A REVIEW AND COMPARISON OF THE HEALTH AND HEALTHCARE SYSTEM OF

THE REPUBLIC OF THE PHILIPPINES AND KINGDOM OF SAUDI ARABIA

BY

LIMON, JASTYN ALAIN H.,

SANTIAGO, NEIL ANGELO E.

3ECONOMICS

A TERM PAPER SUBMITTED AS A

REQUIREMENT FOR

ECON 9 – HEALTH ECONOMICS

NOVEMBER 23, 2015

ASSOC. PROF. EMMANUEL J. LOPEZ, PH.D.

INTRODUCTION

Given the underdeveloped situation of the Philippine healthcare system, general

healthcare policy of other countries similar to the Philippines must be considered in

order to develop its healthcare system that will be sufficient to suffice the needs of its

people. The private sector has the burden in ensuring the health of the people, with the

supervision of the Department of Health. While in Saudi Arabia, the healthcare is

directly managed by the Ministry of Health, with the help of other agencies which

provide healthcare services for a specific group (for example, the Royal Commission for

Jubail and Yanbu and Red Crescent Society which is active during the annual

pilgrimage, the Hajj) (MInistry of Information, 1996).

According to the Philippine Statistics Authority (PSA), the population is projected to

reach 101.6 million in 2015, and US $12 billion was spent for health by both domestic

and international funding. The country placed sixtieth in the World Health Organization

(WHO) raking of health systems in 2000. Saudi Arabia on the other hand, with a

population of 30.7 million in 2014, spent US $24 billion purely from domestic funding.

64% of which were shouldered by the government. Its healthcare system ranked

twenty-sixth in the world surpassing Canada (30), Australia (32), United States (37), and

New Zealand (41) (Musgrove, et al., 2000).

The review and comparison of the healthcare system of two countries aim to gather

important information regarding the healthcare policies of the Kingdom of Saudi Arabia,

specifically the programs of the Ministry of Health, test its feasibility in the Philippines

and recommend if it is proven applicable.

DEMOGRAPHICS OF THE PHILIPPINES AND SAUDI ARABIA AND THEIR

RESPECTIVE HEALTH STATUS

The latest official data from the PSA from the year 2010 revealed that the census of

population was 92,337,852, with an annual growth of 1.90% referring to the year

2000 – 2010, (Ericta, 2012). It is three times larger than the latest census of population

of Saudi Arabia (30,770,375) according to the Central Department of Statistics and

Information, but stated a much higher annual growth of 2.55%.

“The Climate of the Philippines is tropical and maritime. It is characterized by relatively

high temperature, high humidity and abundant rainfall. It is similar in many respects to

the climate of the countries of Central America.”, (Philippine Atmospheric Geophysical

and Astronomical Services Administration, n.d.). The mean temperature of the country

is 26.6 degrees Celsius, excluding Baguio. Coolest months fall in January (25.5 degrees

Celsius) and May as the highest (28.3 degrees Celsius). The country has a high relative

humidity ranging from 71% to 85%, and is mainly because of the archipelagic terrain.

There are two seasons: the rainy season from June to November, and the dry season,

which is divided into cool dry (December to February), hot dry season (March to May).

Saudi Arabia in contrast, has an extreme climate, and the temperature can reach as

high as 43.3 degrees Celsius, and can drop to freezing. Humidity is undistributed in the

Kingdom with high level in the coastline and low level in inland. The same with rainfall,

some regions experience higher level of rainfall, the majority receive less rainfall, and

some receive none at all. Shamal is a wind that can stretch across the country in spring

or early summer which causes sandstorms that lead to reduced visibility and general

inconvenience, (MInistry of Information, 1996).

Also from the PSA, Saudi Arabia had the most number of Overseas Filipino Workers

(OFWs) in 2014 comprising 575,360 or 24.8% of the total number of OFWs abroad. It

surpassed the number of OFWs in Australia (1.7%), Europe (7.1%), and the Americas

(6.5%) combined.

According to the World Bank, et al., the life expectancy of the Philippines for both male

and female from 2006 – 2013 was at 67.95 years, while Saudi Arabia was at 74.61

years over the same period. However, life expectancy in the Philippines from 1960 –

1978 was higher than Saudi Arabia with an average difference of 7.73 years, and with

the highest difference of 12.14 years in year 1960. And over the years, the difference

became smaller due to the higher percentage of growth (life expectancy) in Saudi

Arabia averaging at 1.65%, while the Philippines with only 0.37% of growth (life

expectancy).

The United Nations Development Programme released its 2014 Human Development

Report, with the Philippines in 117th place (medium) while Saudi Arabia placed 34 th (very

high). Study showed that the overall growth of human development slowed down due to

the growth of income inequality and unequal education among the population. The

report also revealed that the overall inequality, as measured by the Inequality-Adjusted

Human Development Index (IHDI) has declined slightly in most of the regions mainly

because of the development in health and healthcare systems in recent years.

The Global Health Observatory Data Repository of the WHO estimated the rate of each

cause of death of children ages from zero to four. From the year 2000 – 2013, both the

Philippines and Saudi Arabia had not recorded any incident of HIV/AIDS and Malaria.

The Philippines however recorded a 34.74 deaths per 1000 live births. Main factors

include acute lower respiratory infections (6.76), prematurity (6.03), birth Asphyxia and

birth trauma (3.88), congenital anomalies (3.64), diarrheal diseases (3.01), other

communicable, perinatal and nutritional conditions (2.7), injuries (2.67), Sepsis (2.41),

other non-communicable diseases (1.46), Pertussis (1.15), Meningitis/Encephalitis

(0.71), Measles (0.17), and Tetanus (0.14). Saudi Arabia on the other hand, recorded a

lower rate of death per 1000 live births with 19.14 deaths. Main reasons are: prematurity

(5.06), congenital anomalies (4.43), birth asphyxia and birth trauma (2.11), acute lower

respiratory infections (1.71): which is the highest reason of death in the Philippines for

children aged 0-4 years, injuries (1.66), other non-communicable diseases (1.45), other

communicable, perinatal and nutritional conditions (1.06), Sepsis (0.8), diarrheal

diseases (0.49), Meningitis/Encephalitis (0.16), Pertussis (0.2), but no incidents of

Tetanus and Measles, as compared to the Philippines.

Adult mortality rate, as measured by the probability of dying between 15 – 60 years

per 1000 population – the most economically productive age group greatly affects the

economy of the country as a whole. The Philippines has an average of 19.98% adult

mortality rate from the estimation of the WHO for the years 2013, 2012, 2000, and 1990.

Male mortality rate (25.7%) is higher than female mortality rate (14.05%). Moreover,

Saudi Arabia has an average adult mortality rate of 10.8% over the same period, with

male mortality rate averaging at 12.1% and female mortality rate with 8.95%.

Middle East Respiratory Syndrome (MERS) is a viral respiratory disease caused by a

coronavirus, Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was first

identified in Saudi Arabia in 2012. 36% in approximate, all cases reported with MERS

have died. Symptoms include fever, cough, and shortness of breath. Camels, which are

abundant in Saudi Arabia are likely to be considered as a major reservoir of MERS-CoV

that can infect unprotected people, (World Health Organization, 2015). The Ministry of

Health of Saudi Arabia stated that as of November 22, 2015, 548 patients with MERS

have died since 2012, 727 cases were recovered, another 2 cases under treatment for

a total of 1277 cases all over the Kingdom, (Ministry of Health, 2015). Reported cases

of the disease spread in 26 countries, including South Korea, United Arab Emirates,

Lebanon, Iran and some isolated cases in Europe, United States, Philippines and the

rest of western pacific region.

HEALTHCARE POLICIES OF THE GOVERNMENT OF THE PHILIPPINES AND

SAUDI ARABIA

In the Kingdom of Saudi Arabia, The Ministry of Health (MOH) is responsible for

managing, planning and formulating health policies and supervising health programmes,

as well as monitoring health services in the private sector. It is also responsible for

advising other government agencies and the private sector on ways to achieve the

government’s health objectives. (Almalki, Fitzgerald, & Clark, 2008) The system offers

universal healthcare coverage. According to the MOH, The Ministry of Health operates

62% of the hospitals and 53% of the clinics and centers; the remaining facilities are

operated by government agencies, including the Ministry of Defense, the National

Guard, the Ministry of the Interior, and several other ministries, as well as by private

entities. The MOH serve the general public and are located in both the large cities and

the small towns throughout Saudi Arabia. The Military Hospitals serve members of the

Saudi Arabia armed forces and members of their families. The National Guard provide

care to the soldiers of the Saudi Arabian National Guard and their dependents. And

Ministry of Defence and Aviation(MODA) provide care to the soldiers of MODA and their

dependents. (Ziegler, 2015)

Throughout the years, Government expenditure on the MOH increased from 2.8% in

1970 to 6.2% in 2009. Data from the World Health Organization shows that total

expenditure on public health during 2013 was 3.2% of the gross domestic product.

The MOH provides health services at 3 levels: primary, secondary and tertiary. PHC

centres supply primary care services, both preventive and curative, referring cases that

require more advanced care to public hospitals (the secondary level of care), while

cases that need more complex levels of care are transferred to central or specialized

hospitals (the tertiary level of health care), while cases that need more complex levels of

care are transferred to central or specialized hospitals (the tertiary level of health care).

In accordance with the Alma-Ata declaration at the WHO General Assembly in 1978,

the MOH decided to activate and develop the preventive health services by adopting the

PHC approach as one of its key health strategies. In 1980, a ministerial decree was

issued to establish Public Health Care centres. The first step was to establish suitable

premises throughout the country. Existing facilities like the former health offices,

maternal and child health centres and dispensaries areas were integrated into single

units. The health posts in small and rural districts were upgraded to PHC centres.

Wherein focusing on a PHC strategy and applying a logical referral system has helped

to reduce the number of visits to outpatient clinics. The health centres aimed to focus on

the 8 elements of the PHC approach

1. Educating the population concerning prevailing health problems and the methods of

preventing and controlling them

2. Provision of adequate supply of safe water and basic sanitation.

3. Promotion of food supply and proper nutrition.

4. Provision of comprehensive maternal and child health care

5. Immunization of children against major communicable diseases

6. Prevention and control of locally endemic diseases

7. Appropriate treatment of common diseases and injuries

8. Provision of essential drugs.

Its constitution states that the government must provide all citizens and expatriates

working within the public sector with full and free access to all public health care

services. Expats in Saudi Arabia also benefits from the Kingdom’s health care system.

During the Hajj season, around 2 Million people from all around the world visit Saudi

Arabia’s Holy places like Mecca and Medina. The KSA government provide curative and

preventive care like health education programmes, vaccination and chemoprophylaxis

at quarantine services at airports and land ports for all pilgrims regardless of nationality.

(Almalki, Fitzgerald, & Clark, 2008)

According to the World Bank 2007-13 data, there are 2.5 hospital beds per 1000 people

in Saudi Arabia. While the Philippines has 1.0 bed per 1,000 people

In the Philippine setting, the Philippine healthcare system has rapidly evolved with many

challenges through time. Health service delivery was devolved to the Local Government

Units (LGUs) in 1991, and for many reasons, it has not completely surmounted the

fragmentation issue. Health human resource struggles with the problems of

underemployment, scarcity and skewed distribution. There is a strong involvement of

the private sector comprising 50% of the health system but regulatory functions of the

government have yet to be fully maximized. (Department of Health, 2012)

In 1995, the Government Established the Philippine Health Insurance Corporation

(PhilHealth). About 86 percent of the population is a member of PhilHealth as of today.

The scheme is government-controlled and tax exempt. It is funded by employers,

employees and subsidies from local and national government. All employees

irrespective of what other insurance cover they may have or who they work for must

joint PhilHealth. They pay a 2.5 per cent tax on their income.

About 40% of hospitals in the country are public. Of the over 700 public hospitals,

around 10% are managed by the DOH while the rest are managed by local government

units (LGUs) and other national government agencies. The DOH categorizes both

public and private hospitals based on their service capabilities, from Level 1 (primary),

Level 2 (secondary), to Levels 3 and 4 (tertiary). Level 1 hospitals, which have very

limited capacity comparable only to infirmaries, account for more than half of the total

number of hospitals in the country.

According to former DOH Secretary Dr. Enrique Ona (2010) in his speech at the 2010

World Population Day Celebration, “70% of Filipino health professionals are working in

the private sector serving about 30% of our population. Only 30% of health workers are

employed by the government to address the health needs of the majority of Filipinos.”

CONCLUSION

Given the geographic, economic, health status and programs of both countries, there is

a significant change in the quality and system of general health and healthcare services

of the Philippines compared to what Saudi Arabia has. The continuous endeavors of

their government paid off by the series of reforms through the direct supervision of their

Ministry of Health. Their large problem of manpower has been eased coincidentally by

the huge number of Filipinos working in the Kingdom together with other nationalities.

Infrastructure is rarely a problem due to the robust growth of their economy, giving

opportunities for learning institutions, primary, secondary, and tertiary health service

providers to grow rapidly and consistently. The Kingdom did not deviate to its

development plan – the Saudi Development Plans. It generally aims to promote Islamic

values, develop the productivity of people and economy, utilize natural and mineral

resources, and complete basic infrastructure for sustainable development, (The

Kingdom of Saudi Arabia Ministry Information, 1996). Despite the high status of Saudi

healthcare, the Ministry of Health should consider more reforms for the betterment of

the overall healthcare system in the Kingdom. The Philippines in contrast, should get

more support from the national government in implementing laws that will improve the

health and well-being of all Filipinos regardless of socio-economic status.

Health is a both basic need and right. People need to take care of their health, and with

the help of the private sector and guidance from the government and its agencies, a

healthy society and economy will follow.

RECOMMENDATIONS

Saudi Arabia and the Philippines both established a governing body that manages the

health concerns of its citizen, The Ministry of Health and The Department of Health,

respectively. Recent data from the World Bank shows that Saudi Arabia spent around

2% of their GDP on Healthcare in 2013 while the Philippines lag at 1.4%. Since the

1950’s, the Kingdom of Saudi Arabia had been keen on reforming its health policies and

saw great improvements both quality and quantity. It established free healthcare to all

its citizens, had achieved high level of care in all hospitals and thus, resulting to the

improvement the national health of the Kingdom. The Philippines on the other hand

lacks government funding to address the health needs of its people. Despite having a

huge supply of Medical Professionals, the Philippines faces brain drain wherein

professionals migrate abroad to better-paying nations like the United States and the

Middle East. The Philippines also lacks a nationwide high standard of healthcare

facilities wherein most provincial hospitals are not in par with city hospitals in terms of

medical infrastructure. However, according to Bloomberg, Saudi Arabia has now been

slowly decreasing its Health Budget since it is facing an economic slowdown. As a final

recommendation, given the positive economic growth the Philippines, the National

Government should further increase its expenditures on health care to further improve

medical services and to allow free healthcare for its citizens despite their socio-

economic status just like that of Saudi Arabia’s.

REFERENCES

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reveals-philippine-population-9234-million

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http://www.moh.gov.sa/en/CCC/PressReleases/Pages/default.aspx?

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https://kidlat.pagasa.dost.gov.ph/index.php/climate-of-the-philippines

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