13.6 17.7 10.6 7.1 49.0E Policy and Regulation and Sector 8.8 9.2 9.5 9.9 37.4  TOTAL 83.8 89.6 97.2 95.5 366.1

Where are we in UHC implementation?

Increase in PhilHealth enrolment rate •1 0 0 % c o v e r a g e o f N H T S - P R identified poorest households (14.7m families/40 M with annual premium P 2,400 or totalling P 35.7billion.

•2013, enrolment increased to 82.4M •200+%inc in enrolment of the poor universal coverage achieved

Introduction of More PhilHealth Benefits

•Primary Care Benefit Package •Case rates for most common medical and surgical conditions and selected catastrophic diseases with “No Balance Billing” Policy for the poor or Sponsored members

Poor Covered by PhilHealthTotal PhilHealth EnrollmentColumn1

Year

Population

Year

Population

Year

Population

Year

Population 95.8 M

65%

17%

Health Financing

• Implementation of Primary Care Benefit Packages (PCB):

a. PCB 1 – consultation, screening and diagnostics for NCDs i.e. Visual Inspection Using Acetic Acid Wash (VIA)

b. PCB 2 - management and provision of medications for NCDs i.e. Complete Treatment Packs for DM and HPN

• Z Packages for catastrophic illnesses i.e. breast cancer and ALL

• Case payment rates

What needs to be done to achieve UHC?2012 2013 2014 2015 2016

Refocus preventive and promotive services to NHTS-PR/CCT families; Deploy Community Health Teams (CHTs) to increase use of services

CHTs deployed Rnheals nurses/ others deployed

50,000 22,500

100,000 22,500

100,000 11,000

100,000 11,000

100,000 11,000

Enroll/register, inform, and guide families on their PhilHealth benefits/entitlementsHouseholds covered by PhilHealth

Poorest identified using NHTS-PR *Catastrophic care package introduced

Expand to next poorest (Q2); Universal Coverage *Catastrophic care package fully implemented

Universal Coverage 14.7m poorest families

Universal Coverage 14.7m poorest families

Universal Coverage 14.7m poorest families

Upgrade quality of care at health facilitiesFacilities upgraded

RHUs/Main Health Centers – 2,243 District Hospitals – 403 Provincial and City Hospitals – 100 DOH-retained Hospitals – 37* *Will take more than 3 years Note: Incentives to sustain delivery of quality care introduced by 2014

Maintainenance and upkeep of upgraded facilities; construction of new ones to ensure service capacity

UHC implementation statusTreatment Pack (Medicines) and Vaccines

•Basic medicine packs for outpatient care (antihypertensives, antidiabetic, antibiotics, antiasthma etc.) distributed quarterly to all Rural Health Units nationwide

•Rotavirus vaccination for diarrhea for 700,000 poor children •Pneumonia vaccines for 700,000 poor children and 1M senior citizens

•Influenza vaccines for senior citizens Health Human Resources Deployed

•Doctors to the Barrios: 62 in 2010, 113 in 2011, 221 in 2013 •Nurses (RN Heals): 2010: 12,500, 2011-2012: 22,500 annually •Community Health Teams: 164,456 members deployed in 2012

Health facilities upgraded •3,258 hospitals, rural health units and barangay health stations upgraded and rehabilitated from 2010-2012, P 18 billion spent for infrastructure and equipment

National Center for Health Promotion

NCHP is the Department of Health’s arm in promoting health in settings where people live, work, learn and play.

Some Health Promotion Activities…

• LAKBAY BUHAY KALUSUGAN KALUSUGAN PANGKALAHATAN ON WHEELS - 1 Victory Liner-donated Bus - Transformation of 8 China-donated Mobile Clinic buses to LBK-KP

Health Promotion & ISO 9001:2008

In the pursuit to continuously improve, meet, and even exceed people’s expectations of a

QUALITY MANAGEMENT SYSTEM that enhances health care service delivery...

• Increase the logistics capacity and lifelines for health sector response:

◦ Emergency communications system ◦ Air Transport to, and within the affected areas ◦ Emergency logistical needs such as generators, hospital tents, etc.

• Build resilient health facilities ◦ Hospitals as the last facility standing ◦ Hospitals as hubs for energy, water, logistics, communications, and

shelter • Develop self-sufficient teams ◦ Properly equipped Mobile surgical, public health teams ◦ Physically and psychologically prepared teams to withstand the

disaster conditions

Recommendations for DRRM

PPP

700 Beds70%

Sponsored Patients • Cost of treatment is covered by PhilHealth

case rates

• No co payment by the patient

• PhilHealth/Insurer reimburses hospital operator for service

Beds Reserved - 490

30%

Pay Patients •Patients with co-payment ( i.e. balance exceeding insurance coverage paid by patient)

Beds Available - 210

‘Point of Care’ Patients

Service Beneficiaries

7

Philippine Health Information Exchange

Equity

Equity

Equity

Equity

GOVERNANCE

Department of Health

Sin Tax National Budget Foreign Assistance•Health facilities: infrastructure, equipment, operations, human resource •Public health programs: FP, MCH, TB, NCDs, WASH, Health Promotion

•PhilHealth PremiumsSUPPLY DEMAND

• 4,000 mothers per year saved from deaths due to pregnancy and childbirth • 2 million unwanted pregnancies prevented • 2.5 million children per year immunized • 5.6 million saved from malaria

• 14.7million poor families enrolled in PhilHealth and assigned to primary care facility by Community Health Teams • 200 doctors, 2,000 midwives, 11,000 nurses deployed yearly (100% municipalities with health professionals) • 100% of government hospitals able to provide all services at No Balance Billing • 2,783 modernized BHS, RHUs, hospitalsMDGs achieved

Poor and near poor financially-protectedAffordable and accessible quality care for all Filipinos

HEALTHIER FILIPINOS

INCREASED PRODUCTIVITY

INCLUSIVE GROWTH

Universal Health CareBetter health

outcomesResponsive health

systemEquitable health

financing

Health Financing

Service Delivery

Policy, standards and

regulation

Health Human

Resource

Health Information

Governance for Health

What full UHC implementation will achieve by 2016

1. Save lives of 16,000 mothers from dying due to pregnancy and childbirth complications

2. Prevent 2M unplanned pregnancies, including abortions 3. Save and protect over 5.6M Filipinos from malaria, dengue

and other preventable diseases 4. Immunize 10M children against vaccine preventable

diseases 5. Reduce death and disability from non communicable

diseases (e.g. heart disease, diabetes, cancers)longer life expectancy at birth

6. Poor and near poor families not pushed to poverty by high cost of health care

7. Access to 2,783 modern community health centers and hospitals

0

75

150

225

300

PhilHealth DOH

70.6

66.6 165.9

63

CurrentScale Up

Fully implementing UHC: Scaling-up programs and resourcing

PhilHealth insures an additional 5.6M families with improved package covering all poor and near poor families (from the current 5.2 million poorest)

DoH ensures the Philippines attains MDGs, and all Filipinos are provided with the preventive & promotive care fit for a middle income country

+ 105%

+ 42%

Scale up priorities by program

Total Gap for Rest of Aquino Administration PHP 137.2 billion

PHP

Billio

ns

0

35

70

105

140

A. Preventive & Promotive Health Programs E. Policy and Regulation and Sector Management

5.13.9

66.6

61.6 Current 2013-16Scale up 2013-2016