health financing and budgeting practices in the philippines - ivor beazley, oecd
TRANSCRIPT
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HEALTH FINANCING AND BUDGETING PRACTICES IN THE PHILIPPINES
Asian SBO, Bangkok December 13-14, 2017
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An international perspective
11.4
9.4
9.0
9.0
7.1
7.1
5.8
5.7
5.6
5.1
4.9
4.7
4.7
4.7
4.5
4.3
4.2
4.1
3.5
2.8
2.8
2.6
2.6
2.3
1.9
0
2
4
6
8
10
12
Public¹ Private%
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Trends in health spending
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Policy Goals
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Health delivery system - responsibilities
• Regional secondary/tertiary hospitals • Mental hospitals • Research Centres • Vertical programmes (TB, AIDs Malaria etc.)
National (DoH)
• Provincial, city and district hospitals Provinces (81) and independent cities
• City health clinics • City hospitals
Municipalities (1489)
• Local health stations
Barrangay (42,000)
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Financial flows in the health sector
TaxesBorrowings
National Government
PhilHealth Provinces DOH
Specialty public hospitals
HMOs/Private Health Insurance
Household and Private Companies Insurance payments
Retained public hospitals
Provincial, District Hospitals
Local govt taxes, fees & other revenues
Hospital revenues
Private hospitals, clinics, MDs
Household out-of-pocket payments
Foreign assistance/grants
Rural Health
Units
Municipalities Cities
City hospital
City Health Center
Barangays
Baran-gay
Health
Stations
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Major reforms related to health
financing
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Key achievements
• Funding for UHC - Sin Tax earmarks
• Expanded insurance benefits package and population coverage (PhilHealth)
• CCT program helps poor to access free health insurance (household targeting system)
• Improvements in PFM at national level
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Increases in DOH Allocations
0
20
40
60
80
100
120
140
2010 2011 2012 2013 2014 2015 2016
DOH Budget Allocations, 2010-16 (in billion pesos)
National Health Insurance Program Health Facility Enhancement Program Others
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The national health insurance
programme
10
20
30
40
50
60
70
80
90
100
10
20
30
40
50
60
70
80
90
100
2010 2011 2012 2013 2014 2015 2016
% o
f p
op
ula
tio
n
No
. o
f m
em
be
rs
& d
ep
en
de
nts
PhilHealth Beneficiaries, 2010-2016
SP/IP Other Membership Programs % of pop
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CCT program linked to health
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
2007 20082009 2010 2011 2012 2013 2014 2015
Mil
lio
n p
es
os
Nu
mb
er
of
ho
se
uh
old
s
Household coverage and annual budget of the Pantawid Pamilya Pilipino Program, 2007-
2010
Household Coverage Annual Budget (million pesos)
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Key budget issues - 1
• Under-execution.
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Key budget issues - 2
Inconsistency between LGU spending plans and DoH policy objectives
Complex planning and procurement for vertical programs leading to stock outs
Poor quality of local investment planning leading to under-investment in capital
Weak response to program impact evaluation
Weak oversight and accountability (Health Boards)
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Little change in local government
spending on health
0
5
10
15
20
25
Share of health in total local government expenditures, by local government level,
2001-2014
Province (%) City (%) Muni (%)
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Selected recommendations - 1
Fully implement LGU PFM Reform Roadmap to match progress made at national level.
Streamline local planning processes (including investment plans for health, poverty reduction plans) to improve consistency and avoid duplication.
Improve programming and monitoring of the intergovernmental fiscal transfer system.
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Recommendations 2
LGUs to reinvigorate local health boards, through civil society participation.
PhilHealth to shift performance focus from enrolment to benefit utilization and develop the necessary monitoring indicators and information system. Conduct independent audits or value-for-money evaluations of selected government programmes and projects, and increase the visibility of local financial indicators.