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TheEuropeanUnion’sDCI-ASIAProgrammeforthePhilippines

TechnicalAssistanceforthePhilippineHealthSectorReformContactEuropeAid____

NameofReport:Documentationofthe22ndAnniversaryPhilHealthSymposiumTheme:ChallengedbyChanged,EmpoweredbyUnityBannerTitle:BawatFilipino,Protektado:APhilHealthSymposium

Date:February27,2017

ThisprojectisfundedbyTheEuropean

Union

AprojectedimplementedbyEPOSHealthManagement

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DocumentationoftheProceedingsMiguelF.Manalastas,MD-MBALeadDocumentorKristianDiorV.Capili,RNDocumentorEunicePauleneL.Morada,RNDocumentorIslaBallroomEDSAShangri-LaManila1GardenWay,OrtigasCenter,MandaluyongCityFebruary27,2017EPOSHealthManagementincooperationwithPhilHealthandtheEUDelegation.

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TABLEOFCONTENTSPreface………………………………………………………………………………………………………...........................5ListofAbbreviations……………………………………………………………………………………………………..6ProgramofActivities……………………………………………………………………………………………….........9JourneyTowardsUHC…………………………………………………………………………………………………13

WelcomeRemarks……………………………………………………………………………………………15MessageoftheSecretaryofHealth……………………………………………………………………16PresentationofMediumTermDevelopmentPlanandCorporateDashboard………18MessagefromtheEUDelegationtothePhilippines……………………………………………23AchievingUHCinthePhilippines:anInternationalPerspective………………………….27ThePhilippines’JourneyTowardsUHC……………………………………………………………..30

ACloserLookattheUHCCube

ServicesCovered:WhatandWhere?Introduction…………………………………………………………………………………………..33ResourceSpeakers…………………………………………………………………………………35SynopsisofPresentations………………………………………………………………………38Discussion…………………………………………………………………………………………….44Synthesis……………………………………………………………………………………………….46

ProportionofCostsCovered:WhoPaysforWhat?

Introduction…………………………………………………………………………………………..47ResourceSpeakers…………………………………………………………………………………48SynopsisofPresentations………………………………………………………………………51Discussion……………………………………………………………………………………………..59Synthesis……………………………………………………………………………………………….66

PopulationCovered:WhoBenefits?

Introduction…………………………………………………………………………………………..67ResourceSpeakers…………………………………………………………………………………69SynopsisofPresentations………………………………………………………………………71OpenForum…………………………………………………………………………………………..77

Synthesis…………………………………………………………………………………………………………………….79ClosingRemarks………………………………………………………………………………………………………....80Appendices

QuestionsfromtheAudience………………………………………………………………………………….81InterviewswithParticipants…………………………………………………………………………………..86ListofAttendees…………………………………………………………………………………………………….89GuidelinetoPresentations……………………………………………………………………………………..99PostConferenceEvaluation…………………………………………………………………………………102PhotoDocumentation…………………………………………………………………………………………..103

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FullVerbatimTranscription…………………………………………………………………………………105PowerpointPresentations……………………………………………………………………………………191

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PREFACE2017isamilestoneforPhilHealthasitmarksthe22ndAnniversaryofthePhilippineHealthInsuranceCorporation.ThissymposiumisoneofthemajoreventslinedupinFebruary,incelebrationoftheNationalHealthInsuranceProgramMonth.Here,almost500participantsconsistingofpublicandprivatesectorstakeholders includinggovernmentagencies, localgovernment units, health providers, the academe, civil society organizations, patientsgroups,andthemedia,allcametogetherinpursuitofonegoal,UniversalHealthCoverage(UHC).This year, its theme: “ChallengedbyChange,EmpoweredbyUnity,” brought internationalandlocalspeakersintooneforuminordertosharetheirexperiencesandthelessonslearntonworkingtowardsUniversalHealthCareasechoedbythebannertitle,“BawatFilipino,Protektado: A PhilHealth Symposium.”Speakers from across the globe presented variouscountry experiences and best practices in the pursuit of UHC. At the same time, localleadersandexpertsdetailedtheprogress,thechallenges,andthestrategiesandmeasuresthatPhilHealthiscurrentlyfacing.Supported by the European Union (EU), this activity showcased local and internationalexperiencesonachievingUHC.Theone(1)dayprogrambeganwithatalkbyProf.KonradObermann who shared about other countries’ experiences in pursuit of UHC. This wasfollowedbyanarrativehighlightingPhilHealth’sjourneytowardsUHC.Astheorganizationlookedbacktomorethan20yearsofservice,theconferencewasabletorecognizeandpaytribute to the hardwork and successes that each and every onemade in order to bringPhilHealthtowhereitistoday.The symposium was divided into three (3) major parts, patterned after the three (3)dimensionsoftheUniversalHealthCoverageCubenamely,(1)theservicescoveredorthedepth,(2)theproportionofservicescoveredortheheight,and(3)thepopulationcoveredor the breadth. Each dimension was discussed and moderated in panel sessions thatfleshedoutthetrialsandopportunitiesforearlyharvestinsocialhealthinsurance.Intheend,recommendationsandstrategiesonhowtoexpeditetheprocessoffulfillingthedreamofUniversalHealthCareforall.Anexhibitwasalsoset-upoutsidetheconference,whichfeaturedthehistoryandjourneyofPhilHealthfor22years,aswellasa3-DmodeloftheUHCCube.

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LISTOFABBREVIATIONS4Ps PantawidPamilyangPilipinoProgramAO AdministrativeOrderARMM AutonomousRegioninMuslimMindanaoARPaC AseanRegionofPrimaryCarePhysiciansAssociationsBHS BarangayHealthServiceBLES BureauofLaborandEmploymentStatisticsCAGR CompoundAnnualGrowthRateCAR CordilleraAdministrativeRegionCDC CenterforDiseaseControlCEO ChiefExecutiveOfficerCPG ClinicalPracticeGuidelinesCOA CommissiononAuditCOO ChiefOperatingOfficerDALY DisabilityAdjustedLifeYearsDILG DepartmentoftheInteriorandLocalGovernmentDOH DepartmentofHealthDPRI DrugPriceReferenceIndexDSWD DepartmentofSocialWelfareandDevelopmentGDP GrossDomesticProductEU EuropeanUnionFACP FellowoftheAmericanCollegeofPhysiciansFEC FormularyExecutiveCouncilFFS Fee-for-ServiceFPCP FellowofthePhilippineCollegeofPhysiciansGDP GrossDomesticProductGHBP GuaranteedHealthBenefitPackageGOCC GovernmentOwnedandControlledCorporationGSIS GovernmentServiceInsuranceSystemHFEP HealthFacilitiesEnhancementProgramHFPS HealthFinancePolicySectorHMO HealthMaintenanceOrganizationHTA HealthTechnologyAssessmentIEC InformationEducationCampaignIHME InstituteforHealthMetricsandEvaluationIRR ImplementingRulesandRegulationsofRepublicActIT InformationTechnologyLGU LocalGovernmentUnitLMIC LowandMiddleIncomeCountriesMAP MedicalAssistanceProgramsMCP MaternalCarePackageMD DoctorofMedicine

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MDG MillenniumDevelopmentGoalsMHA MastersinHealthAdministrationsMRDP MaximumRetailDrugPricesNAPC NationalAnti-PovertyCommissionNBB NoBalanceBillingNCR NationalCapitalRegionNEDA NationalEconomicandDevelopmentAuthorityNHIP NationalHealthInsuranceProgramNHTS-PR NationalHouseholdTargetingSystemforPovertyReductionNKTI NationalKidneyTransplantInstituteNSCB NationalStatisticalCoordinationBoardNSM NationalStatisticsMonthNSO NationalStatisticsOfficeOIC Officer-in-ChargeOOP Out-of-PocketOSEC OfficeoftheSecretaryPAFP PhilippineAcademyofFamilyPhysiciansPAPO PhilippineAllianceofPatientOrganizationsPCARES PhilHealthCustomerAssistanceRelationEmpowermentStaffPDP PhilippineDevelopmentPlanPHA PhilippineHealthAgendaPhD DoctorofPhilosophyPHIC PhilippineHealthInsuranceCorporationPMT ProxyMeansTestPNF PhilippineNationalFormularyPNHA PhilippineNationalHealthAccountPOC Point-of-CarePRC ProfessionalRegulationCommissionPSA PhilippineStatisticsAuthorityPSDP PhilippineStatisticalDevelopmentProgramRA RepublicActRHU RegionalHealthUnitSDG SustainableDevelopmentGoalsSDN ServiceDeliveryNetworksSHA SystemofHealthAccountsSSS SocialSecuritySystemSTL SinTaxLawSVP SeniorVice-PresidentSWS SocialWeatherStationsTHE TotalHealthExpenditureUHC UniversalHealthCareUNICO UniversalHealthCoverageStudySeries UP UniversityofthePhilippinesUSAID UnitesStatesAgencyforInternationalAid

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UST UniversityofSantoTomasVP VicePresidentWHO WorldHealthOrganizationWHO-EMRO WorldHealthOrganization–EasternMediterraneanRegionalOffice

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PROGRAMOFACTIVITIES

JourneyTowardsUHCTIME ACTIVITY LEAD

9:00-9:15AMNationalAnthem

PrayersPhilHealthHymn

PhilHealthChorale

SMReyBalenaSeniorManager,FormalSectorMembershipManagementGroup

Atty.AllanPanolong

Chief,HealthCareDeliveryManagementDivision

PhilHealthRegionalOffice-ARMM

9:15-9:25AM WelcomeRemarks

Mr.JohnnyY.SychuaOIC-ExecutiveVicePresidentandChief

OperatingOfficer&ConcurrentCARAGARegionalVicePresident,

PhilHealth

9:25-9:45AM MessageoftheSecretaryofHealth

Dr.PaulynJeanB.Rosell-UbialSecretary,DepartmentofHealth

DeliveredbyDr.RaulQuillamorHeadoftheExecutiveStaff,Officeof

theChairperson

9:45-10:15AMPresentationofMediumTerm

DevelopmentPlanandCorporateDashboard

Mr.RamonF.Aristoza,Jr.ActingPresidentandCEO,PhilHealth

10:15-10:30AM

MessagefromtheEUDelegationtothePhilippines

Mr.LoiusDeyActingHeadofDevelopment

Cooperation

10:30-11:00AM

AchievingUHCinthePhilippines:anInternationalPerspective

Prof.KonradObermann,MD,PhDSeniorLecturer,MIPH

MainheimInstituteofPublicHealth,HeidelbergUniversity

11:00-11:30AM

ThePhilippines’JourneyTowardsUHC

Mr.RubenJohnA.BasaSeniorVicePresidentforHealthFinancePolicySector,PhilHealth

11:30-11:45AMPhotoSession11:45-1:00PMLunch

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ACloserLookattheUHCCube

TitleofPanel:WhatandWhere?Definingthecontinuumofhealthcareservicesanddeliverynetworks

Time Topic Presentor

1:00–2:30PM

LifeStageApproachDr.MariaOfeliaO.Alcantara

HealthPolicySpecialistDepartmentofHealth

ServiceDeliveryNetworks

Dr.EnriqueTayagDirectorIV

BureauofLocalHealthSystemsDevelopment

DepartmentofHealth

BenefitPrioritizationProcess

BenefitPrioritization:PrimaryCare

Dr.JohnWongCEO

Epimetrics,Inc.

Hon.AnthonyLeachon,MDFPCP,FACP

IndependentDirectorPhilHealth

RepresentativeoftheMonetaryBoard

Discussion

DISCUSSANT

Ms.KarenIdaVillanuevaPhilippineAllianceofPatients’

Organizations

OpenForum

MODERATOR

Dr.TessaTan-TorresEdejerCoordinator,UnitCosts,Effectiveness,ExpenditureandPrioritySettingWorldHealthOrganization

TitleofPanel:WhoPaysforWhat?Sharingtheresponsibilityforfinancialrisk

protectionTime Topic Presenter

2:30–4:00PM

PhilippineNationalHealthAccounts

Ms.RaquelDoloresSabenanoSeniorStatisticalSpecialistPhilippineStatisticsAuthority

ImplementationofNoBalanceBilling(NBB)PolicybyaLGU-

ownedHospital

Dr.ElenilaI.JakosalemChiefofHospital

BisligDistrictHospitalImplementationofNoBalanceBilling(NBB)PolicybyaDOH-

Dr.SorayaPesyAbubakarChiefofMedicalandProfessionalStaff

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retainedHospital ZamboangaCityMedicalCenter

RepresentedbyMs.MichelleLibagoAdministrativeOfficer

ZamboangaCityMedicalCenter

Discussion

DISCUSSANTS

Ms.Ma.GildaResurrecion,MHAConsultant

NationalKidneyandTransplantInstitute

Dr.AlejandroHerrinSchoolofEconomics

UniversityofthePhilippines-Diliman

OpenForum

MODERATOR

Dr.BeverlyLorraineHoChief,ResearchDivision

HealthPolicyDevelopmentandPlanningBureau

DepartmentofHealth

TitleofPanel:WhoBenefits?EnsuringtheinclusivenessofpoliciesandprogramsTime Topic Presenter

4:00–5:30PM

ImplementationofSinTaxReformActof2012(RepublicAct10351)

Mr.ToomasPaluRegionalPracticeManager

TheWorldBank

TargetingthePoorUndertheListahanan2

Usec.RositaVillarUndersecretary

DepartmentofSocialWelfareandDevelopment

RepresentedbyMs.Krupska

LeninaApitProjectCoordinator,Listahanan2DepartmentofSocialWelfareand

Development

SqueezingtheMiddleandOtherSourcesofFunds

Dr.EduardoP.BanzonPrincipalHealthSpecialist

SustainableDevelopmentandClimateChangeDepartment

AsianDevelopmentBankOpenForumandSynthesis

MODERATOR

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Mr.ManolitoNovalesProfessor,AteneoSchoolof

GovernanceAteneodeManila

Synthesis

Prof.KonradObermann,MD,PhDSeniorLecturer,MUHMainheim

InstituteofPublicHealth,HeidelbergUniversity

5:30-5:40PM

5:40-5:45PM ClosingRemarks

Mr.GregorioRullodaSeniorVicePresident,FundManagementSector&Chair,AnniversaryCommittee

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JOURNEYTOWARDSUHCPromoting and protecting health is essential to human welfare and sustaineddevelopment. This was recognized more than 30 years ago through the Alma-AtaDeclaration. The Alma Ata reaffirms that health, which is a state of complete physical,mental and social well being, and not merely the absence of disease or infirmity, is afundamentalhumanrightandthattheattainmentofthehighestpossiblelevelofhealthisamostimportantworldwidesocialgoalwhoserealizationrequirestheactionofmanyothersocialandeconomicsectorsinadditiontothehealthsector.According to WHO, Universal health coverage (UHC) means that all people andcommunities can use the promotive, preventive, curative, rehabilitative and palliativehealthservicestheyneed,ofsufficientqualitytobeeffective,whilealsoensuringthattheuse of these services does not expose the user to financial hardship. As such, thePhilippines embarked on the challenge to achieve Universal health coverage whereeveryonewhogainsaccess tohealthcarewillnotbe impoverished. In this context,UHCwould require PhilHealth to extend coverage tomore people, offer guaranteed services,andpayagreaterpartofthecostfrompooledfunds.

This morning, we have twodistinguished speakers whowilltalkabouttheirinsightsonhow countries, including ourown, have moved towardsachieving Universal HealthCoverage including the roleand contribution of thePhilippine Health InsuranceCorporation (PhilHealth)towards the realization of thisgoal.

Theprogramstartedwith thesingingof thePhilippineNationalAnthem, followed by solemn prayers, and the singing of thePhilHealthHymn.ProfessorNinaCastillo-Carandang, theoverallmoderator for the event, welcomed all the participants to thesymposium. She credited thosewhomade the special logo forthesaidcelebration.Shesharedthemeaningofthissymbolasitsymbolizeswhat PhilHealth is all about. She explained that themulticoloredvector images indicate thedifferentpublics,whichPhilHealth caters towhile thehalo formedby threebright bluecolors signifies their commitment to protect the people fromfinancial hardships due to medical necessities. Lastly, the solidgreenentityinthesymbolwasassociatedwithnatureandhealth.

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ProfessorCarandanggreetedthedifferentdignitarieswhoattendedthisoccasionsuchasthe PhilHealth Boardmembers, peoplewho had been part of the PhilHealth history, thevarious partners who made this symposium possible, colleagues in the Department ofHealth, attendees from different private and government institutions and organizations,and league of provinces. She then introducedMr. Johnny Sychua, OIC-Executive VP andCOOofPhilHealth,togivethewelcomeremarks.

MODERATORProf.NinaT.Castillo-CarandangHealthSocialScientistandAssistantDepartmentChairDepartmentofClinicalEpidemiologyCollegeofMedicineUniversityofthePhilippines-ManilaAhealthsocialscientistandclinicalepidemiologist.She is currently the assistant department chair of theDepartment of Clinical Epidemiology, College ofMedicineUniversityofthePhilippinesManila

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WELCOMEREMARKSByMr.JohnnyY.Sychua

OIC-ExecutiveVicePresidentandChiefOperatingOfficer&ConcurrentCARAGARegionalVicePresident,PhilHealth

Mr.Sychuaopenedthesymposiummentioningitstheme,“Bawat Filipino Protektado.” He described today’sactivityasanotherexcitingand learningopportunityaswe take a closer look on how the National HealthInsuranceProgramhasbeendoingafter22yearsof itscreationandtheestablishmentofPhilHealthonFeb14,1995. He explained that the presentations have beenclusteredaccordingtohowtheuniversalhealthcoveragein general and through social health insurance inparticular can be achieved, assessed, and appreciateddependingonthecountry’shealthcareneeds,resources,andpriorities.To quote, he said, “With this theme, this symposiumwillshowcaseinternationalexperiencesinachievingUniversalHealthCoverage. Itwill alsogive in-depthdiscussions onthe dimensions of Universal Healthcare, as well asinteresting viewpoints from global experiences, and howthe countries’ culture play a vital role in the successfulimplementationofsocialinsuranceprograms.”He continued with, “This day will not be complete without discussing Philippine’s ownjourneytowardsUniversalHealthCoverage.WeshalltackleonhowfarandhowneararewetofulfillingthevisioninseeingeveryFilipino,especiallythedisadvantaged,theunderserved,the underprivileged, is able to access healthcare services that are of highest quality, at therighttime,withtherightcosts.”HementionedthattheyinvitedpanelistswhowillbediscussingtheirownperspectivesonhowtheNationalHealthInsuranceProgramwillalwaysmakeapositivedifferenceinthelivesofallFilipinoshereandabroad.Toendhisremarks,heencouragedeveryonetojoininthis journeybyactivelyparticipatinginthediscussions,sharingtheirinsights,andaskingquestions because at the end of the day all of us are stakeholders of National HealthInsurance Program. He motivated all the participants to continue the initiatives thatconcernourhealthandreiteratedthatbeinginvolvedinthissymposiumisagoodstart.

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MESSAGEOFTHESECRETARYOFHEALTHByDr.PaulynJeanB.Rosell-Ubial-Secretary,DepartmentofHealth

DeliveredbyDr.RaulQuillamor-HeadExecutiveStaff,OfficeoftheChairperson“(Greetings) It givesmegreatpleasuretoaddressthepeoplewho appreciate and pursueUniversal Healthcare. Thepursuit of UniversalHealthcare underscores thevalues we aspire for realpositive change that ourcountrymen can feel in linewith President Duterte’spromise of “Tunay napagbabago.”

Equity, efficiency, quality, and transparency - these values are the backbone of thisadministration’snewhealthagenda,whichwecallthe“PhilippineHealthAgendaorPHA.”The Philippine Health Agenda was the product of collaborative efforts of the people whoheededthecallofthePresident’sthreemarchingorders,oneofwhichistohelpthepoor.Andinlinewithhelpingthepoor,heinstructed,yourstruly,togotoCubatostudytheirunitaryhealthsystemwiththehopethatitcanbereplicatedinourcountry.The task at hand may seem insurmountable, as the Cuban health system is impossible tocompletely replicate in our setting. One main difference is our dichotomy in health caresystemwhereinabout50%ofourhealthservicesaredeliveredbytheprivatesectorcausingawidegap in the costsof thehealth services.Asa consequence, only thosewhoare rich canaccess decent health services, either through out-of-pocket payments or a hefty healthcareinsurancecoverage,while the lowermiddleclasscanbecome impoverished just so theycanmeetOOPpayments.Thesituationisevenmorehelplessforthepoorestofthepoorwhodon’thavepocketstobeginwith.Thisisourrealitythatwehavebeenenduringforthelongesttime-tomeetthecostsofhealthservices.Hence a paradigm shift is in order, to shift from a dichotomist health system to a unitarysystem through ourNationalHealth Insurance Program. Through the PHA,we aim: (1) toguarantee services that provide care for all life stages and address the triple burden ofdiseases,(2)toensureservicesareavailable,acceptable,accessible,affordable,ofquality,andequitableand(3)tosustainablyfinancetheservicesthroughuniversalhealthinsurance.Every Filipino, most especially the poor, should have the ability to access both public andprivatehealthserviceswithoutthefearofbeingunabletopayforthese.PatientswantingtogotoaprivatefacilitywouldnowgetqualityhealthcareassessmentsandtheprivatefacilitywillnotbeleftwantingbecauseNHIPwillhavethecapacitytopayfortheseservices.

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On the other hand, our public health facilitieswill continue to be improvedanddeveloped,andbeatparwiththebestprivatefacilitiesouttheresothatourvaluedclientsandpatientswill still be able to access same quality health services given in private facilities. This willcreate friendly competition between private and public health facilitieswith the hope thatbothof themwillhave thedrive to improve themselvesandbeable toattractandcater tomore clients and patients, leading health to be subsidized by one single payer, which isPhilHealth.Throughthisprocess,wewillcreateaunifiedhealthcaresystem.Wearenow,therefore,seeingPhilHealthtakingthecenterstageinguaranteeingthehealthoftheFilipinos.ThisisthewayforwardifwearetoensurethateveryFilipinogetsashotinlifetomakesurethattheyreachtheirmaximumpotentialandbecomeproductivecitizensofourcountry.WehopetoattainthisthroughourstrategywhichwecallACHIEVE:A-dvanceprimarycareandqualityC-overallFilipinosagainstfinancialhealthriskH-arnessthepowerofstrategichealthhumanresourceI-nvestindigitalhealthanddatafordecision-makingE-nforcestandards,accountability,andtransparencyV-alueclientsandrespectpatientsE-licitmultistakeholdersforhelpIfweachieveourgoals for financialprotection,responsiveness,andbetterhealthoutcomes,then our commitment to the entire Filipino nation is fulfilled. We owe it to our sons anddaughterssotheywouldn’thavetogotothesameprocessonseeingtheirlife-worthsavingsgo down the drain just to meet the costs of getting well. We owe it to our parents andgrandparents,whoarenowinthestageoftheirliveswheretheyneedinsurancethemost.Weowe it to the Filipino people, especially the poor and the marginalized, because health iseveryone’sfundamentalright.I’vealwaysbelievedthathealthiseverybody’sconcern,notjustthegovernment,butthewholeofsocietyaswell.Hence,wehavetorallybehindourhealthagenda,thePHA,andmakeitarealityforeveryFilipino.Letuscommitourselvestoworktowardsonesharevisionandthisis,“ALLFORHEALTHTOWARDSHEALTHFORALL.”

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PRESENTATIONOFTHEMEDIUMTERMDEVELOPMENTPLANANDCORPORATEDASHBOARD

ByMr.RamonF.Aristoza,Jr.ActingPresidentandCEO,PhilHealth

“Salamat Nina. Nina is my classmate way back… Nevermind the years. As usual you always look good.PalakpakannatinsiNina.Thankyou.Good morning. Let me greet you in my signaturegreetings -magandangbuhay. Please say it again. Thatmeansgoodlife.Iamtaskedtopresentourmediumtermdevelopmentplanwhilepreparing for thismaterial thatI’m about to present. I’m thinking about how best topresent corporate strategy map vis a vis PhilHealth’sjourneytowardsUniversalHealthCoverage.I guess there’s no other betterway to do that than buyworking along with our theme for today’s symposium,which is, is it there? Bawat Filipino Protektado. HowexactlydowemarchtowardsensuringthateveryFilipinoisabletoaccesshealthcareserviceswithoutrunningonanemptypocket.I’mtaskedtopresentthisasdefinedourmedium term development plan onwhatwe plan to dofromthisyearuntiltheyear2022.Onthequestionofhowdoweimproveequityandefficiencyinfinancing?Foralmost50yearsnow,financinghealthcareandthePhilippineshasgainedalotofheadwaybutadmittedlyitisstillfragmented.Weareseeingmultiplefundingstreamsthatsometimesoverlap.WhiletheNationalHealthInsuranceProgram(NHIP)hasbecomethesinglebiggestpurchaseofhealthcareservicesinthecountry,itcanstilldoalotofleveragingtoserveascatalystsforhealthsector development. It has yet to fully exercise its power to infuse, change and cultivate aculture of improved performance and accountability from its partner providers, whileensuringequitableaccesstohealthservices.Ourvision,missionandvalues,indeed,weneedtorefocusourstrategiesfromsimplyensuringequalityofopportunities. Inotherwords,bawatmiyembro,to improvingequity inaccesstohealth care services. In otherwords, bawatmiyembro, protektado anddriving efficiency inresource allocation as we’re saying kalusugan ng lahat, sigurado.We now aim to rapidlyensurethatallFilipinoshavetheuniqueopportunitytogainaccesstohealthservicesatanystageoflife,withoutexperiencingfinancialburden.Wehearstoriesofindividualandfamilieslosingtheirsavingtoasingleincidentofillnessinthefamily.Thisisonemajorconcernwewantedtoputanendbyofferingamorerationalizedbenefits.WealsowanttheNHIPtobecomesustainableinthelongrun.Itisourdutytomake

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surethattheNHIPisabletofulfill itsobligationtothe100millionstrongmembershipthatincludestoday’sdigitalmembers,themillenials.On our PhilHealth corporate strategy map from 2017 to 2022, on your screen is thePhilHealthcorporatestrategymap from2017to2022, it isablueprint that isalignedwithambition,notin2040,thecountry’sdevelopmentmap.Weareanchoringourjourneyontheoverall goalsof thehealth sector.Under thePHilippineHealthAgendauntil year2022, theNHIPtakescareofthehealthfinancingaspecttohelprealizethethreeguaranteesthatthesaidagendahasspelledout.WeaimtoseeourfellowFilipinosawaitingthemselvesofqualitymedicalservices,servicesmadepossiblebysocialhealthinsurance.Alldelightedcustomers.Amongourmajorstrategies istoprovideourmembersthatuniqueexperiencethatwillnotonlydelight,butwillalsoprobethemtosharetheirexperiencewiththeirfamily,friendsandacquaintances.Totalcustomerdelightshouldstartfromthemomentofnewmember,anewmembersignsuptotheNHIPtothenextphasewhichwillenablehimtofulfillhisobligationsuchaspremium,paymentandmemberdataupdatingtothattheveryinstancewhenamemberaccessesthebenefits.Wewantthemtofeelsecureandthattheycanseekmedicalhelpwithoutworryinghowtofundthehealthexpenses.All delighted customers quote, “I feel secured” to generate that assurance formembers,wehavetwomajorobjectives:pushfortotalcustomerexperienceanddevelopslowlyresponsivebenefit packages. For total customer experience, in the marketing world, the challenge isalwaystobringaboutthepeaksales,encouragedbyhowengagementwascarriedout,inourcase,thechallengeisachievingcustomerdelightisdefinedbythemember’sexperienceatthedifferenttouchpointsmadeavailabletoourcustomers.Asingleunsatisfedmembercaneasilyspreadthatunfortunateincidenttoathousandandoneothermembersinthesamewaythatonesuccessfulhasslefreetransactionatourservicepointcanbringaboutpositivevibes.Among our key initiatives under these objectives are to cover difficult to capture segmentsand retain informal sectormembers - to expand contracting private sector and functionaldelivery networks, and improve delivery and quality of customer services by engaging ourfrontliners or frontlines, our collection partners, our partner providers. For responsivebenefits,providingresponsivebenefitpackagesisalsocrucialtoachievingcustomerdelight.We recognize ourmember’s desire to get value for theirmoney thatwe should be able toreduceinefficiencyinchoosingandpurchasinghealthcareservices.Our key initiatives under these objectives are to expand primary care benefits for all,implement guaranteed health care packages and supplemental benefits. Strictly implementthenobalancebillingforwardaccommodationandinteriorpromoteco-paymentschemeforallothermembersandupdatethebenefitpackageinviewofthepricedifferentiationacrossgeographic areas. For responsive benefits in the area provider payment,we are looking atimproving price negotiations and setting tariff for benefit packages in 2020. In terms ofPhilippine coverage it will be a step from identifying the minimum guaranteed healthpackageperlifestagetoexpansionofsecondaryoutpatientbenefitsby2019.

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Onhowtosustainthefunds,wenowmoveontoournextmajorpillar inthisstrategymap,which is funding sustainability.Webelieve thatwecanonlydelightourcustomer ifweareabletomaintainandsustainthefundingforanobleNationalprogramliketheNHIP.How dowe plan to achieve funding levels that are sustainable? First, wemust generate 3billionintermsofpremiumlevelsandcollectionefficiencyandoptimizeassets,notforprofitbuttobetterserveourmembers.Weneedtoadaptaprogressivepremiumcontributionratesintheformalsectorandadjustthepremiumlevelsforothercategories.Ibelieveconsultationwith the concerned stakeholders are already on-going. We are also strengthening ouraccountsmanagementandmonitortherevenueraisingefforts.Fulloutsourcingofcollectionof services of the electronic remittance system or otherwise known as EPRS, is now beingrealizedthroughourhardworkingaccountmanagement,whoisconstantlykeepinganeagleeyeoncriticalaccounts-onhowtooptimizetheassetsofthecorporationaswecantakecareofpublicfunds,weneedtobetterourinvestmentportfoliowhilecopingmeasuretomaximizeproductivity of our assets to proper aging, monitoring of asset performance and timelydisposal of sets. Efficient resourcemanagement can actually dowonders for a governmentcorporationthathasinvestedinfundingthehealthcarerequirementsoftheFilipinocitizens.The thirdmajor component of our strategymap is enhancing internal processes to betterrespond to the needs of our clientele. Despite the many accolades that we have earlierreceivedforefficientclientservicing,westillneedtostriveforexcellenceatafairlyconsistentlevel so that we are able to provide our clients and stakeholders with highest quality offrontlineservicesaspossible.Excellentprocessesisonemajorcomponentofthestrategyplan.Underthispillarofexcellentprocessesarethethreemajorobjectives,thatifmet,willcertainlyputPhilHealthatthelevelof efficiency never been experienced. First is strengthening stakeholder relations. Second,ensuringoperationaleffectivenessandefficiency.Andthirdisboostinginnovationinresearchpolicyandprocesses.Onstrengtheningoncustomerandpartnerrelation,improvingthelevelof engagement and communicationwith our customers andprogrampartners is crucial inbringingustowherewewanttobeasaninstitution.Thiscanbeachievedfordevelopmentand implementation of an integrated marketing and communication plan that featuresmarkets segmentation and localization, anduse of effective channels.Weare alsoworkingtowards strengthening customer relation and management system to better managecustomer feedback and concerns. It is inevitable for feedback to come in from so manychannels and the biggest channels here are to be able to attend to them and address theconcernsinthesoonestpossibletime.Intermsofmanagingourprogrampartners,weneedtoenhanceourperformancewiththemby integratingclearperformance incentivesandpenalties.Wealsoaimtotapmoreprivatesector involvement for better program implementation to achieve operational effectivenessandefficiency.Wearelookingatimplementingleanerfrontlineprocessesandimprovingourturnaroundtimeespeciallyforbasicstructuredtransactions.Atthesametime,keepingtrackof the progress of our initiated program and projects will be a major undertaking. Thecorporationshallstrengthenmechanismstocontrolandminimizefraudagainstit.ThiswilladdresstheleakagethatwillthreatenordepletetheNationalHealthInsuranceprogram.

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Inboosting innovationandresearch,policyandprocess foryears,wehavealwaysreliedonresearchtogeneratesoundpolicydecisionsforourvariousoperations.Thistimeweneedtobring in a different of the exploring and planning into policy making - policy making bytightening research collaborations with local and international partners and adaptingglobally recognized reporting standards for organizational transparency.Strongfoundationisaveryvitalcomponentofourmediumtermdevelopmentplan.Thisisabusinessmindsetthatsaysifyoutakecareofyouremployees,thentheywilltakecareofyourclients. Ladies and gentlemen, we have set our sights, early on to become the employer ofchoice ingovernmentsectorand thecontest for thisbrandofemploymentwillnevercease.Thisisthereasonwhywearebuildingthisstrongfoundationhingedonleadershipcapacity,human capital development and information and knowledge results and resourcemanagement. These are the elements that will support our nationwide operations -collectively,ifwewanttoforgeahead,armedwiththeskills,talentsandtechnicalknowhowthatourmandaterequiresofussothatwecanbringaboutthekindofgovernmentservicethateveryFilipinodeserves.ThreekeyitemswillkeepusfocusedonbuildingthestrongfoundationonwhichPhilHealthwill stand. One, creating transformative leadership and culture. Two, aligning theorganization and engaging the workforce. And lastly, integrating and optimizing theinformation system.Create transformative leadershipandculture isoneofamong thevitalcomponentsofourmediumtermplanandmosttakesplace,themainactorhasanunderstudywhorehearsesthelinesasthemaincharacterdoes.Thesamegoesforourorganization.Wewillcontinuetopursuefulfillingourleader’sanddevelopingthenextlinetoensurecontinuityofbusinessoperations.Atthesametimewewillinstitutionalizethefeedbackmechanismsuchastheperiodicreviewandthetimelyinterventionstofosteracultureofcontinuouslearning.Oneoftheprioritiesistofightcorruption.Thus,thecorporationshallensurethatitremainsto be corrupt free organization. Just recently the board has improved a policy on whistleblowingandthisisjustthestartofthemanymoreinitiativestocomealongthisline.AlsoI’mhappytosaythatourpresentlegalsectorisdoingmoreforourpoliciestoensurethatensurethat PhilHealth pays the right money to the right benefits. Ensuring organization andworkforce engagement, it is also important that we create an environment that givespremium to employees engagement. The non-monetary benefits of work satisfaction canactuallymotivatetoperformattheirmaximumcapacityandsuchworkattitudewillleadtothebenefitoftheorganizationnoless.Organizationalalignmentandworkforceengagementsisvital toourmajordevelopmentplan.Wewanttobe forward lookingaswellandprovideouremployeeswithopportunitiestodeliverontheirtasksdespitethechallengesoftime.Wehave seen, just likeNina, the traffic condition, situation in the national capital region, hasaffectedouremployees.Onestudythatthestressourcommutersgothroughonadailybasisactually affect family relations. That’s why all avenues are being explored such asteleconferencing,workfromhome,faultlessscheduleandarrangement,andthelike.Thebestway to survive in this fast paced world is to keep up with the changing time and takeadvantageoftoday’sinformationandcommunicationtechnology.

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Onintegratedandoptimizedinformationsystem,itisanationalprogram,onamassivescope,asthenationalhealthinsuranceprogram,willdefinitelyrelyonaninformationsystemwhatthe operations need andwhatmanagement require for an effective and informed decisionmaking. We will operate on a cost efficient computing environment, tapping availableapplication and outsourcing stakeholders support for IT applications. We will continue toadvocateknowledgeresourcemanagementforlearningcanalwaysbeenrichedbyliteraturepublicationontheNHIPthatthenextgenerationofsocialhealthadvocatescanbuildupon.As thePhilippineHealthAgendagetsoff theground,PhilHealthwill takeonthe formidabletask of continuous recalibration as it faces the challenge that is ensuring financial riskprotection that brings. We have weathered 23 years, the journey was not exactly smoothsailing but the lessonswehave learnedalong thewaywill all themore prepare us for thebiggerwavesahead.Soallofthis,ladiesandgentlemen,I’mconfidentthatthisorganization,thisveryorganizationthatIhaveservedforalmost19yearswillcontinuetosoaraftereveryFilipino has social health insurance coverage that grants access to medical care serviceswithoutnecessarilybeingimpoverishedbythecostoftheseservices.Bythen,universalhealthcareorUHC,hasbeenachieved.Thankyouandmaramingsalamatpo.”

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MESSAGEFROMTHEEUDELEGATIONTOTHEPHILIPPINES

ByMr.LouisDeyActingHeadofDevelopmentCooperation

“Honorable Paulyn Jean Rosell-Ubial, Secretary ofHealth;HonorableRamonAristozaJr,ActingPresidentandCEOofPhilHealth;HonorableJohnnySychua,ChiefOperating Officer; Dr. Raul Quillamor, Head ExecutiveStaffPhilHealthBoard, SecretaryManuelDayrit,Deanof Ateneo de Manila, Professor Konrad Obermann,friends, colleagues, partners, ladies and gentlemen,health isenshrined in the1987PhilippineConstitutionasafundamentalhumanrightforeveryFilipino.Itisagreat honor to share a fewwordswith you today - attoday’s important symposiumtocelebratePhilHealth’s22ndanniversary.In doing so, I’d like to focus on three main messages.First, onbehalfof theEuropeanUnion, Iwould like tocongratulatePhilHealthandtheDepartmentofHealthonthenoteworthyachievementsinhealthmadesofar.We greatly appreciate the continued commitment ofthePhilippinegovernmenttowardsachievingUniversalHealth Care. Today’s symposium entitled, BawatFilipino,Protektado,highlightsthehealthsystem–notjustaboutimprovinghealth,butalsoprotectingpeoplefrom falling into poverty because of the financialconsequenceofillnessandseekingmedicalcare.

WhenPhilHealthwascreatedin1995,itonlyinitiallycoveredgovernmentandprivatesectoremployees. 22 years later, PhilHealth hasmade great strides inmoving forward along thethreedimensionsofuniversalhealthcare.Coveragenowreaches92%ofpopulation–that’salmost93millionpeople.Byachievingtheimpressivecoverageofthepopulation,PhilHealthhashelpedputthePhilippinesattheforefrontofglobalexperience.Anotherdimensionofuniversalhealthcarerelatestotherangeoftheservicescovered.Theintroduction of several benefit packages has enabled Filipinos access to a wide range ofservices.PhilHealthconstantlycontinuestoinnovateandadaptbenefitpackagestomeetthechallengingdemandsoflocalandglobalhealthconcernsofFilipinos.With increased funding support from the government, the paid amount paid per benefitpackagereimbursementsdouble from47millionpesos in2012 to97millionpesos in2015.Andthenumberofclaimshavealsoincreased,from5millionin2012to8.4millionin2015.At

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theendof2011,PhilHealthadoptedthenon-balancebillingpolicy,whichaimstoensurethatthepoorwouldnothavetopaychargesoverandabovewhatisreimbursedbythePhilHealthbenefit packages. In public, aswell as in private health accredited facilities, compliance ofhealthfacilitiestothenon-balancebillingpolicywasinitiallywasquitelow,butsignificantlyincreasedfromonly7%in2013to51%in2015.PhilHealth has also made considerable progress in terms of process improvement,strengthening its workforce and making access to PhilHealth benefits simpler. PhilHealthreceivedISOcertification inDecember2014.ThisdemonstratesPhilHealth’scommitmenttocontinuedimprovement,customerfocusanddeliveryofqualityservices.PhilHealthhas identifiedequity,accountability, customer focusandsocial solidarityascorepillarsof itsmission.The importanceofPhilhealth isalsowellarticulated in thePhilippineHealthAgenda–achievinguniversalhealthinsuranceisoneofitsthreeguaranteesandputsspecial emphasis on leaving no one will be left behind and reaching the vulnerablepopulationswhofacefinancial,culturalandgeographicalbarrierstoaccessmedicalservices.Thesefindingsandthepoliciestoenhancefinancialriskprotection,thecontinuedexpansionofgovernmentsubsidizehealthinsuranceforthepoor,deepeningofthebenefitpackagesaswellasproviderpaymentreformaimedatcostcontainmentaretobeapplauded.Aheartfeltcongratulationstotheseachievements.And this brings me to my second point, by emphasizing how much the EU values theopportunities to support PhilHealth, since 2007 when the first Philippine sector supportprogram was launched, the European Union has provided support to the National HealthInsuranceschemethroughtechnicalsupportinvariousdomainssuchascosting,anddesignofbenefitpackages, improvingdatamanagement, strengtheningriskmanagementandactualanalysis. We consider PhilHealth an important pillar for continued progress for universalhealthcoverage–onethathelpstosecureefficientandeffectiveuseofgovernmentresourcesandenablestoimproveaccesstomedicalservicestothepoor.Weseehugeopportunities.Wearealsoawareoftheverystrongcapacityandlongstandingtrackrecordthecountryhasinpublic healthbeinga regional leader in somanyareas. It ismost encouraging to see somany key stakeholders represented here today: PhilHealth board directors, offices andemployees from central, regional and provincial offices, Department of Health officers andhospital directors, local government and private sector representatives, civil societyorganizations,universitiesandprofessionalbodies,mediaanddevelopmentpartners,thanksto the collective efforts of somany in this room.Many health indicators have significantlyimproved.Localexecutivesarecrucialpartnersandprimeactorstoensurequality,affordableandaccessiblebasichealthservices.After the devolution of health services, a number of local government units especially ingeographically isolated and disadvantaged areas, had difficulty responding to the newresponsibilities.They lackbehind inachievingthesaidtargets.Weappeal togovernorsandmayorsto joinandtakeupthechallengeandseizetheopportunitiesoffered.Wedobelievethattheoverallsuccesstowardsuniversalhealthcarewouldheavilydependonwhetheritwill

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beabletogetlocalgovernmentsonboard.Leavetheexpectationsarehugeandallhandsareneededondeck.Thisbringstomythirdandfinalpoint. Indeed,aswe looktothe future, it seemsthatmoreremains to be done. The remarkable progress made in many areas has not reached allFilipinos andmany people still feel excluded from health care. Improve national averages,mask the remaining inequalities in many health outcomes and wide regional variationspersists. Similarly, available data show consistently poorer health outcomes amongindigenouspeople.That’s why today’s symposium on exploring the dimension of universal health care is soimportant. It presents a unique opportunity to share experiences and best practices onpolicies.Withyourpermission,therearesomeareaswewouldliketohighlight.Out of pocket spending, when sick remains rather high. Latest national health accountsestimatedoutofpocketspendingremainingratherhighat57%oftotalhealthexpenditures.This severely limits access to essential health care services for many Filipinos. PhilHealthshareintotalhealthexpenditurewithonly14%.Ensuringcontinuedgovernmentsubsidizedofpremiumsof thepoorandexploringother fundingpossibilities forPhilHealth, to furtherincrease revenue will translate to increase in benefit package payments to reduce out ofpocket spending. 80% of PhilHealth reimbursements going to in patient health care.Specialists treatmanyconditions thatcouldbe treated in theprimary level.Manyhospitalsarecongestedandhavehighbedoccupancyrates.Significantcostcontainmentandefficiencygainscanbeachievedthroughinvestingandexpansionofprimarycarebenefitpackages.Inaddition,treatingmanychronicnoncommunicablediseasesatearlystages,attheprimaryhealthcarelevel,canpreventcomplicationsandavoidexpensivetreatmentsathighlevelsofcare.ThePhilippinehealthsystemiscomposedofmanystrongelements.Andthecountryhasworldclassexpertsinmultipledomainsbutthehealthremainsfragmented.Astronghealthsystemisneededtodeliverwitheachof itspartsoptimized:financing,procurement,humanresourcesandstrategicinformation.ThePhilippines’healthsystemfinancingthehybridsystemscomposedoftaxbasedsupplysidefundingbytheDepartmentofHealthandthelocalgovernmentunits,aswellasthedemandsidethroughtheNationalHealthInsurancescheme.Toincreaseefficiencyofpublicfunding,itis important toavoidoverlapsamongthedifferent fundingstreams,ensurecomplementaryandengagemorestrategicpurchasingofhealthservices.Who isbestplaced topay forwhatkindof cost?Whatmechanismscanhelpcontaincosts?Whatmechanismscanhelpdrivequalityandperformance.Overallperformancedependsonhowwell thedifferentpartswork together.TheEuropeanUnionwants youachieve the setgoal of health outcomes – that every Filipinowill attain the best possible health outcomeswith no disparity, that every Filipinowill have the sameaccess evidence basedhealth carefree from discrimination and without running the risk of financial hardship – no matterwhere they live, whether they are poor, member of an indigenous group, people who usedrugs,menwho have sexual relationswith othermen, peoplemental illness, disability and

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memberofanyotherminority.Weareconfidentthatthesepointsgiveusfoodforthoughtbutatthesametime,encourageustocontinuethehealthreformcauseinthePhilippines.Once againwewant to express our congratulations for havingmade remarkable progresstowardsachievinguniversalhealthcare.Lookingahead,continuedinvestmentinthenationalhealth insurance schemewill ensure that this vital instrument secures thehealthandwell-being of every Filipino. We look forward to continue our good cooperation. We arecooperation as in the past, will live up to its commitment and will faithfully meet thechallenges inherent towards the task of achievingUniversalHealthCare in thePhilippines.Maramingsalamatpo.

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ACHIEVINGUHCINTHEPHILIPPINES:ANINTERNATIONALPERSPECTIVE

ByProf.KonradObermann,MDSeniorLecturer,MIPHMainheimInstituteofPublicHealth,HeidelbergUniversity

INTRODUCTION

A German medical doctor and an economist with morethan 25 years’ work in clinical care, research, strategicplanning and consulting. His focus is on internationalhealtheconomics,healthsystemdevelopmentandhealthcare financing/social health insurance, as well asempiricalheathsystems.He has broad national and international consultingexperience, in-depththeoreticalandpracticalknowledgeon health systems and hospital care, health carefinancing, social protection, andpolicy applicationswithmore than 15 year experience in internationalcooperation in non-European countries. His project andteaching practice covers more than 20 countries inEuropean, Northern Africa, Sub-Saharan Africa, Central,SouthandSoutheastAsia.He is a senior lecturer at MIPH Mannheim Institute ofPublicHealth,HeidelbergUniversity.

Prof.KonradObermanntalkedabouttheinternationalperspectiveofPhilHealth’sjourneyanddevelopment - ideas todigdeeper,wherePhilHealthcan learn fromothercountries’successfulexperiencesandmakeitevenbetter.The UHC Cube shows national averages and disparities in coverage. In order for thepolicymakers tohavean ideaofwhat’sgoingon, themore importantaspectsof theUHCCubewerehighlightedandareas follows:regions,socioeconomicstatus,howpeoplefeelwithrespecttobeingcoveredhavingtheservices,andnothavingtofearfinancialproblemsduetoaccess inhealthcare.This issomethingthatseveralcountriesstruggle togetdatafrom.On the brighter side, PhilHealth has covered 92%of the Philippines’ population and thevast majority are indigents. Also, premiums, incomes and assets are rising. ThesustainabilityofPhilHealthisstronglyontrack;theywereabletousetherationaleofthebenefitpackages.Finances,on theotherhand,arenotyeta successstory.Firstly,GDP isroughlyat4%andhasnotreachedtheWHOrecommendedtargetof5%.Secondly,thereisstubbornlyhighlevelofOut-Of-Pocket(OOP)expenditureanditremainsabout50%ofthe

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totalexpenses.Nonetheless,PhilHealthhasmovedforwardsince2006butitneedstobringdownthelevelofOut-of-Pocketexpenses,andfromanexternalpointofview,itwillneedtocoveralargerchunkofthetotalexpenditure.

While achieving UHC equitably would require data in different regions, within differentincome quintiles, and ethnicities, status of how good the access, quality, coverage andfinancialhardshipinthesedifferentregionsandincomequintilesshouldalsobetakenintoconsideration.

The Family Income and Expenditure Survey by NSO in 2006 showed 68% of thehouseholds’Out-of-Pocket expensesgo todrugsandmedicine.Themainproblem is thatthe people who cannot afford medicines should be included in their benefit packages.Additionally,accordingtoL.J.RiveraofNAPC(2016),only7outof10poormothersgotohealthcarefacilitiestogivebirthbirthandonly4out10usedPHICcard.AndmotherswithPHIC cards still spend above Php 2,000.00 Out-of-Pocket. This is the reason why poormothersfailtoenjoyPhilHealthbenefits.There are currently 5 UHC studies, namely: Vietnam, Nigeria, Indonesia, Tunisia andThailand, available fromWorld Bank’s Universal Health Coverage Study Series (UNICO),which describe how these countries are working towards UHC. It can identify“mechanisms”ratherthan“programs”likeincentive-giving,rule-following,“howtopassonwisdom” likepeer education, anddetect the contextualdifferences.PhilHealth shouldbecarefulonhowtodoitbecauseonethatworksinothers,maynotworkinthePhilippines.AccordingtoCummingJ.,(2015),localcontext,values,costsofchange,andpoliticalfactorsshouldalsobeconsidered.PhilHealthisinacomplexwebofresponsibilitiesindifferentinstitutionsandconnections.Theseinfluencethecorporation’sabilitiesandlimitations-firstly,theofusetechnologyforleap-frogging. Providing medicines to local government units by using technology onconsignmentattheRHUlevel.Inthisway,itcanbeusedtocheckregularlyifthedoctorsprovidemedicines,ifprescriptionsarebeingusedandtowhomwerethesemedicinesusedforintheRHUlevel.Secondly,PhilHealthshouldhaveacompletesetofdatastructureandsourceswithalistofindicators like inputs, processes, outputs, outcomes and impact.With these information,thecorporationwillhaveacompletepictureofwhatisgoingonwithrespecttotheinputandprocesses,whatcomesoutatthedifferentlevelsandatthedifferentregions,andwhatare their impacts in health outcomes, risk protection, responsiveness and efficiency. Acompleteandcoherentapproachtothiswouldhelpinmovingthisissueforward.Furthermore,thecorporationshouldworktowardsacleargoalwithbetterdata–usingtheBibingka approach: to get data from the top anddata from thebottom, to get data fromLGUs,theoverallgeneraldataandreconcileit.Thereisaneedtoinstitutionalizeanalysis,perhaps a research center for PhilHealth, looking for specific issues concerning socialhealth insurance. This includes identifying key tasks at hand (e.g. balance billing,

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medicines,qualityofcareintheruralareas)andbeingawareofthetargets.Anindicatorasatargetceasestobeagoodindicator.Andlastly,PhilHealthshouldberelentlessintheirInformationEducationCampaign(IEC).Throughthisprogram,alotofcountriescanlearnfromitanditcanbeharnessedforthefurtherdevelopmentofthecorporation.

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THEPHILIPPINES’JOURNEYTOWARDSUHCByMr.RubenJohnA.Basa

SeniorVicePresidentforHealthFinancePolicySector,PhilHealth

INTRODUCTION

A graduate of Political Science from the Ateneo de ManilaUniversity and earned his Masters degree in DevelopmentStudies fromDeLaSalleUniversity.Hewas involved in theHealth Finance Development Project of DOH and USAID(1993-1995) as a Health Policy and Legislative Fellow. Healso served in the Senate as theTechnical StaffHeadof theCommittee on Health and Demography until the signing oftheNationalHealthInsuranceActorRA7875.HeheldvariousexecutivepositionsinPhilHealthsince1997aside from serving as Head Executive Assistant for fourformerPresidentandCEOsofPhilHealth.Currently,heistheSenior Vice President for the Health Finance Policy Sector(HFPS)atPhilHealth.Mr.Basabeganhistalkbyplayingasmallpartofthesong,“I’vegotafeeling”bytheBlackEyedPeas.Heexplainedthat justbyhearingthissong, itmakesus feel that itseems likeyesterday,butitwasactuallybackin2010whenthesongfirstmadeittotheheadlines.HeusedthisasareminderthatalotofthingshavealreadyhappenedtoPhilHealthinthelast6years. He started with a question - “How far have we come in our national insuranceprogramsince2010?”Hestatedthat thesymposium’s theme,“BawatFilipinoProtektadowas a truncation of their vision statement, “Bawat FilipinoMiyembro, BawatMiyembroProtektado and that the first part of his presentation is actually anchored on these twophrases..The Philippine’s current situation describes all employees of both private and publicsectors to have beenmandatorily covered by PhilHealth.With this, there are 29millionFilipinos from the employed sector, and about 1.6 Million Overseas Filipino Workers(OFW) that are currently covered as PhilHealth members and dependents. OFWs arerequired to enroll in the National Health Insurance Program before their deploymentabroad.Ontheotherhand,thereare46.5millionmemberscoveredintheindigentsector,which is far fromtheoriginalnumbersofenrollmentback in theyear2000 to2010.Mr.Basa shared that in the early years, the indigent programwill always be heardwith theword“marketing”astheywouldhaveprogramspreviouslycalled,“Enrollone,getone”and“Enrollaquarterandyou’llgetlockedintheremaining3quarters.”Butalothaschangedinthelast6years,astheRepublicAct10351ortheSinTaxLawwasenacted,whichprovidedthefundingfortheNationalHealthInsuranceProgram.Thiswasthe first earmarking provision for the health sector and a big portion of it goes to the

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enrollmentintheNHIP.In2010,theGAAprovidedonlyPhp5billionfortheenrollmentofthe indigents.Theactual remittancewasonlyPhp2Billion for thatyearcompared to thePhp37 Billion for PhilHealth indigent program in 2017. Hementioned that there was awindfallof contributions from thenationalgovernmentbecauseof theSinTax revenues.Withtheproceedsfromsintaxes,PhilHealthwasabletotriplethenumberoftheindigentsfrom5.2millionto15millionfamiliesatapremiumofPhp2,400perfamily,doubletheratein2010.Inadditionto indigents,PhilHealth isnowable tocoverallseniorcitizens in thecountrythroughRepublicAct10645.Todate,7.6millionseniorcitizensarecoveredandabout2.1millionlifetimemembersintheprogram.Mr.Basapositively thensaid inhis speech that theywereonly talkingabout15%of thepopulationwhoarenotyetcoveredbythenationalhealthinsuranceprogram.Forthisyear2017 and for the first time as mentioned, the National government provided P3 billionadditionalintheGAAfortheenrolmentofthosewhoarenotyetcoveredbytheprogram.Insummary,itwasawindfallofP53billionfromtheGAAforPhilHealthcoveragein2017.SincePhilHealthhasalreadycoveredabigchunkofthepopulation,issuesofmembership,enrollment, and coverage have always been addressed. He then went on discussing thestatement,“BawatFilipinoMiyembro,”withanagendaofensuringthesustainabilityoftheNationalHealthInsuranceProgramandfocusedontwothings.First,theenrolmentforthepremiumsfortheemployedsector- theyneedtoensurethat theiremployersarepayingthe right premium contributions, paying for all of their employees, and paying for eachmonth of the calendar year. Secondly, the need for PhilHealth programs to reconsiderpremiumasanentryforenrollment–itwasreiteratedthatPhilHealthpremiumisnotjustusedbecauseoneiscoveredbutalso,theymustbestarttoconsiderthatpremiumsshouldbethegatewaytobenefits.Theywouldonlybeabletoincreasetheirbenefitsiftheyhavetherightlevelofcontributionsandforthelongesttime,theyonlyhave1singularpremiumschedulefortheindigents,whichtheydidthesamefortheseniorcitizens.Hethenuttered,“I think it’s about time that PhilHealth differentiate contributions according to differentclassifications.Again,PhilHealthpremiumsasthegatewaytobenefits.”For the 2nd part of his presentation, he then concentrated on the statement, “BawatMiyembroProtektado.”Thefinancialstatementbytheendof2016showedthatPhilHealthpaid about P94 billion in benefit payments and this does not include the P6 billion inapprovals.Iftheyhaveincludedtheactualbenefitpaymentandapprovals,thentheywouldhave paid 100 billion last year alone. Hementioned that 6 years before, when the year2009ended,PhilHealthpaidP24billioninbenefitpayment.IttookPhilHealth13yearstopayP24Billion andonly6 years to pay for thenextP75-76billion in benefit payments,excludingthe2yearsfrom1995to1997,asPhilHealthonlyassumedMedicarefunctionsinthelatteryear.He introduced the PhilHealth’s new benefit alphabet for 4 years. He explained that theyshiftedfromFee-For-Service(FFS)toallcaserates.HistoricallyfromthetimeofMedicare,theywerepayingthroughpeopleserviceshiftingfromfirst23caseratesin2011thentoall

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case rates in 2014. Then they presented the Z benefit for real catastrophic conditionsfollowed by the introduction of KT, PD, MORPH, VSD, TOF, and CABG. With this, theyshowed15ZbenefitpackagesthatpayasmuchasP600,000percase.TheyalsolaunchedtogetherwiththeACRandtheZ,thatallindigentsareentitledtoNBBandexpandeditfrompreviousP300perfamilytoP500perfamily.Despitethispayment,theyhavequadrupledtheirpaymentsforthelast6years.TheystillneedtoaddresshighOOPashighnumbersofFilipinosfaceimpoverishmentinfaceofcatastrophicspending.Asidefromthat,theyhavetoaddresstherelativelylowsupportvalues,themismatchbetweenwhatPhilHealthpaysandwhat themembers actually need, and thatmembersneed to get hospitalizedbeforetheygetreimbursements.For the last part of his talk, he said that PhilHealth is working towards their benefitsaccording to the burden of disease. They would want to have benefit package, whichcorrespondstowhattheirmembersactuallyneed.TheyalsowanttoensuretheNoBalanceBillingforcertainaccommodationswithmaximumcopayforallothers.Theywouldliketoaddress thedisease ineach lifestagesandtheywould like toprevent themajorcauseofhospitalizationsasthechunkofthePhilHealthreimbursementsarefromdiseasesthatcanactuallybepreventedinanearlystage.Also,theywantahealthfinancingsystemthatwillboost referral system. Lastly, their PhilHealth benefits will provide fair providermechanismtotheproviders.Withallofthesevisions,theyareoptimisticthatPhilHealthwoulddelivertheirpromiseby2020,“Kalusugannglahatsigurado”

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ACLOSERLOOKATTHEUHCCUBE

AsPhilHealthcelebratesits22ndanniversary,itsthemeof“BawatFilipino,Protektado,”isaresoundingcryoftheNationalHealthInsuranceProgram’sdedicationofturningUniversalHealthCare(UHC)arealityforthecountry.In fact, the Philippine Health Agenda for 2016-2022 has made, “All for Health TowardsHealthforAll”asitsthrustinitscampaignforachievingUniversalHealthCareforall.Ithasthree guarantees: (1) “angbawatPilipinoaymaykarapatanat kakayahannamanatilingmalakas at malusog,” (2) “mapaglingkuran ng may respeto at dignidad sa lahat ngpagamutan,”and(3)“mabigyanngangkopnaserbisyongkalusugannahindimaglulugmoksa kanya sa lalo pang kahirapan or paghihirap.”All of these can be summarized as thegovernment’s promise as stated, “sisiguraduhin ng pamahalaan na ang lahat ng Pilipino,una na ang mahihirap, ay makakatanggap ng angkop at may kalidad na serbisyongpangkalusugansaanumangorasatantasngpangangailangan.”Universal health coverage (UHC) is fundamentally about equity – all people are coveredwith needed health services (promotion, treatment, preventive, rehabilitative, andpalliative) and available at all levels of the health system. UHC ensures that all peopleobtainthehealthservicestheyneedwithoutsufferingfinancialhardshipwhenpayingforthem.Hence,financialriskprotectionisanimportantcomponentofUHC.TheafternoonsessionswilltakeacloserlookattheUHCcubewhichisoftenrepresentedinthree dimensions: population coverage (or breadth), package and extent of servicesprovided (or depth) and level of financial protection or proportion of costs covered (orheight). Discussionsshall focuson thecurrent reforms in thehealthsector in improvingaccesstoqualityhealthservices,increasingrecognitionofsharedresponsibilityamongkeyplayers, and having a holistic approach of integrating public finance management withhealthreforms.Alloftheseareimportantaswemovetowardsachievinguniversalhealthcoverage(UHC).

WHATANDWHERE?DefiningtheContinuumofHealthCareServicesandDeliveryNetworks

INTRODUCTION

ThepathtoUniversalHealthCarehasthreedimensionstoconsider:(1)thebreadthorthepopulation,whichanswersthequestion,whoiscovered,(2)theheightorthedirectcosts,whichdealswiththeissueoftheproportionofcoststobecovered,and(3)thedepthortheservices,whichposesthedilemma,whichservicesarecovered?Thispanelwillparticularlyzoominononedimensionofthecube,particularly,thedepthoftheUHCcube.Thespeakersandpresentationsinthissegmentputthingsintoperspective;flesh out the real health needs of Filipinos and discuss how the health care systemwill

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addresstheseconcerns.Inhere,peoplewillseehowtheservicesareprovidedandwheretheywillbeprovided–themaintopicsherearetheservicesandtheirprovision.ThefirsttopicdealswithLifeStageApproachandillustrateswhatparticularbenefithealthpackages Filipinos need as they age and grow old. The next topic talks about ServiceDeliveryNetworksandhowthesesystemswillmakearrangements in thedeliveryof theprescribed interventions. Then, the following presentations highlight the BenefitPrioritizationProcessandemphasizethemostburdensomediseases,andhowrefocusingand prioritization on these can be addressed by a functional, responsive and equitableprimary health care network. The discussant shall share the thoughts and opinions ofPhilHealth’sclients,assherelatesthepersonalexperiencesofpatients.

MODERATORDr.TessaTan-TorresEdejerCoordinator,UnitCosts,Effectiveness,ExpenditureandPrioritySettingWorldHealthOrganizationShegraduated from theUniversityof thePhilippinesCollegeofMedicine and did her residency in Internal Medicine andspecialization in Infectious Diseases at the Philippine GeneralHospital. She has a Masters of Science degree in DesignMeasurement and Evaluation from the McMaster University,Ontario,Canada.SheusedtobemyChairmanintheDepartmentofClinicalEpidemiology,UPCollegeofMedicine.AndmyotherChairman,currentChairman,Dr.MarissaAlejandriaisalsothereontheside,andtheyarebothInfectiousDiseasespecialistsDr. Edejer is the coordinator of the unit on Economic Analysisand Evaluation in the Department of Health Financing andGovernance,World Health Organization in Geneva. She has ledtheunitformorethan15yearsandhasmanagedthecoreworkofWHOoncosting,cost-effectiveanalysis,economicburdenanduntil recently, health accounts and priority setting. The unitproduces technical guidance on these areas ofwork, generatesdata including those in theGlobalHealthExpendituredatabaseand theCHOICE(choosing Interventions thatarecost-effective)database and provides technical assistance to countries. The unit is now also in-chargehealth technologyassessmentand theglobalmonitoringofuniversalhealthcoverage fortheSustainableDevelopmentGoals.

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INTRODUCTIONOFTHERESOURCESPEAKERSDr.MariaOfeliaO.AlacantaraHealthPolicySpecialistDepartmentofHealthAmedicaldoctorwithmore than20yearsofexperiencein public health service. She headed the ForeignAssistance CoordinationOffice (now ILED) in PhilHealthandwas theHeadExecutiveAssistantof thenPhilHealthPresident&CEODr.FranciscoDuqueIII.A health policy specialist, engaged with severaldevelopment partners. She is currently a consultant oftheOfficeoftheSecretaryoftheDepartmentofHealth.SERVICEDELIVERYNETWORKSByDr.EnriqueTayagDirector IV, Bureau of Local Health SystemsDevelopment,DepartmentofHealthHe isaphysicianwith training in infectiousdiseasesandfield epidemiology. He occupied various leadershippositionswhenhemovedtoDOHin1998.HeisMemberof the National Board of National Union of CareerExecutive Service Officers, a renowned organization ofgovernmenttechnocrats.His interviews in all media on public health issues hadpreparedhimwell inbecomingtheOfficialSpokespersonoftheDOHsince2005.He is currently Assistant Secretary Designate andconcurrent Director IV at the Bureau of Local HealthSystemsDevelopmentoftheDepartmentofHealth(DOH).

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BENEFITPRIORITIZATIONPROCESSByDr.JohnWongCEO,Epimetrics,Inc.HeobtainedhisdegreeinmedicineandMasterofScienceinEpidemiologyfromtheUniversityofthePhilippines.He is the CEO of Epimetrics, Inc., an institution gearedtowards the achievement of health equity through rigorousandcreativeresearchconception,execution,translation,andcommunication. He was recently awarded the 2016 RouxPrizebytheInstituteofHealthMetricsandEvaluationattheUniversity of Washington and which is what he will bepresentinginthissession.He currently sits in the DOH Formulary Executive Council(FEC) and also a lecturer in Ateneo de Manila School ofMedicineandPublicHealth.BENEFITPRIORITIZATION:PRIMARYCAREByAnthonyLeachon,M.D.FPCP,FACP,IndependentDirectorofPhilHealth,RepresentativeoftheMonetaryBoardHe isan internistandcardiologist. HeobtainedhismedicaldegreefromtheUniversityofSantoTomas(UST)FacultyofMedicineandSurgery.Heisknownasanactiveleaderandahealthreformadvocate-aleadproponentofthegovernmentandcivilsocietyinthepassage of sin tax law for tobacco and alcohol andintroducinginnovativeconceptsforunhealthydietinforourhealth care system. He has been recognized for authoringExecutive Order No. 595 - Health Education Reform Order(HERO),whichremainsthelargestphysician-ledadvocacyoncomprehensive health education and disease prevention. AformerPresidentofthePhilippineCollegeofPhysicians, thecountry’s premier organization of internal medicinespecialists.HecurrentlysitsasanIndependentDirectoroftheBoardofDirectorsofPhilHealth.

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DISCUSSANTMs.KarenIdaVillanuevaPhilippineAllianceofPatients’OrganizationsA graduate of UP Diliman BS Business Administration,CommunicationsandHealthPolicy.A former member of the Board of Directors of PhilHealthandChairofitsBenefitCommittee.Shewasawardedasoneof the 100 Most Influential Filipino Women 2016,Innovators and Thought Leader Category by the FilipinaWomen’sNetwork.She successively headed the communications and externalaffairsofficeofpharmaceuticalcorporations,namelyZuelligPharma,Pfizer andMerckSharpandDohme from1994 to2015. Currently, she is the president and managingpartner of Health PRX communications, a group ofprofessionals from the communication, healthcare anddevelopment sectors aiming tomerge various engagementplatforms to help craft solid solutions to Filipino people’shealthissuesandconcerns.SheisalsotheTreasurerofThePhilippineAllianceofPatients’Organizations(PAPO).ThePAPO represents at least one million patients nationwide. It is a coalition of patientorganizationsadvocatingforuniversalaccesstohealthcareandalliedservices.WeaimtoempowerFilipinopatients,includingpersonswithdisabilities(PWDs),througheducation,networking,policyadvocacyandcapacitybuilding.

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SYNOPSISOFPRESENTATIONS

LIFESTAGEAPPROACHByDr.MariaOfeliaO.AlcantaraHealthPolicySpecialist,DepartmentofHealthThere aremany challenges facing the Philippine health care system, such as the lack ofgatekeepers toensure theprovisionofhealthservicesand thebackslidinghealth indicesthatreveal thestagnant,andperhaps thedeterioratingqualityofhealthamongFilipinos.TheseareallunderminedbythelackofcommitmenttoachievetheunattainedMillenniumDevelopmentGoals(MDGs)andthenextSustainableDevelopmentGoals(SDGs).But thegoodnews is, theseplaguingproblemspresentasanopportunity forchangeandimprovement.AndthatiswhatthePhilippineHealthAgendahopestoaddressinitsthreeguarantees.Firstisuniversalcoverage,whichisamandatoryordertoincludeallFilipinos.NextistheuniversalNHIP,whichaimstoincreasebenefitdeliveryratesandreduceOOP.Andlastisuniversalhealthcare,whichisanendinitself.MostFilipino familiesoverlooktheprimary levelofcareandprefer togo immediately tothehighestproviderofhealthservices,thetertiarylevel.Thisbehaviorisgroundedonthebeliefthatthesefacilitieshavethebestandmostcomprehensivelevelofcare,whichisverycostlyonthepartofthepatients.Andifeverybodygoestothetertiarylevelofcare,thenthiscreatesbottlenecksandpeoplehavetoqueueinline–leadingtofurtherdissatisfactionin service. Hence, there should be proper mapping to the nearest provider of healthservicessothatpatientscaneasilynavigateandseekearlymedicaltreatment.So thereshouldbeemphasisonaprimarycaresystemthat is functional, responsiveandequitableatthelocallevel.Morethanensuringgatekeepersatthesecriticalpointsofcare,servicesshouldalsoshifttoasystemicapproach,soastoavoidoverlapsinservicedeliveryandpayments.Collectively,withthesupportofboththelocalandnationalgovernment,thePhilippineHealthAgendacanmovetowardsachievingtheFilipino’sprimaryhealthgoals–startingwiththeLifeStageapproachasoneofitsguarantees.TheLifeCourseapproachmeansthatanyindividualacrossthespectrumoflife,fromwombto tomb so as to speak,will receivemandatory benefit health packages such as prenatalcareandimmunization,dependingontheirpresentlifestage.Thisstrategycaterstobothwellandsickpatientsinordertoaddressthetripleburdenofdisease,whichincludesnon-communicable,communicableanddiseasesofrapidurbanizationandindustrialization.Inotherwords,thisguaranteewillfacilitatetheservicesthatFilipinoswillneed-wheretheywillneeditandwhentheywillneedit.TodeveloptheLifeStagehealthcarepackages,acriteriaforinclusionandexclusionmustbedeterminedbasedonpolicies,clinicalpracticeguidelines(CPGs)andexpertopinion.Butmorethanjustsimplyidentifyingtheneededservices,thesemustbecost-effective,notjustintermsofcost,butmoreimportantly,intermsofearlyharvest.Allofthesemustbebased

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onmost commoncomplaints and conditionsofpatients, and topburdenofdiseases thatcanbecomecatastrophic.Inshort, thedifferent lifestages frompregnancy toelderlywillneedvariouspopulation-and individual-based services, depending if one is sick or well. The population-basedservices will primarily focus on surveillance and monitoring, prevention and control ofepidemics, and quality protection and accessibility. Basically, they are the systems thatensureservicesarebeingprovided.Ontheotherhand,individual-basedinterventionsaretailoredtothepatient’sneeds,dependingifoneiswellorsick.Thebasicrequirementsareagoodhistoryandphysicalexamination,butitmayrequirefurtherlaboratorydiagnosticsandtreatmenttomanagetheirillness.Asawhole,thelifestagesthatapersongoesthroughare covered from the mandatory and specialized services provided in order to achievebetterhealthoutcomes.TheguidelinesfortheinstitutionalizationofprimaryhealthcareguaranteestoallFilipinosfollowastep-by-stepprocess.Thehealthcaresystemneedstodefinewhat interventionsare needed by patients, taking into consideration safety, household financial impact andsocialacceptability.Theseserviceswillbereviewedbyahealthguaranteegoverningboard,composedof leadersandexperts inthefieldsofpublichealth,clinicalpracticeguidelinesandformulariesthereafter.Andfinally,thepaymentmechanismandfinancingagentshallbeidentifiedinordertodeterminethechannelsforfunding.All in all, the basic package of the Life Stage approach is dedicated to all Filipinos,mostespeciallytothepoorwhoarepronetocatastrophicillnessesandpayments.Hence,allthestakeholders must ensure the operationalization of providing these services. Everyone,includingtheDepartmentofHealthandLGUs,needstoworktogethertomakethePHAandtheGuaranteeONEareality-toensureuniversalhealthcoverageandprotection.SERVICEDELIVERYNETWORKSByDr.EnriqueTayagDirectorIV,BureauofLocalHealthSystemsDevelopment,DepartmentofHealthServicedeliverynetworks traceback its roots tomore than20yearsagowhen the localgovernmentcode(RA7160)waspassed.Thismandatepassedtheautonomyandauthoritydowntothegrassrootslevel,givingmorepower,responsibilitiesandresourcestothelocalgovernmentunits.Thisdividedthesystemfromanationalgovernmentdowntodifferentadministrativeentities,fragmentingthehealthcaresystemtoprivateandpublichealthsubsectors,andmultiplepayersandpaymentmechanisms.But the Philippine Health Agenda (AO 2016-0038) paved theway to the futurewhen itguaranteedallFilipinosequitablegeographicandfinancialaccesstoqualityhealthservicesacrossdifferent levelsof care. It redefinedservicedeliverynetworksasmandatory,non-prescriptive and adaptable, creating a network of organizations that provided andmadearrangements for equitable, integrated and continuous health services to a defined

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population.Thegoalwasnotjusttodeliverbettermedicalservicesbutrather,thepurposewastoprovidebetterhealth.Themainobjectiveistodevelopandenhancecurrentandfutureservicedeliverynetworksbecausetheassumptionis thattheyarealreadyinexistence.Theupgradeswill includeafocusonprimaryhealthcarethatmaximizesparticipation,sensitivetothedisadvantaged–namelythepoor,marginalizedandvulnerable.Andmostimportantofall,thesystemmustfocusontheneedsofthefamilyandcommunity,notjustthedisease.Thenetworkwillbemadeupofthreemajorcomponents.Thefirstcomponentiscomposedofprimary care servicesareas thatassignhealth careprovidersasgatekeeperswhowillrenderservicesattheBarangayHealthStation(BHS)andRegionalHealthUnit(RHU).Thenextcomponentincludestheintermediateservicefacilitieswithcapacitiesforsubspecialtyandcriticalcare.Andthe lastcomponentcompriseof theapexhospitals thatwilldeliverspecialized services not available in the lower levels. The catchment area will bedeterminedbytheproximityofthepopulationratherthanthegeo-politicalboundaries.And these service delivery networks shall bemanaged by governing boards at differentlevels–attheregionallevel,theprovinciallevelandatthemanageriallevel.Thesewillbesustained by funds coming from the national and local government budgets, a commonhealthtrustfundandashiftfromfacility-basedpaymentstonetwork-basedcontractingbyPhilHealth.Theservicedeliverynetworkswillalsoserveasameanstoassessandmonitortheindividualandpopulationlevelstoassistinplanningandserviceprovision.Itwillalsoutilizethehealthinformationsystemforreferralsandmonitoring.TheseareallguaranteedbecauseFilipinosareentitledtoinformationandeducation,serviceandcostcoverage,andmostimportantofall,coordinationofcare.In short, the ServiceDeliveryNetworks assures the following, “SapamamagitanngSDN,angbawatPilipinoaymakakatamasaomatatamasaangmabisaatorganisadongugnayansapagitanngmgapasilidadpangkalusugan.Malinawnadaloyngreferralmulasabarangayhanggangsamalakingospitalngrehiyon.Maysiguradongtransportasyonatkomunikasyonatmay siguradong pagtanggap ng pasyente saang kang pasilidad pangkalusugan ayon saantas ng kanyang pangangailangan. Responsibilidad ng bawat isa sa atin, na ang bawatPilipinoaymayresponsibilidadnamagingmiyembrongPhilHealthatalaminangkanyangmgakarapatanatugnayansamgaitinilaganaServiceDeliveryNetwork.”BENEFITPRIORITIZATIONPROCESSByDr.JohnWongCEO,Epimetrics,Inc.Looking back at the UHC Cube, PhilHealth needs to fill the entire volume of the cube inordertoachieve“ideal”UHC.However,PhilHealthisstillbehindintermsofreducingcostsharingandfeesasOut-of-Pocketexpendituresstillremainhigh,andintermsofprovidingservices that Filipinos actually need. The reasons for these shortcomings are the lack of

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standardizedprocessesandstandardsofcare.Assuch,thepresentcaseratesarenotabletocoveralloftheexpenses.Hence,theBenefitPrioritizationProcesswasdeveloped,asastudy for PhilHealth, funded by Unicef, aimed at identifying the services needed by themembersofPhilHealth.Toputthingsintoperspective,thebenefitpayoutofPhilHealthhasbeenincreasingto8%of Compound Annual Growth Rate (CAGR). However, despite the growing payouts, themoney is not spent wisely due to amismatch between the top 10 claims of PhilHealth,whichrepresentsalmost40%ofpayouts,andtheburdenofdiseasethatpatientsactuallyface.Attheveryleast,only3conditions,namelypneumonia,strokeandroutineobstetriccare,matchbothlists,whichmeansthatfundingarenotallocatedappropriatelytoaddressthemajor illness plaguing its members. These are rooted to issues in lack of focus andprioritization,unequalaccessandlackoftransparency,anduncertaincostcoverage.Overall, the study has three main recommendations. First, PhilHealth should develop apackageofguaranteedhealthbenefitsforallFilipinos,basedonthehighburdenofdiseasesand cost-effective interventions. Information from the Institute of Health Metrics andEvaluation (IHME) show that only 48 out of 200 diseases already represent 80% of theDisability Adjusted Life Years (DALYs), most of which are non-communicable diseases.Therefore,morefocusandattentionshouldbegiventothiscategorysothatthedevelopedbenefitpackagesbecomemoreappropriateandresponsive.Andtheapproachtothistwo-fold;oneistospendmoreinorderimprovecostcoverageandreduceOOP,andtheotheristospendwiselysoastomaximizeoutcomes.Second, the corporation should have an explicit prioritization process based on a set ofstandardized criteria to guide decisions on coverage. This is done through extensiveresearchandconsultationsthatstartswithacomprehensivereviewofliterature,followedby focus group and round table discussions with experts and finally, validation andfeedback from stakeholders. All of these should be grounded on the principles of ethics,inclusion and preference to the underserved, scientific rigor, transparency andaccountability,efficiency,enforceability,availabilityofremediesanddueprocess.Andthird,thispriority-settingprocessshouldbecomplementedbytheHealthTechnologyAssessment (HTA) tool to guide coverage decisions as required by law, found inImplementingRulesandRegulationofRepublicActs(IRR),Sec76.Thistoolwillmakeanimpactnotonlyinclinicalandcosteffectiveness,butalsointermsofethics,budgetimpact,societal impact and safety. In the long run, this aims to determine cost-effectiveinterventionsthathavetheleastcostsbutthehighestoutcomessothatPhilHealthwillbeabletomaximizeitsresourcesandfundmoreprogramsinthefuture.Allinall,theBenefitPrioritizationProcessaimstoprovidefinancialsupporttoallFilipinos,prioritizingthemostburdensomediseases–inordertoprovideanddeliverthebestcareforthepatientatthebestprice.Andthiscanbeachievedbydevelopingguaranteedhealthbenefits based on the burden of disease while covering the most cost-effectiveinterventionsatthepropercosts.Thiscanbesupportedbyeffortsindesigninganexplicit

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and transparent priority setting process that consists of interventions not found in theGHBP,andinutilizingtheHTAtodeterminecost-effectiveinterventions.BENEFITPRIORITIZATION:PRIMARYCAREByAnthonyLeachon,M.D.FPCP,FACP,IndependentDirectorofPhilHealth,RepresentativeoftheMonetaryBoardThe sad reality is that almost half of the deaths among Filipinos are not attended by amedicallytrainedprofessional.Infact,asonesetsoutfartherawayfromthecity,thelesslikelythattheywillbeseenbyadoctor.So,despitetheprogressthatPhilHealthhasmadeinacquiringthefundsandsettingupthebasichealthfacilities,UniversalHealthcarefailstoberealizedwithoutthemuchneededmanpower.There is a chronic healthcare workforce shortage as the country faces an exodus of itsdoctors and nurses. Health care workers are leaving because of unemployment,underemployment, misemployment, and unjust working conditions because ofpoliticization of appointments and non-issuance of benefits. And this overwhelms theremaining health allies because they undermanned with 2.3 health care workers per10,000population,ascomparedtotheidealratioof24.Atthesametime,Filipinosarenotreceivingthebestlevelofcarebecauseofthemismatchbetween the top conditionspaidbyPhilHealth and thepriority of health conditions thatbefall itsmembers.Due to thisdiscrepancy,payoutsareallocated tocostly interventionsandOOPspendingstillremainshighat57%,puttingmorestrainonthepoor. Infact, thepoorestquintilehas the lowest levelofPhilHealthutilizationat33%,ascomparedto the80%usageofthehigherincomequintiles,duetothefinancialburdenbroughtbytheamissintreatmentinterventions.Thepoorcannotaffordmedicaltreatment.ThisdilemmahasbeenpartiallyaugmentedbythepassageoftheSinTaxLaw(RA10351)last December 20, 2012. Aside from discouraging Filipinos from engaging in hazardousvices–leadingtolesssmokersandavertingatleast70,000deaths,thebillhasalsobroughtinadditionalfundingtotheNationalHealthBudget.Infact,in2016,theSinTaxRevenuesforHealthamountedtoP69.4million,80%ofwhichwasallocatedforuniversalhealthcareexpenditureandtheremaning20%formedicalassistance,drugsandpublicutilities.To review, the Philippine health system wants to establish a solid primary health caresystem.Butasmentioned,thereisadiscrepancybetweentoolittlecareintheruralareasand toomuchcare in theurbanareas.While the fundshave increased, theserviceshavedeteriorated – there is still inequity in human resources. Primary health care requiresgatekeeperswhowillactasthefirstcontactofpatients,providingcomprehensivecareandifneeded,coordinatingdiagnostics,treatmentsandreferralstospecialistsattheprincipalpointofcare.Inordertoarriveatthesereforms,thehealthcaresystemshouldrememberthefiveRs.

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• Recruit-Recruitmedicalpractitionersinboththepublicandprivatesector• Rertrain-Retraintheminprimarycarefocusingonthetopburdenofdiseaseand

healthnavigation• Retain-Retainitsmembersbyshoulderingthecostsofoutpatientcareaswell• Regulate-Regulatetheworkforceandfacilitiesforqualityandaccreditation• Reassess - Reassess the quality of care and health that Filipinos are receiving,

primarilythroughreducinghealthexpensesandOOPAllinall,thegovernmentshouldnotjustfocusonthepatients;theyshouldalsotakebettercare of the health workforce so that they will stay and provide quality service to theFilipinopeople,whichisvitalinachievinggenuinehealthcare.

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DISCUSSIONLedbyMs.KarenIdaVillanueva

PhilippineAllianceofPatients’OrganizationsQ1(Ms.KarenIdaVillanueva):First,Iwouldliketoaskaboutthelifestageapproach.We’reenvisioningasystemwherein it’sno longeraverticalandprogrammaticapproach.Howdowe envision the bureaucracy, particularly the Department of Health, to go beyond theseprogramsandaligntheworkthattheydotowardsthisveryambitiousapproach?A1(Dr.MariaOfeliaO.Alcantara):IthinkIwouldanswerthatin3levels.Thenationallevelwillwork on setting the standards andwith the prioritization as one of the key factors tohave, determine what are the basic services in the life stages? So the national level willdevelopstandardsandpolicies.Andsecondis,howwillthisbeimplemented,whichisactuallyaddressed by the SDN, which is non-prescriptive bottomline. The services that are beingprovidedormakingarrangementsat the facility, family,community-levels, ‘yun ‘yungthird.ButI’lladdpatheoneaboutsustainingthestandardstobeimplementedinanSDN,whichisaveryimportantintervention,andthatiswhoispayingwhat?AndthatbecomesabigpiefortheNationalHealthInsurance.Icansaythatitisanoverwhelminginterventionorguaranteethatmaynotbeimmediatelyresponded or attained. But at this point in the process, we are not just discussing at thenationallevel,weareinvolvingthelocalgovernmentinthediscussiontocomeupwithwhatservicesshouldbepartofthatlifestageapproachservices.Q2(Ms.KarenIdaVillanueva):Intermsoftimeline,howquicklyarewegoingtorolloutthepackages, that’sone;andhowdowe influence thebehaviorof theproviders so thatwegetthemtoparticipateintheservicedeliverynetworkinacost-effectiveand,becauseIhaveseenhow there’sa lot of inefficiencies in the system,a lot of fraudaswell, and the fact thatwedon’treallytakemajorityofthehealthexpenditures,howwillgovernmentenforcethatkindofbehaviorunlesswespendmoreorregulatemore?A2(Dr.EnriqueTayag):Karen,thankyousomuch.Firstofall,theservicedeliverynetworkisnon-prescriptive.There’salreadyanassumptionthattheyalreadyexistandweareworkingona scenariowhereinwearegatheringevidence throughmodel servicedeliverynetworks.Andweareconfidentthatthisservicedeliverynetworkhavepathwaysonhowtheycanmakesurethatprovidersareencouragedandbepartofthenetworks.Nowwhenwepresented this to SecretaryUbial, shewas repeating this important scenariowherein the private sector will have to have a big stake in the service delivery networksbecausetheycanfillinthegapsintheservicedeliverynetworks.Exactlyhowwe’regoingtotackle the timeline, right now, the different regions have submitted to us various modelservicedeliverynetworks.We’regoingtohavearegistryofservicedeliverynetworksthisyear-yes,aregistryofservicedeliverynetworks.Anyonecanaccessitsoyoucannavigatethroughthenetworks.We’regoingtohaveamonitoringandevaluationtoolsothatwecantracktheprogress.Wearelookingatthisyearthatupto8-10%willhaveservicedeliverynetworksand

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it’goingtohappen.8-10%ofeachregionsoforexample,thisyear,becausetherearealreadyexistingmodels,theywillhavereconfiguretheratelimitingstepisactuallytheestablishmentorcreationofgoverningboards.That’swhyourtargetisonlyupto10%.Q3 (Dr.TessaTan-TorresEdejer): I actuallyhaveaquestion from theaudience. It’s a longquestionbutit’salongthatsameline,whichis…whyitisthat,PhilHealthhastriedtodomanythings, including fast track payments of claims, increase the support value, simplify thepaymentmechanism,andtheyhavetriedtoimprove-theproblemheissayingisthatthereisstill a lot of out-of-pocket expenditures and so how can we, i think it’s a very importantquestion, how canwe inculcate thehippocratic oath tomedical professionals to encourageand practice medical and ethical standards. And he… I have to say this because this ispersonalplea, Ihopewecandosomethingabout theseconcerns. Ifwecan’taddress this inthesemeetingsorthissymposium,thenwewillhavethesameorsimilarorrecycledconcerns.Thisisaveryheartfeltcommentandoneofthethingsthatthey’reconcernedaboutisoutofpocket expenditures and to a large extent, this person is putting, based on what he issuggesting, a question aboutwhy are the physicians charging… I don’t know how you candescribethisbuttheirchargesarecausingalotofoutofpocketexpenditures.A3(Hon.AnthonyLeachon,MD): Intermsonthetimeline,basedontheRepublicAct10606,thiswilladdresshumanresources,health financingandpublichealth.But I think it’snotadynamicpicturebecauseyoudon’thavetheprocessorthetimeline.Tome,theburningissuesare basically on number one, human resources. Because even if you have PhilHealth andeverythingbutyoudon’thavepeople toman, that’saproblem.Number two forPhilHealth,youhaveenormousamountofmoneybutwecannottreatall typesofdiseases.YouneedtouseheretheParetoprinciple,basedonJohnWong’sanalysisthatyouhavetofocusoncertainillnesses,killingthemostnumberofFilipinos.Weneedtoreevaluate10,000caseratesandtrimitdownto250or100,andthenidentifythepublichealthstructuresthatwillneedimmediatecare.Sotome,intermsoftimeline,humanresources,thatshouldbesolvedin1-2years,out-of-pocketexpenditureshouldbesolvedinthenext3years,andthepublichealthinfrastructureshouldbesolvedwithinthisadministration.Soyouhavetoearmarkcertainmoneyforthisparticularhealthstructures.Soinanutshell,thatismysuggestion.Q4 (Dr. Tessa Tan-Torres Edejer): John can you say something about the prioritizationprocessandwhatdoweneedtodoinordertomakesureitwillbeimplementedintermsofthis20-80?WhatdoyouthinkisthemostimportantthingtodoconsideringthatPhilHealthisnow providing a lot of things and still have, described as having, different - pneunonia,hemodialysis, infections and cataracts, how do you shift from that PhilHealth to thePhilHealthwhichactuallyaddressesthe80%oftheburdenofdisease?A4(Dr.JohnWong):Ithinkthemostimportantthingthattheyneedtodo,whichIthinktheyhavealreadystarted,istostartdevelopingthebenefitpackageforthe48diseases.Ifthey’veidentifiedthediseases,theprocessof identifyingtheinterventionsandthenextstepswillbecostingitoutanddecidingonaproviderpaymentmethod.

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SYNTHESISByDr.TessaTan-TorresEdejer

Coordinator,UnitCosts,Effectiveness,ExpenditureandPrioritySettingWorldHealthOrganization

Insummary,PhilHealthhasmadesignificantprogressinachievingUHC,butitseffortshavenottranslatedintoconcreteandfeltgainsinhealthyet–asOut-of-Pocketexpendituresstillremainhighandinequitiesinutilizationremainabound.Despitedesigningbenefitpackagesforeach lifestageandputtingupnetworks forservicedelivery, thehealthsystemstill facesbigchallengesintermsofhumanresources,infrastructureandaddressingtherealproblemoftheburdenofdisease.But the corporation remains confident and hopeful. As PhilHealth celebrates its 22ndanniversary,thepoliticalwillisthere–thehealthsystemhasthebudgetandthesupportofthe national government inmaking UHC a reality. The dream of universal coverage couldhappenverysoon,perhapsevenbefore2022,aslongasthereisprioritizationonthepressingneeds and focus on implementation – translating thought, plans and dreams into concreteand proactive action. Dr. Edejer closes the first panel and rallies the participants with afamiliar resoundingbattle cry from the late former Senator and Secretary ofHealth, JuanFlavier,“let’sDOHit!”

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PROPORTIONOFCOSTSCOVERED:WHOPAYSFORWHAT?SharingtheResponsibilityforFinancialRiskProtection

INTRODUCTION

Themoderator forthispaneldiscussion,Dr.BeverlyHo,startedtogiveagistonwhattoexpect for this part of the symposium. Theywere trying to look at the level of financialprotection that theFilipinosarecurrentlyexperiencing.As theywillbe talkingabout the3rddimensionoftheUHCcubewhichisdepth,theywillbetacklingthecostcoverage.Basically,theywillbediscussinghowmuchisthecostofhealthcarethatisbeingbornebythe patient or the families andwhether it leads them to being poor or for them stayingpoor.

MODERATOR

Dr.BeverlyLorraineHoChief,ResearchDivisionHealthPolicyDevelopmentandPlanningBureauDepartmentofHealthA graduate of UP College of Medicine, with a degree ofMasterinPublicHealth,HealthcarePolicyandManagementattheHarvardT.H.ChanSchoolofPublicHealth.She was an Executive Assistant to then PhilHealthPresident & CEO Dr. Eduardo P. Banzon and soon after aPublicHealthConsultantattheAsianDevelopmentBank.Currently, she is Chief of the Research Division, HealthPolicy Development and Planning Bureau, DOH and parttimeFacultyofAteneoLoyolaSchoolsandanIndependentconsultantofAllianceforImprovingHealthOutcomes,Inc.(AIHO)

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RESOURCESPEAKERS

PHILIPPINENATIONALHEALTHACCOUNTSByMs.RaquelDoloresSabenanoSeniorStatisticalSpecialist,PhilippineStatisticsAuthorityMs. Sabeñano finished BS Applied Statistics andcompleted the academic requirements leading to MSApplied Statistics. She also earned her Master inDevelopmentManagement.She has been in the public service for almost 20 years,specifically in the threemajorstatisticalagencies in thePhilippines - National Statistics Office (NSO), Bureau ofLabor and Employment Statistics (BLES), and NationalStatistical Coordination Board (NSCB), prior to theirmerger into what is now known as the PhilippineStataisticsAuthority(PSA).She is currently the Senior Statistical Specialist at thePhilippineStatisticsAuthority(PSA).SheisthePSAleadtechnical specialist on the compilationof thePhilippineNationalHealthAccountsestimation.Ms.Sabeñanohasbeen involved in theestimationofhealthcarespendinginthecountrysince2002. IMPLEMENTATION OF NO BALANCE BILLING (NBB)POLICYBYALGU-OWNEDHOSPITALByDr.ElenilaI.JakosalemChiefHospital,BisligDistrictHospitalDr. Elenila Irizari Jakosalem is a graduate of CebuDoctor’sCollegeofMedicine. Shehas aMasteralDegreein Community Health and is a Fellow of the PhilippineSocietyofMedicalSpecialist.She is theChiefofHospitalof Bislig District Hospital for more than 2 decades, 27yearstobeexactandjustfinishedherDiplomateCourseinOccupationalMedicine.Under her administration, Bislig District Hospital hasreaped several awards including the Red Orchid Awardfor2consecutiveyears,PresidentialAwardlast2008and

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has been consistently high on itsNBB implementation. This committedpublic servant ismarriedandamotheroftwochildrenIMPLEMENTATIONOFNOBALANCEBILLING(NBB)POLICYBYADOH-RETAINEDHOSPITALByDr.SorayaPesyAbubakarChiefofMedicalandProfessionalStaff,ZamboangaCityMedicalCenterShe is amedicaldoctor, earninghermedicaldegree from theUP College of Medicine. A family physician and adermatologist, she earned her Masters Degree in HospitalAdministrationatUP-PGH.She is a former President of the Philippine Academy of Family Physicians (PAFP), thebiggest organization of primary health care and family medicine specialist in thecountry.Duringherstint,shevisitedthechaptersoftheacademyalloverthecountryandadvocateduniversalhealthcarewithqualityhealthcareforallthroughcontinuingmedicaleducation. She served for three terms owing to her dynamic and active involvement intrainingandcredentialingoffamilyphysiciansalloverthecountry.SheisthefirstFilipinatobecomeelectedPresidentoftheASEANRegionofPrimaryCarePhysiciansAssociation(ARPaC),aspearheadorganizationfortheASEANharmonizationofmedicalstandardizationfortheintegrationoftheASEANHealthCenters.Sheisalsoaneducator-afacultymemberoftheAteneoSchoolofMedicine.Currently,sheistheChiefofMedicalandProfessionalStaffoftheZamboangaCityMedicalCenter.RepresentedbyMs.MichelleLibagoAdministrativeOfficerIVandHealthofBillingandClaimsZamboangaCityMedicalCenterShe graduated with degrees of Bachelor of Science inManagementAccountingandBachelorofLaws.Shehasbeenwith Zamboanga City Medical Center for 12 years now, 9years in the Accounting Section and 3 years as the head ofBillingandClaims.Currently, she isAdministrativeOfficer-IVoftheZamboangaCityMedicalCenter.

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DISCUSSIONByMs.Ma.GildaResurrecionConsultant,NationalKidneyandTransplantInstituteA faculty member of the Ateneo Graduate School ofBusiness:Economics,FinanceandAccounting. SheholdsaMastersDegreeinHospitalAdministration.Atpresent, she isaConsultantat theNationalKidneyandTransplantInstitute(NKTI). AndDr.AlejandroHerrinSchoolofEconomics,UniversityofthePhilippines–DilimanHe was Professor of Economics and Conrado BenitezProfessor of Demographic Economics at the UP School ofEconomicsfrom1978untilhisretirementinJune2004.He specializes in population, health human resource, anddevelopment economics. He has extensiveprofessorial experience spanning 45 years includingteaching, research, providing technical advice tointernational organizations and ministries, and workingwith various government agencies in policy development,programassessments,andcapacitybuilding.HisiscurrentlyaProfessoriallecturerattheUniversityofthePhilippines(UP)-Diliman,SchoolofEconomics.

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SYNOPSISOFPRESENTATIONSPHILIPPINENATIONALHEALTHACCOUNTSByMs.RaquelDoloresSabenanoSeniorStatisticalSpecialist,PhilippineStatisticsAuthorityProfessorinEconomics,UniversityofthePhilippines-DIlimanThe Gross Domestic Product (GDP) rate grew at 9.6% in 2014which is higher than thegrowthrateof9.3% in2013.Among the threemajoreconomicsectors, services fosteredthehighestsharewith57.4%,followedbyindustrywith31.3%andagriculture,hungting,forestry and fishing came last with 11.3% in 2014. With the service sector having thehighestexpenditure,4.6%ofitcamefromthePNHA.Theconceptualframeworkshowncameassimpleandstraight-forwardasthePhilippine’stotal health expenditure is simply the sum of the aggregate expenditures on health caregoods and aggregate expenditures on health care services. But, the question is who ispayingforhealthcare?Thesourcesoffundsarepeopleorinstitutionsthatdirectlypaythehealthcareprovidersor the finalpayer.Under thegovernment: therearenational, local,and government owned and controlled corporations or GOCCs. In the social insurance:there is the national health insurance program or PhilHealth and the employees’compensation.Whilefortheprivatesourceswhicharetheout-of-pocket:thereareprivateinsurance,HealthMaintenanceOrganizations(HMOs),privateestablishmentsandprivateschools.Lastly,thesourceistherestoftheworld.Theusesof fundsaredivided into3 categories. First ispersonalhealth that comes fromgovernment hospitals, private hospitals, other professional care facilities, dental carefacilities, and traditional health care. Second is public health care, which includesexpendituresfromtheDepartmentofHealthprogramsfortheproductionortheprovisionsofbothhealthcaregoodsandserviceswitheconomicexternalitiesthatarecharacterizedaspublicgoods.Examplesofthesegovernmentprogramsarethebreastfeedingcheck,4Slaban sa Dengue, Zika virus, STOP HIV/AIDS, and Oplan Iwas Paputok. And the third isothers,whichisthegeneraladministration,operatingcosts,andresearchandtrainingThe country’s totalhealth expenditure showed improvementbetween2013and2014. Itincreasedby10.4%,fromPhp530BilliontoPhp585Billion,respectively.Atconstant2006prices, total health expenditures rose by 6%. The Per capita health expenditure in thecountryroseby8.5%fromPhp5,400in2013toPhp5,859in2014.Ontheotherhand,percapitahealthexpenditureincreasedby4.2%atconstant2006prices.ThedistributionofHealthexpenditurecanbecomputedbythisillustration-assumingthatonehasPhp100astotalhealthexpenditure,thisamountwillbedividedasfollows:fortheprivatesources-Php68,forthegovernment-Php17,forthesocialinsurance-Php14,andfortherestoftheworld-Php1.Onecantakenotethatundertheprivatesources,theout-of-pockethasthehighestsharewithPhp56comparedtotheotherprivatesourceswhichisonlyPhp12.

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In this example, it only shows that Filipino households continue to carry the heaviestburden for spending for theirownhealthneedsas they still contributewithhighout-of-pocketpaymentsaccountedfor56%oftheTotalHealthExpendituresin2014.Out-of-pocket(OOP)spendingiscontinuouslyrisingovera10-yearperiod.TheOOPgroupincreased from Php 115 Billion in 2005 to Php 327 Billion in 2014. This is an averageannual increase of 12.40% at current prices. However, OOP as percentage of the TotalHealthExpendituresdidnot fluctuatemuchovertime.TherewereonlyslightmovementswiththeshareofOOPhealthexpendituresandothertypeofhealthcareintheTotalHealthExpendituresfrom2005to2014.TheshareofOOPhealthexpendituresrangefrom52%to58% while the other types of healthcare comprise 42% to 48% of the Total HealthExpenditures.Closeto½ofOOPspendinggoestopharmaceuticalproducts,or¼ofT.H.E.isconsumedindrugsormedicines.Tosimplify,apersonspends¼ofhisincomeindrugsandmedicinesalone.Withthegivenillustrationinthepresentation,itshowsthatthelowerquintilehouseholdshave the least share in total health spending. Income is positively associatedwithmosthouseholdexpenditures,thismeansthehigherthehouseholdincome,thegreaterthepesoamount is spent on goods and services. In regards to this, the total amount spent onhousehold increased from Php 13 Billion or 4% in the household of the lowest incomequintiletoPhp179Billionor55%forthoseinthehighestquintile.Basedon the2010 to2020healthcare financingstrategy,3outof8healthcare financingindicators surpassed the respected target, namely, (1) Total Health Expenditures aspercentage of GDPwith 4.6%which is slightly higherwith the 4.5% target, the nationalgovernmentspendingaspercentageoftheTotalHealthExpenditures is10.6%comparedtothe10%targetand(3)thenationalgovernmentspendingforpublichealthisat21.6%whichismorethantwicethe10%targetOut-of-pocket spending and social insurance as percentage of the Total HealthExpendituresconsistentlymissedthetarget.OOPhasbeenmissedaround7%to13%forthe last10yearswhileSocial insuranceisbelowthetargetwhichisbetween5%to12%withthelowestgapof5%in2015.The Philippine Statistical Development Program or PSDP is amechanism for setting thedirection and trust of strategies of the Philippine Statistical System and for defining thepriorities of statistical development programs and activities to be undertaken in themedium term. It also addresses the data requirement of the PDP or the PhilippineDevelopmentPlanofNEDAandothersectors.Inchapter17oftheHealthandNutritionstatistics,thefollowingprogramsarelisted:(1)enhancementof the statistical frameworkonhealthandnutritionwhich is to review thestatisticalframeworkofthebenefitpackageofthesocialinsuranceprogramspecificallyonsupport value, (2) improvement and compilation of the PNHA which is the conduct ofspecial surveys to update estimation parameters and generation of more disaggregated

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information on OOP health expenditures, and (3) regular conduct of training and othercapacitybuildingprogramsfordataproducersinthecompilation,analysis,andutilizationofhealthandnutritionstatisticssuchastheSystemofHealthAccounts2011(SHA).InkeepingwiththeNationalStatistician’svisiontobesolidandresponsive,thePhilippineStatisticsAuthoritywillcontinuouslycomeupwithrelevantproductsandservicesforthenational development aswell as international competitiveness. Specifically, in the healthsector,PSAwillwork towardsadapting theSHA2011,which is thecurrent internationalstandards for health accounting, as the framework of PNHA. This will provide detailedinformation needs by giving more expenditure breakdown by financing agent, healthfinancingschemes,healthcarefunctions,healthprovider,byregion,agegroup,sex,diseasegroupandincomequintile.Currently, thereareongoingtrainingsthatPSAisconductingwithDOH,PhilHealth,WHOconsultantsastrainers,anditwillendbyMarch9,2017.The followingrecommendationsmaybeundertakenbyPhilHealth inachievinguniversalhealthcoverage.Firstistostrengthentheadvocacyandintensifytheinformationcampaignabout PhilHealth coverage and its various programs especially among the low-incomefamilies.Secondistomonitorproperimplementationofpoliciesrelatedtolowerpricesofpharmaceuticalproducts.Thirdistoensurethatthegovernmenthealthcareservicesreachthepoorandthedisadvantaged.AndfourthistoconsidertheperiodicreviewofPhilHealthbenefitpackages to identifypossible improvements that canbe implementedandensureitsrelevanceandusefulness.The Out-Of-Pocket spending of the lower income quintile should be minimized byproviding extensive information dissemination. To improve utilization of medicines,nationalization in identifyingbeneficiariesparticularly theoutpatientbenefitpackages, isneeded.Coveringout-patientmedicinesmayalsopreventin-patientvisitsanddecreasetheOOP health expenditures on pharmaceutical products. The current benefit packages arelimitedtocertaingroupofthepopulationthustoreducethehouseholdOOPexpenditures,thegovernmentneedstofurtherexpandthebenefitstocoverthewholepopulation.Lastly,morethan50%ofthetotalout-of-pocketexpensesareintheupperquintilewhichmeans more people, not only the poor, would need help to bring down the OOPexpenditures.IMPLEMENTATION OF NO BALANCE BILLING (NBB) POLICY BY AN LGU-OWNEDHOSPITALByDr.ElenilaI.JakosalemChiefHospital,BisligDistrictHospitalThe Bislig District Hospital is a 50-bed capacity health facility and the only governmenthospitalinthelocalitylocatedatBisligCity.Itisclassifiedaslevel1categorybasedonthe

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new classification of the Department of Health. Its funding support comes from theprovincialgovernmentofSurigaoDelSurbyvirtueofitsdevolutionfromthenationalgovtin 1993. It has 2 catchment areaswhich includesBislig City composing of 24 barangayswitha91,400populationand themunicipalityofLingigcomprising18barangayswithapopulationof33,403.Thetotalcatchmentareashaveatotalof42barangaysandanoverallpopulationof124,803.Allinall,thehospitalisdesignatedastheco-referralcenteroftheCamayo local health development zone. It has been serving themunicipalities of Tabina,Hinatuan,andLingig.NoBalanceBillingpolicy,knownasthezeroco-payment,isamongPhilHealth’sinitiativestowards achieving Universal Healthcare Coverage. Bislig Hospital started theimplementation in2012whereinthe indigent familiesareenrolledtoPhilHealththroughthe following: (1) Bislig hospital’s partnershipwith Bislig’s local government unit (LGU)undertheleadershipofMayorNavarro,(2)Kanamihealthinsurancewhichisthetri-partyscheme for indigent family sponsored by Non-Government Organizations (NGOs), LocalGovernment Units (LGUs), and National Health Insurance Program (NHIP), and (3)InnovationofBislig’sLGUthroughBislig’scityhealthoffice,fromthecongressman’soffice,andfromtheNGOinthelocalityInthelast5years,thereisanincreasingrateofoccupancyintheBislighospital.Thetotalnumber of patients admitted is 30,880 in which 2,375 patients were admitted withPhilHealth in 2012, 3,071 in 2013, 4,714 in 2014, 4,853 in 2015, and 5,193 in 2016respectively.Intotal,thereis20,836admittedpatientswithPhilHealth.Ontheotherhand,thenumberofpatientsadmittedwithoutPhilHealthdecreasedovera5-yearperiod.Thefiguresareasfollows:2,639in2012,2,500in2013,2,253in2014,1,451in2015,and1,201in2016withatotalof10,044patientswithoutPhilHealthinthelast5years.Inconclusion,itjustshowsthatthenumberofpatientsadmittedintheBislighospitalwithPhilHealth increased, accounting to the 70% of the totality and those patients withoutPhilHealthdecreasedaspartoftheremaining30%overthelast5years.At the same time, there is also a growing number of patients benefitting from the NBBpolicyatBisligHospital. In2012, therewas1,799patientswhobenefittedwhile in2016therewere 4,174,which is twice the number ofNBB patients in 2012. A sumof 17,031clientswashelpedbytheNoBalanceBillingpolicy,whichis80-85%ofthetotalnumberofpatientsadmittedinthelast5years.One can see an upward trend on the number of patients enrolled in the point of care,whereinthere’sanaugmentationfrom74patientsin2014,124in2015,and206patientsjustlastyear.Theentiretyamountedto404totalenrolledclientsinpointofcareinthelast3years(2014to2016).Inthefinancialaccomplishmentofthepointofcareenrollees,Php969,600waspaidinPhilHealthwhilethePhilHealthreimbursementisPhp3,674,800.Withthis, the Bislig Hospital benefitted an amount of Php 2,375,930 in PhilHealth and thisbecamea valuable contribution in thehospital operations and the communities they areserving.

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BisligDistricthospitalisthe1sthospitalinSurigaoDelSurtoimplementthepoint-of-careprogram and with regard to this, they formed strategies and initiatives. They producedincomegeneratingactivitiessuchasdinner-for-a-causeandRafflePamaskongAlaybackin2014. The hospital had a net income of Php 148,800 from the dinner-for-a-cause andearned Php 90,854 from the raffle draw. They also made an intra-agency collaborationwherefreeservicesoflicensedsocialworkersfromtheLGUsofBisligCitywereutilizedinthe implementation. Aside from these, they also built partnership with the provincialgovernment thru their former Governor Johnny Pimentel who passed a provincialordinance that utilizes 5% of their trust fund for the enrollment in the point of careprogram in all district hospitals. Thus, this sustains the NBB program in Bislig DistrictHospital.AnotherimportantinitiativeisthelinkageswiththelocalhealthagenciessuchasthecityhealthofficethroughtheirKanamihealthinsurance.Andlastly,astrategywasalsoformed through the inter-localHealth zonecollaborationwith themunicipalityofLingig,the municipality health facility, and the Lingig Community Hospital. Communityparticipation was practiced by having barangay visit every month with an advocacy ofreinforcingtheNBBpolicyofPhilHealth.NoBalanceBillingisanobleprojectthatishelpingthemarginalizedpeopleofoursociety.Thisprovidesequitableaccesstothehealthservicesthatourpeopleneed.Thus,politicalwill andcommitment isamust tosustain thisprogram. “Whatwearedoinginthehealthsectorisforourpeople.Thebottomlineisservingourpeopleinthecommunityandagreatpartnershipwithourstakeholdersistheykeytowardsenhancingourhealthcaresystemanddelivery.Together, letuspursuequalityhealth, consistentlykeeping inmindof thepeople’sbestinterests.”Intheend,thePhilippinelocalhealthinsuranceofficeofBisligCityundertheleadershipofMs. JulietGolez, localhealth insuranceofficer, for contributing to the successof theNBBprogram together with the PCARES - PhilHealth Customer Assistance RelationEmpowerment Staff assigned in the hospital who assisted their patients and theirsignificantotherswererecognizedandappreciatedon thecompletionandsubmissionofvitaldocumentsneededforfilingandclaimingPhilHealthbenefits.IMPLEMENTATION OF NO BALANCE BILLING (NBB) POLICY BY A DOH-RETAINEDHOSPITALByDr.SorayaPesyAbubakarChiefofMedicalandProfessionalStaff,ZamboangaCityMedicalCenterRepresentedbyMs.MichelleLibagoAdministrativeOfficerZamboangaCityMedicalCenter

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When Zamboanga CityMedical Center started, itwas never easy implementing theNBBpolicy.ThatiswhythehospitalhasalwaysbeencalledbyPhilHealth’sofficewhenexitcallsarebeingconducted.ZamboangaCityMedicalCenterstartedasGeneralHospitalonSeptember1,1918.In1962,thehospitalwasdesignatedasthetraininghospitalforRegion7,thereafteritwasrenamedas Zamboanga Regional Training Hospital for Region 9. On March 24, 1992, throughRepublic Act No. 7272, the hospital was converted to Zamboanga City Medical Centerupgradingitfrom200to250.InAugust28,2013byvirtueofRANo.10613,thehospitalwasupgradedto500bedscorrespondingIRRwasissuedthroughDOHAONo.2014-0018datedMay29,2014.ItsvisionistobealeadingsociallyaccountablemedicalcenterofchoiceandpartnerforAllinZamboangaPeninsulawhile itsmission is tohelppromoteHealthdevelopment in theZamboangaPeninsula thruHospitalTertiaryService, trainingandResearch.ThehospitalwasISOCertifiedin2015.Thishospitalisauthorizedtooperatewithabedcapacityof500bedsperRA10613however,theimplementingbedcapacityisat400beds.Itisamedicalcenter, DOH licensed-to-Operate (2016) Level 3 Teaching-Training General. It wasaccredittedbyPhilHealthlast2016at400beds.ThetotalnumberofadmissionsatZamboangaMedicalCenterare:24,255in2013,27,776in 2014, 36,600 in 2015, 37,562 in 2016.With these given figures, the total number ofPhilHealthclientsareasfollows:10,385in2013,20,293in2014,31,495in2015,33,552in2016 inwhich thePercentage of PhilHealth Clients: 43% in 2013, 73% in 2014, 86% in2015,89.32%in2016.ThenumberandcostofnewPhilHealthenrolleesthroughPoint-of-careareasfollows:112(268,800) in 2013– 3 862 (9,268,800) in 2014 – 5,838 (14,011,200) in 2015 – 7,602(18,244,800) in2016, this includesBadjaoswhoare living inthe islandswhoarenotyetmembersofPhilHealth.Forin-patients:outoftotalclaimsfiledwhichis31,495in2015,77ofwhichiscoveredbyNBB.In2016,therewere32,341totalclaimsfiled,inwhich,82.49%isNBB.Ontheotherhand, for the out-patientswhich includes hemodialysis, radiotherapy,Minor Operations,AnimalBite,EmergencyRoomcases,andChemotherapy,1313claimswerefiled.The implementation of NBB policy was never easy. With regard to this matter, theyidentifiedreasonsfortheOOPspendingandwereabletodevelopGoodPracticessuchas:(1) bills of emergency patients are being charged to bill to ensure no out-of-pocketexpenses,NBBpatientsinOut-PatientDepartmentwhoarereferredforadmissionwithinthe same day and have incurred out-of-pocket expenses are being reimbursed withinconfinementperiod-this isthemainreasonforOOPspendingincurredbyNBBpatients,and (3) proper tagging of NBB-eligiblemembers upon admission – PhilHealth providedthemwithportaland thehospitalwasgiven theNBBcardgiven toqualifiedNBBclientswithPhilHealthrequirementsandemphasizedthatallisfree.

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Petty Cash Fund is granted to the supply officer to address issues on non-availability ofdrugs and medicines, medical supplies, and laboratory examinations. This is alarmingbecause of the big amount of money being spent on this which is million in values.Likewise, there are fieldbiddings that takeplacedue to lowDrugPriceReference Index(DPRI)whereinnosupplierwantstobidbecauseoftheadditionalcoststhatfreightfromManilatoZamboangagives.Outsourcing of Laboratory and Diagnostic Tests is done with existing Memorandum ofAgreement executed between Zamboanga City Medical Center and Ciudad MedicalZamboangatoaddressissuesonnon-availabilityoflaboratoryanddiagnostictests.Thisiswhattheydo.First,billing&claimswillissuealetterofAuthoritytohavethediagnosticsdone.Thenthesewillbeconductedviaanambulancewithoutanyadditionalcost.Next,theCiudadMedicalZamboangawillbillZamboangaCityMedicalCenter.ItshallbeZamboangaCityMedicalCenter’sexclusiveresponsibilitytobearthecostofsuchservicesOntheotherhand,fortheoutsourcingofblood,thebloodbankpersonnelwillissuealetterof Authority for retrieving of blood in Philippine Red Cross. Then, Red Cross will billZamboanga City Medical Center. It shall be Zamboanga City Medical Center’s exclusiveresponsibilitytobearthecostofsuchProblemswereencounteredinZamboangaCityMedicalCenter,especiallythelongqueuesin claiming Philhealth benefits. They always go forward to address this because NBBpatients sometimes opt not to avail PhilHealth due to long queues. They formed a“PhilHealthExpress” counter that isupdating the recordsof theirmembers andprintingtheMember’sDataRecord,sothatpatientsdon’thavetogooutofthehospitalpremises.Likewise,PCARES ispresent toassist themin thecompletionandsubmissionof thevitaldocumentsneeded tohave their claims filed.They currentlyhavea2-year contractwithPhilHealthwhichtheyhopetobeextended.Theyalsohavea24-hourfrontlinerdutyintheadmitting section for PhilHealth requirements before admitting to the birthing clinic tolessenthelengthofstay.Theyhavethemainbillingandclaimsunitfrom8amto6pmanditsscheduleisfromMondaytoSunday.Herearetheproblemsthattheyarefacing:the4Psmembersareusingthesurnameoftheirpartners andwhen they go to the hospital to deliver, the information given in the birthcertificate of the baby is different from the declared information in 4Ps data record. Toremedy the situation, they reported it to the Department of Social Welfare andDevelopment.Withthis,theymadeaformthatincludesthecivilstatusofthepatientsandthattheformcertifiesthepartner’ssurnameandthewoman’smaidennameisthesameforthebaby.Likewise,theyrecommendedthatAllCaseRatesmustberevisited.Moreover, ZamboangaCityMedicalCenterhas an excessNoBalanceBillingwhich is thesumoftheactualhospitalchargesandlessPhilHealthcaserate.Thefiguresareasfollows:in2014Php77228283.76,in2015Php115197735.52,andin2016Php146886115.34withatotalofPhp339312134.62for3yearschargedagainstthehospitalfunds.

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Inconclusion,theZamboangaCityMedicalCenterisbasicallythehomeofNBBconsideringin2015,only20%areregularPhmembers,and19.2%in2016.“ItisourpridetosaythateventhoughourgoodpracticesarejustsimpleourNBBComplianceis99.33%.”

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DISCUSSION

Ms.Ma.GildaResurrecionConsultant,NationalKidneyandTransplantInstitute

“Goodafternoon, justafewthoughts ‘no?Igotthematerialsinadvance,soIhavemynotesready. I was just asking doktora, from my experiences in other hospitals, apparently, thePhilHealthbenefitpackageisvery,veryeffectiveforprimary, level1hospitals.Asyougouptheedge,that’swhereyouseethedifferences.OneofthethingsthatInoticedinmostofthehospitalsisthat,wedon’tdohonest-to-goodnesscosting,sowereallydon’tknowhowmuchisthecostofourservicestothepatients.AndwhenPhilHealthmixesupthisinformationfromtheclaimsthatwefiled,misleadingposiya-you’renotabletoprovidetherightinformationthathastobereimbursed.Agoodexamplewouldbeaurinalysis.Therewouldstillbeaurinalysisatahundredpesos.When the cost of a urinalysis would go up to as high as P125-150, there’s not much costrecoverythere.Butforhospitalsthatareprimary,especiallytheLGUs,gettingpaidisalreadyabigdealforthembecausethey’reusedtojustgettingsubsidiesbornfromtheLGUs.Nowthey’regettingthemoneyfromPhilHealth.There’sanothersourceandthesecouldhelpthemimprovethehospitals.Iwasaskingdoktora.Ithelpedthemalot.ForZamboanga,whichhas 400beds - I’ve seen thehospital. Youwill notice that there is P339million in termsofexcess. That’s what I’m trying to mention - this is a level 3 hospital. See, as you go up,pneumonia for thisbighospitalbillwillnotbe the sameas thepneumonia forZamboangaCityMedicalCenterand theLungCenterof thePhilippines, so that’swhereyou see thebigdifference. I remember looking at the bills of the Lung Center - the PhilHealth package of13,000,18,000forpneumonia,15,000?So,15,000isjusta1to1½daysatLungCenter,soit’snotabletocoverifyougohighertheechelonorthelevelofhospitalcare.So, I guess what we need to see here is a revisit. There is a revisit of the case rates butPhilHealthmaywant to see it fromthedifferentperspectivesof the three levelsofhospital.Plus,youmaywanttolookatthisalso-ifthisweretoberolledoutinprivatehospitalsaswellbecausetheelementofprofitcomesinandwillkickin.The other thing I did notice is that these are two government hospitals here - at leastZamboangaCitysaidsomethingaboutexcess.Wewould’vewantedtoseehowthosemoneycame in to support their operations. PhilHealth has already provided another source ofrevenueandInormallyturntothemasinternallygenerated,meaningIdon’thavetoasktheLGUs, I don’t have to ask donors to bring in the money - meaning internally generatingthroughgoodsysteminPhilHealth.Soshouldthesetranslateintoimprovementsinfacilities,improvements in availability of supplies, because at the end of the day, if I improve myfacilities, I improve my availability of supplies, I am able to improve my PhilHealthreimbursement aswell. So that could be part of their financialmonitoring of the effects ofPhilHealth.

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TheotheronethatInoticedisthattherewasaslide–Iforgotwhichofthehospitals–whereout-patientserviceshadtobereimbursedthroughtheiradmission,somethinglikethat.Therearecertaincasesofthesepatients:whathappensisthattheyhavetobeadmittedtogettheirPhilHealth, but their cases can be done on out-patient basis. So, we’d like to see astrengtheningoftheOutpatientBenefitPackage.You see in the health care industry, hospital operations, you’re trying to shift in-patientservicestooutpatient.This is two-pronged:Youhelpthepatientreducehisout-of-pocketatthesametimeasfarasthehospitalisconcerned,thisislesscostexposureforthehospitaliftheydooutpatient rather than inpatient, soPhilHealth should support that shift. See if youweretolookattheout-of-pocketexpenses,agoodnumberofthemareonpharmaceuticalandsomeservices.IfthiswerecoveredbyPhilHealththen,thiscouldreduceyourout-of-pocket.AlsoonhowPhilHealthcaninfluencethesuppliersintermsofcertain---well,myexperiencerightnow forperitonealdialysis, peritonealdialysis is influencedbyalmost80-90%of thesuppliers’ cost of the piggy banks. So if PhilHealth cannot help us control that cost, theirservicesortheirPhilHealthZpackagewouldnotbeassubstantialastheywouldhavewantedittobeintermsofcoverage.And lastly, I was looking at a statement by an earlier speaker: increase rates to increasebenefitswherepremiumpaymentwillbethegatewaytobenefits.I’dliketoparallelthistothehospital. You review your rates with proper costing so you will be able to provide morebenefitsintermsofPhilHealthbenefitsorPhilHealthaccommodations.Thankyou.

Dr.AlejandroHerrinSchoolofEconomics,UniversityofthePhilippines–Diliman

First of all, thank you for inviting me to being part of this panel discussion. You knowprofessorscannottalkwithoutablackboardbutinthiscase,apowerpointwillbeenough.I’lltrytobebriefgiventhetimekeeperthere,andIusetheworkofthepreviousspeakersassomesortofaframework.The first thing, the presentation by Ms. Sabenano on the national health accounts. Thenational health accounts is a long history, and she concentrated on themost recent 2013,2014althoughshehadalongerseries2005–2014ontheout-of-pocketpaymentsandsoon.Thisisgoingbacktothefirstyearoftheseries1991–2014,soyouactuallyhavea24-yearseriesofthenationalhealthaccountsthatcanserveasareminderofhowwellwe’removingalongintermsofthefinancingthehealthcosts.Theseareexpressedintermsofpercapita,constantpesossothatwecontrolpopulationandinflation. As you can see, the yellow one there is the out-of-pocket. As you noticed, it isincreasing, andwhat seems to be happening is that, in spite of the rapid economic growthespeciallyinthelastfewyears,thegrowthindispensableincomehasnotbeentranslatedintogreaterfinancialprotection,andsowecantakealookatthetrendsin1991(firstseries),thatshareofPhilHealthinparticular,whichwasthentheMedicareprogram,wasaround5%,and

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IknowIdon’thavemuchtimebutletmegiveyouabackwithashortstoryregardingwhatwasyear0likesinceyou’recelebrating22years.Sowhatwasyear0?Year0, the1991nationalhealthaccountswasproduced.Thatwas in1994. Itwas presented by DOHwith a group of senators and some congressmen. The firstthingtheynoticedinthattablewastheshareofMedicareinthetotalhealthexpendituresandatthattimeitwassomethinglike5%,andimmediately,theynoticed:howcomeit’sonly5%wheninfactMedicareprogramhasbeentherefor22years?Thishastochange.We expect that it should cover a lot more share of total health expenditures. So, theyconsideredthatasaproblem,andtheyhadasolution.Theyarelegislatorssotheirsolutionislegislation.Ithinkoneofthesenators,SenatorAngara,calledonthenSecretaryFlavierandsaid“Johnny,canyouprepareadraftbill?”,andthingsmovedonveryquicklysoonFebruary14,1995,youhaveanact,theHealthInsuranceActof1995,sothatwasthefirstdayofyour22years.Sothat’showthehealthaccountsarebeingwitnessintoevent.Butasmentioned,from5%,ithasbeenmentionedthatithasbeenonlyupto9%,andit’sonlyrecently that it’s 14% in the last year. How can the share of that healthcare insuranceincrease?IthinktheanswertothatwasgiventhismorningbyPresidentAristoza,youcan’treally increase the share unless you increase your revenues because no matter howmuchbenefitpackagesyoubringin,youwillbeconstrainedbythetotalamountofresourcesthatyou have, and these suggested revenues through premiumpayment increases among otherthings,andthatisclearlywhatneedstobedone.Andthequestionisinhisaggregateclaims,howcanpremiumsbeincreased?Canweaskthegovernmenttoincreasethepremiumoftheindigent?Thatwouldbegreat.WestillhavetheSinTaxmoneybeforeeverybody stops smokingandwe runoutof sin taxes.Theotherone,which ismore tricky, is howdoyou increasepremiumpayments for the formal sector?Formanyyearsthathasnotbeenadjustedandevenintherecentadjustments,theceilingisstillrelatively low. I think the ceiling, salary ceiling is around P30 000. So the person earningP30,000paysthesameamountofpremiumasthepersonearningP300,000,soisitpossibleto,ifnotincreasetherates,toincreasetheceiling?Buthowfarcanyouraisetheceiling?Ofcourse,thereareimplicationsregardingthecostofproduction to the employers. Will they take it, or will they demonstrate? And there’s alsoimpactonemployment.So,therearethingsthatneedtobeaddressedthere.Inthequestionofhowmuchmoneydoyouneedtoraise,sothat’swhereactuarialcomesin.Theanswertothatwasintheprevioussession.Perhaps,weshouldlookat,inansweringthatquestion:what is it really thatweneed to spendon?And, that is the cost effect, those thatreflectdiseaseburden,whichIwillcometolateron.Thenexttwopaperstalkabouttheno-balancebilling,andhere,thisishowwetransformout-of-pocket payments into premium payments. From the national health accounts, themorerecent,moredetailedsystemthatisrecommendedbytheWHO,inwhichRaquelisverymuchinto, this aggregates the total health expenditures into various categories: one of them

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isincomequintile,andyoucanseewebrokedownthetotalexpendituresbyquintileandthesourcesbyeach,toeachofthequintileissupportingtheirtotalexpenditures.Sotheblueoneisthelocalgovernment,thennationalgovernmentandthensocialhealthinsurancethenyouhaveprivateinsuranceandHMOsandenterprisesandothers.Andasforthegreenone,isout-of-pocket payments, sowhatNBB does is to eliminate that green portion in the bottom oreveninthesecondquintilevianobalancebilling.Well, the two presentations have given us exactly how that is done and innovations thatthey’vemade.Oneofthecriticalcommentsbeforethisstartedissomesurveyshowthatthereisstillout-of-pocketpaymentsandthesecamefromwhendrugsarenotavailable.Drugsareboughtoutside,andforsomereasonthesenevergetreimbursed,althoughitshouldbe.Whenthey have to get diagnostic procedures outside, which are not reimbursed and so on. I’mhappy to see that in the report of our presenters that that particular element has beenaddressedandsothetrueNBBhasactuallybeenmaterializedandsoon.So, in effect it can be done, and even If certain expenditures are done outside, these areeventually reimbursed as part of the bill. But having said that, we could actually improveaccesstohealthcarebyeliminatingextraout-of-pocketcostsfortheverypoor.Perhapsanotherquestionislet’snotbecontentbyjusttakingoutthegreenonesinfinancingthebottomandsecondbottomquintile.Whatifweraisetheconsumptionofhealthcare?So,it’snotenoughthatwetakeoutout-of-pockets.Whatisprobablymoreimportantishowtoraise their level of consumption? Because it’s hard to imagine that the poorer are morehealthy that the rich. That’s why they don’t need asmuch healthcare. Somore likely theywon’t be able to accessmore healthcare because before therewas out-of-pocket paymentsandeveniftherewerenoout-of-pocketpayments,therearestillalotofcostsneededtoaccessthosecare.Sohowcanweincreasethelevelofconsumption?Ofcourse,weknowthatthosewhoarenotabletoaccessout-of-pocketpaymentsoranymeanstosupportotherexpendituresotherthanhealthcare,inaccessingthatwecannotbeinthisgraph,they’llbeinanothergraph:thepoorwhoarenotabletoaccesshealthcare- theyare inthegraphcalledmortalityrates.Sooneapproachistoreallocateorcanwereallocatethesubsidies?Theblueandtheredfromthe4thand5thquintileandreallocateittothe1st,2ndandmaybe3rdthatwayyoureducesubsidieshereandincreasethetotalconsumptionandsubsidiesontheleftside,sothat’soneoption.Onhowitcanbedone,whatcouldbethepoliticaleconomicissuestherecanbediscussed.Theother one of course, is going back to the earlier solution of increasing the revenues is toactually increase the share of PhilHealth to increase in the revenues. That grey bar therewouldincreaseforeverybody,particularlyforthebottomquintiles.Butagain,howtoworkonthosemechanicsmightbesomethingthat’sneededtobediscussedifyouhaveideas.Thethirdideais-thisisjusttosummarize,againI’llusethehealthaccountsinviewofits-well,itgetsexcitingbecausewedon’thaveanymoretablessothat’sonethingtotalkabout.This is looking at expenditures by disease category. So this is broad. There’smore specificdiseases,andforeachdiseasegroup,wealsolookatwho’spayingforthem,andyoucansee

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thegreensarethere,buttherearemoregreensinthenon-communicablediseases,infectiousandreproductivediseaseswhichincludeHIV-AIDSperhaps,reproductivehealthandinjuries.Injuries is practically out-of-pocket. The expenditures are small probably because it reliesmostly on out-of-pocket, so the question is ifwewant to reduce out-of-pocket through themechanismsthatwementioned,wearealreadyheatingup,perhapswhatJohnWongwouldsay the more important diseases if they are under non-communicable, infectious andreproductive,sothequestionishowdowefinancethis?AndgoingtowhatwasmentionedbyJohnWongandTonyLeachonaboutlookingatthemostcost-effective tactics that can be funded to this category. Next idea is while we all agreedabouttheneedtoreducefinancialrisk,perhapsanothercomplimentaryapproachwouldbeto reducehealth risks in the firstplace. ItwasmentionedbyAnthonyand theothers,Tonyabouttheprimarycare.JohnWongaddressedtheneedtoreallydeterminingwhatshouldbepaid intermsofhowwell theycontributetothediseaseburdenandthatmightbehowcanaddresstohowweneedtopayforwhatneedstobepaid.Butthere’salsoanotherwaybeyondthehealthsector,onhowthesizesof theexpenditurescanbeaddressed.but thatwouldbeworkingonthesocialdeterminantsofhealth.Justtogiveyouanideaofthingsthatwehavedonealready,weareconsideringaboutmanythingsthatwecandoforlet’ssaypricechanges.Thatiswhattheeconomistsfavorbecausetheythinkthatbehaviorchange,communicationsandsoonmighttakealongtime,butifyouchangetheprice,you’llprobablygetresultsquickly.Sotaxesmightaffectpollutionratesandperhapscancerrates;tobaccouse,wehavealreadyseenhowoursintaxisworking;harmfulalcoholuse,they’realsopartofsintax.Noticethatintobaccouse,theyjustsaytobaccousebut,inalcoholthereissuchthingasharmfulalcoholuseand presumably harmless alcohol use. Poor diet, I think this is being discussed about theincreaseexcisetaxonsugarandotherfoods.Isthateasiertodothatanotherapproach,whichisonlawsandregulationsandIthinkinsomecountries,insteadoftaxinghighsaltcontentorhigh sugar content, they regulate it in suchaway that your salt or sugar content declinesgraduallysothatpeopledon’tnoticethatitisnowlesssaltyandmorehealthy.Buttheydon’tmindbecausethepresumptionisifyoudon’tchangethecompositionoftheproduct,notonlywillthemanufacturerscomplainbecausetheirpocketswilldeclinequickly,buttheconsumerswillalsocomplainbecausenow,itdoesn’ttastelikeitusedtobe.Butperhaps thereareother things that canbedone,andyour ideasonwhatmightbe thekindof innovations regardinghow these canbe implementedwill bemostwelcome.Thankyou.”

OPENFORUM

Q1 (Dr.BeverlyLorraineHo): “Howdowesustainhealth financing to increasehelpbenefitpackageifwebecometooreliantonsintaxredemptionswhenitmightdecreaseinthelongrun?”

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A1(Dr.AlejandroHerrin):“Well,Ithinkweshouldweshouldnotthinkof-wellImentioneditbefore:sintaxisasourceofrevenue.Butwhatyoushouldbeconcernedisthatitwillreducesmokingandalcoholuse.SogoingbacktohowitisfinancedtransformingandincreasingintooutofpocketintosocialinsurancepremiumswasdiscussedbyAristozathismorning.”Q2(Dr.BeverlyLorraineHo):“ThisisforthefirstspeakerontheslideonOOPexpenses,canyou suggestwhatmeasures should be taken byDOH, being a regulatory body on prices ofdrugs andmedicines, professional fees and ethical practices and government hospitals anddoctors?A2 (Ms.RaquelDoloresSabenano): “For thePSA,wehavenodata for thepricesanddrugsandmedicinefortheprofessionalfees.Somaybewecanaskfor,Ithinkit’sinPhilHealththatwecanhavethisdataforthepricesofdrugsbecauseinthePNHA,wedonotcollectforthesestatistics.Professionalfeesalso,wehavenodataforthis.So,collectthedatafirstbeforewecandecideonwhatcanbedone.”CommentbyHon.Leachon:“MayIanswerfirstthesintaxbeforeIgivemycomment?Well,wecannotbeforeverdependentontheSinTax,andIwouldagreewiththetwodiscussantsonthismatter.It’saninteragencycollaboration.Basically,improvingtheriskofthesocio-determinants.OnethingthatwecanimitateisactuallytheSingaporeapproach,inwhichtheyincreasethesintaxandthenpenalizedwhoaregoingtosmoke.Forexampleifyouwanttosmoke,thepricesofcigarettes inthePhilippines isrelatively lowcomparedto let’ssaySingaporeP50forone(Philippines), then in Singapore, it’s P400 right. Somore or lesswe canhave the readinessthatwewantasidefromtheotherproblemstosolvetheout-of-pocketpaymentsbecausethenumberonekiller inthecountryissmokingsoweswingonthenon-communicablediseasesandthenputitawayontheout-of-pocketincare.SoatleastwecandecreasetheZpackageswhichisactuallyenormous-it’scurativeandisactuallymoreexpensive,sowehavetoswingatthat.ButmylastcommentifImay,isthatPhilHealthat22,andthenPresidentDuterteat2022,it’sa Catch 22 situation meaning to say, Webster would define it as a difficult dilemma orcircumstances which is not actually solved or there’s no escape because of conflicting ormutuallydependentconditions.Forexampleyoucannotachieveuniversalhealthcarewithoutaddressing human resources. You cannot address financing problem without addressingpublichealthinfrastructures,sofragmentedparineh.Iwasthinkingofaninteragencycollaborationwithanationalscorecardwithatrafficgreenblueandyellowwithasignaturecomingfromthepresident,theDOH,DILG,DBMsecretariesandtheLGUheadsaddressingtheall themetricsrelated to the threeparametersuniversalhealthcare,andpublishthatintothenewspaperyearlyandwewillseewhowillbethelagershere addressing all of this because as we can see right now, we cannot solve all of ourproblems right now the way we see the problems before. It’s quite fragmented. The datepresentedhereisonlythefirsttimethatIwasabletoseethosestatistics,soweneedtolookat

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it at a helicopter view, so that we can address the problem andmore town hall meetingsnatureonaquarterlyorsemestralbasis,sothatwecanfollowup.Theproblemisintheplanofactionbuttheproblemiswhentherubbermeetstheroad,andthatwillbeanenormousproblem.”

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SYNTHESISByDr.BeverlyLorraineHoChief,ResearchDivision

HealthPolicyDevelopmentandPlanningBureauDepartmentofHealth

“TheTotalHealthExpenditure (THE) is increasing, thus this isactuallygoodnews.But,wealso see that theTotalHealthExpenditure is largely driven byOut-of-Pocket spending andmostof thesearehighlyconsumptionof therich.Nevertheless, themore importantpoint isthat,afteralongtimethatPhilHealth’sshareofTHEhasbeensleepingat9%it’sfinallyupto14%. It probably tells us that reforms may be really impacting the system. However, theprevious presentation was only a macro-picture, so we still have to hear from the 2 nextcolleagues about how the patient is experiencing the reforms in the point of service in thehospital.Insummary,herearetheissuesthatwerediscussed.FirstisthatPhilHealthwillneedtoinvestmore in financing primary care and working on reducing risks especially the socialdeterminantsofhealth.Nextwouldbetheneedtoinstitutionalizecostaccountingamongourvarioushealthcareproviderssothatweareabletogetthetruecostofprovidingcare.Thirdwouldbetoraisetheconsumptionofthepoor.Howthiscanbedone,weneedtothinkaboutandworkonit.Andlastly,topayforoutpatientservicesinamoreefficientmanner.Sothesearethefour(4)mainpointswegotinthisdiscussion.”

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POPULATIONCOVERED:WHOBENEFITS?EnsuringtheInclusivenessofPoliciesandPrograms

INTRODUCTION

Themoderator,Prof.ManolitoNovales introducedthesessionwhichwill talkaboutWhoBenefits or the Breadth dimension of the UHC Cube: Ensuring the inclusiveness of thepoliciesandprograms.Thepanelwillparticularly focusof thepopulationcoverageof theUniversalHealthCare.Guaranteeingthatallpeoplewillbenefitfromthenationalhealthinsurance.AmongthetopicstobediscussedistheImplementationofSinTaxReformActof2012tobe discussed by Dr. Toomas Palu. How the law significantly helped the overall taxstructuresandsupportedoverallhealthexpenditures.AnothertopictobediscussedistheListahanan2byMs.KrupskaApit.Thistopicwillfocuson how the government particularly DSWD identified who and where the poor arenationwide. She will also tackle the phases of the project, the results and therecommendationofDSWDtoPhilHealth.Lastly, theUniversal PopulationCoverage to be discoursed byDr. EduardoBanzon. Thisparticularsessionwillfocusontheissueonhowtheinformalsectorofthepopulationwillbe able to pay for the health insurance. Also, to be discussed are ways in achievinguniversalpopulationcoverageandwherecanweactuallygetothersourcesoffundsforthenationalhealthinsuranceprogram.

MODERATORMr.ManolitoNovalesProfessor,AteneoSchoolofGovernanceAteneodeManilaUniversity

He got his degree of Master in PublicManagement from theAteneodeManilaUniversity.He has worked in various fields: Governance and InstitutionBuilding, Public Policy, Health Financing, Social Reform andPoverty Alleviation, Program Monitoring and Evaluation,amongothers.He is Faculty Adviser, Master in Public Management andDevelopment Program (PMDP),DevelopmentAcademy of thePhilippines. He is a Consultant with Government and

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International Agencies such as with PhilHealth on developing its capacities for PolicyDevelopment and Analysis, and on Extending Social Health Insurance to the InformalEconomyWorkers,UNDPondevelopingitsGovernanceFrameworktowardsanIntegratedApproach toSafeWater,SanitationandHygiene,andwithDOHonDeveloping thePolicyforCivilSocietyEngagementintheBudgetProcessamongothers.Currently,he isProfessorat theAteneoSchoolofGovernment (ASoG),AteneodeManilaUniversity

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RESOURCESPEAKERS

IMPLEMENTATIONOFSINTAXREFORMACTOF2012(RA10351)ByMr.ToomasPaluRegionalPracticeManager,TheWorldBankHe is amedicaldoctorwith special interest inpublicpolicyand medical sociology; and health economics. His areas ofexperienceincludehealthpolicyandhealthsectorreformsinmiddle-income transition economies and health systemsstrengtheningindevelopingcountries.In his prior engagements, he led World Bank healthprogramsinseveralcountriesinEasternEuropeandFormerSovietUnion,servedasaDirectorintheEstoniaSocialHealthInsuranceFundManagementBoardandasaDeputyDirectoroftheTallinnEmergencyCareHospitalinEstonia.Currently, he is the Global Practice Manager for Health,Nutrition,andPopulationattheWorldBank. TARGETINGTHEPOORUNDERLISTAHANAN233333ByMs.KrupskaLeninaApitProjectCoordinatorSheholdsaBachelor’sDegreeinCommunicationArtsobtainedfromtheUniversityofthePhilippinesin2009.She is a Project Coordinator for the Listahanan or NationalHousehold Targeting System for Poverty Reduction (NHTS-PR). Before this, she was the Social Marketing Specialist forsaid project and an Information Officer for PantawidPamilyangPilipinoProgram.DuringhertenurewiththeDepartment,shehasorganizednumerousfora,workshopsandothereventsthatpromotetheNHTS-PRprojectandthePantawidPamilyaprogramtobothitsexternalandinternalstakeholders.Theseincludethelearningforumentitled“Peopleatthe Edge: Defining the Near Poor in the Philippines”, which was awarded with BestInformation Dissemination Activity in the 25th National StatisticsMonth (NSM) AwardsandthemorerecentlaunchingoftheListahanan2databaseinApril2015.Now,inhercapacityasProjectCoordinator,shecontinuestorepresenttheDepartmentinactivitiesthatengagevariousstakeholdersofListahanan.

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UNIVERSAL POPULATION: SQUEEZING THEMIDDLEANDOTHERSOURCESOFFUNDSByDr.EduardoP.BanzonPrincipalHealth Specialist, Sector Advisory ServiceCluster,Sustainable Development and Climate ChangeDevelopment,AsianDevelopmentBankHecompletedhismedicaldegreeattheUniversityofthePhilippinesCollegeofMedicineandlaterhisdegreeMasterofScienceinHealthPolicy,Planningand Financing from the London School ofEconomicsandtheLondonSchoolofHygieneandTropicalMedicine.He is former President and Chief Executive Officer of the Philippine Health InsuranceCorporation(PhilHealth)andRegionalAdviserforHealthEconomicsandFinancingoftheWorldHealthOrganization-EasternMediterraneanRegionalOffice(WHO-EMRO)whereheadvisedcountries in theMiddleEastandNorthAfricaon improving theirhealthsystemsandachievingUHC.HewasalsoaHealthEconomistinWHO-BangladeshandSeniorHealthSpecialistfortheWorldBank.Currently, he is a Principal Health Specialist in the Asian Development Bank where hechampions Universal Health Coverage (UHC) all over Asia and the Pacific, supportscountriespursueUHC, andprovidesadviceondesigningand implementing countryUHCstrategies.

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SYNOPSISOFPRESENTATIONS

IMPLEMENTATIONOFSINTAXREFORMACTOF2012(RA10351)ByMr.ToomasPaluRegionalPracticeManager,TheWorldBankTheSinTaxLawof2012hassimplifiedoveralltaxstructures,reducedtiersandshiftedtounitary over time. It has also increased taxes on cigarettes, beer and spirits – includinghigher floorprices,and ithas indexedtax increases to inflation.Additionally, theSinTaxLaw significantly increased the pro-poor earmarking for health by deducting the(enhanced) historical allocation for tobacco farmers of around 15%. Almost 80% of theremaindergoestoNHIPtocoverthepoorandnearpoorandlater,throughthesubsequentlaw, also the elderly. The attainment of the Millennium Development Goals, healthawarenessprogramsandtheremaining20%goestoMedicalAssistancePrograms(MAP)andHealthFacilitiesEnhancementProgram(HFEP).Earmarkingwasusedtopositionthereformandassociatedtaxincreasesintheinterestsofthehealthofthepoorandmitigatingthe riskof adversepoverty and social impacts.The reformwas framedas ahealth issueratherthanataxissue.

Butthereformwasnotaneasypassageasithaddifferentimpactsonthetobaccoindustryandonalcoholindustries.Thehealthandpovertyimpactofthereformwascentraltothedebate.

TheimpactoftheSINTaxLawhasbeenprofound.Ithasincreasedthetaxrevenuesfrom0.4%oftheGDPtocombinedtaxrevenuesofabout1%,providingsignificantproceedstohealth sector. Moreover, the DOH budget allocations in 2010-2016 showed significantincrease in the allocation. In 2017, the DOH budget is Php151 billion, of which, Php53billionisallocatedtoPhilHealth.There has also been a dramatic increase in the share of the population covered byPhilHealth,intermsofbothindividualsandfamilies,from53millionin2010tomorethan90millionfamiliesin2015(2000-2006PhilHealthCorporatePlanningDepartment;2007-2015 PhilHealth Stats and Charts). Additionally, there has been a positive impact oncoverageamongthepoorsincetheSinTaxLawearmarkskickedinfrom2014(PhilHealthStatsandCharts)andthecoverageofpeopleroseover60steeplyafterSTL(SinTaxLaw)wassubsidized.Subsequently,theshiftfromrelianceonLGUidentification,andsponsorshipofthepoortouse of National Household Targeting System for Poverty Reduction (NHTS-PR) list andnationalgovernmentsponsorshipwasalsoa“goodgovernance”reform.AnotherimpactofSTLwasthedeclineinsmoking,thoughtheprocessisslow,butstillencouraging.The2015GlobalTobaccoSurveyresultsshowed22.5%adultscurrentlysmokecigarettes,withonly21.5%smokingmanufacturedcigarettesandonly18.7%smokingdaily.AccordingtoSocialWeatherStations(SWS)surveys,evensharperreductioninsmokingamongtheyouth(18-

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24years):35% to22%,between2012and2015andevena sharperdecline in smokingamongthepoorest(38%to27%)thanamongthemiddleclass(constantat26%.)Issues pertaining to population coverage transpired. One concern is household surveysconfirm an upward trend of PhilHealth coverage, but there is a persistent gap betweencoverage estimates from PhilHealth administrative data and household surveys. Therehave been measurement issues like difficulty in translating NHTS-PR “households” intoPhilHealth“families”andthechangingdefinitionof“PhilHealth”family.Moreimportantly,inasystemwherepeopleare“automaticallyenrolled,”byvirtueofbeingontheNHTS-PRlist,administrativedatacapturesthenumberofpeopleentitledtofreehealthinsurance(dejurecoverage),notthenumberofpeoplewhoknowthattheyhavesubsidizedcoverage(defactocoverage). To ensure that thosewho are entitled to free insurance know about it,thereshouldbemorepublicinformationcampaigns,probablyissuehealthinsurancecardstoallthosewithfreehealthinsuranceandexpandhealthinsurancecoveragetoeveryone,thusremovinganyquestionaboutwhoisentitledandwhoisnot.Coverageshouldbecomemorepro-poorandequitable.NeverthelessSTLgivesfreehealthinsurance to 15.3million poor families and senior citizens, effectively giving free healthinsurancetoalmosthalfofthepopulationandtheuseofnationaltargetingmechanismhasmadeidentificationofthepoormuchmorecredibleandtransparent.Another issue is that, are PhilHealth contributions equitable or pro-poor? PhilHealthpremiumsarenotrisk-rated;thepoorandnearpoordonotpayanypremiums.However,allseniorcitizenmembers,eventhosewhoarewealthy,donotpayanypremiums;shouldameanstest(e.g.NHTS-PR)beappliedtothem,too?Furthermore,formalsectorpremiumsincrease proportional to salary, but only up to a fairly low salary ceiling after whichpremium payments become aggressive. Should the ceiling be increased abovePhp35,000.00?PremiumsfortheformalsectorinthePhilippinesarelowbyinternationalstandards.At2.5%intotal,1.25%employerand1.25%employeerespectively,theyarefarbelowthanthe5% maximum allowable law. But it doesn’t automatically mean that PhilHealth shouldincreasethepremium.Thereareanumberofquestionstobeaskedfirst like,whatistheneed to increase the premium; do premiums cover actuarial cost of the formal sectorbeneficiaries,anddoesbenefitpackagerequireexpansion?Benefitstructureshouldbeequitable.Thepooriscoveredandthenon-poorisnot.Primaryhealthcareisnotreallyafinancialprotectionissuebuttherearepoints,thoseintermsofefficiency and effectiveness, that this benefit should be expanded to all. Policy of NoBalanceBilling(NBB)forthepoorandseniorcitizensensuresprovidersthattheydonotchargepatientsanythingbeyondthePhilHealthbenefitpackageandthelackofpredictableandformalco-paymentpolicythatactuallyprotectsfromcatastrophiccosts.Thetotalvalueofbenefitsgoingtothepoorhaveincreased,in2015theindigentsreceivedthe most benefit payments comprising of almost 50% of the enrollment population;consumingabout34%of the resources. In that case, theuseofPhilHealth resourcesper

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capitabasisisnotpro-poor.Moreover,higherhealthinsurancecoverageisnottranslatinginto improved financial protection but achievement of these financial protection goalsdependsonlypartlyontheexpansionofhealthinsurancecoverageanditalsodependsonother health financing and service delivery arrangements of PhilHealth, as well as theDepartmentofHealthandLGUs.Some of the PhilHealth’s extraordinary powers to get health results are: it hasopportunities tomaximize the value formoney and the value for health. The process ofaccreditationsetsqualitystandardsforproviderssuchastheMCPpackage, inpatientandZ-package;theabilitytocontractwithbothpublicandprivateprovidersexpandsaccesstoservices. Thepopulation coverage is nowgreater than90%, giving leverage to negotiatewith providers – and influence health care for almost all Filipinos, reducing people’svulnerabilitytothediscretionarydecisionsoftheLGUsinwhichtheyhappentolive,shiftfromLGUsponsorshipofhealthinsurancecoveragetonationalgovernmenttargetingandfinancingofpremiums;andthepurchasingofhealthservicesguaranteespeopleaccesstoanationally-defined PhilHealth package of services, rather than being reliant onwhateverLGUsmaybeabletoprovide.Purchasingprovidesincometohospitalsandproviderseventhepoorestlocations,withtheprofessionalfeeshareencouragingretentionofhealthstaff.PhilHealth can itspowersbetter togetmorehealthandvalue formoneyby revising thecase rates to include evidence-based clinical practice guidelineswill allow PhilHealth tobetteruseitspowertogetmorehealthandvalueformoney.Furthermore,thecorporationshouldmakeallcaseratesrealizetheirpotentialbycomplementingthemwithapolicyoffixed co-payments, while also considering reforms in provider payment methods toincentivizequality,aswellasbuildingastate-of-the-art informationsystem.ThenationalgovernmentcouldchannelmoreresourcesthroughPhilHealthandtheLGUsshouldensurePhilHealth accreditation of all their facilities to guarantee that people everywhere canbenefitfromhealthinsurancecoverage.Inconclusion,thePhilippinesisrecognizedasagloballeaderinsintaxreformfor(i)STLdesign thatmaximizes revenue and health, and (ii)monitoring its impact. Also, STL hasbrought tangible benefits, potential to further strengthen the use of STL expenditurethrough policy reform and program implementation to get more health and value formoney. And continued public and political support for the Sin Tax – and of recentDOH/PhilHealthreforms–willdependonshowingthatthereformbenefitsthepeople.TARGETINGTHEPOORUNDERLISTAHANAN2ByMs.KrupskaLeninaApitProjectCoordinatorListahananisaninformationmanagementsystemthatidentifieswhoandwherethepoorarenationwide.Itmakesavailableasocioeconomicdatabaseofpoorhouseholdsasbasisinprioritizingbeneficiariesofsocialprotectionprogramandservices.EO867Seriesof2010mandatedallgovernmentagenciestoutilizetheListahananDatabase.TheListahananwas

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a result of 2 problems encountered by social welfare programs: (i) poverty incidencecontinued to increase despite implementation of anti-poverty programs, and (ii) poorlytargeted social services resulted in the exclusion of the poor from the necessary socialservicesandleakageofresourcesonthosewhoarenotactuallypoor.There are 4-phases in the project cycle. The first phase is the preparatory phase,whichincludesgeographic targeting, anddata collection strategy, assessinghouseholds in ruralbarangaysand in identifiedpoverty locations. It also includeshiringand trainingof fieldworkers,andorientationofLGUs.Thesecondphaseincludesdatacollectionandanalysis.Duringthisphase,enumeratorsconductedhouseholdinterviewsusingassessmentforms.InformationcollatedbyfieldstaffsusingpaperformswereendorsedforencodinganddataprocessingusingtheProxyMeansTest(PMT)Model.PMThasbeenproveneffectiveinLatinAmericancountrieswithlargeinformalsectors.Inthe Philippines, 40% of the population belongs to the informal sector, whose income ishard to measure. PMT, however, is not perfect or 100% accurate like anymodel-basedmethodologies.Listahanan2tightenedthequalitycontrolonoperationsandenhancedthePMTmodeltominimizeerrors.AftergeneratingtheinitiallistofthepoorbasedontheresultsofthePMT,thislistispostedatthebarangaylevelforthecommunitytovalidateaspartofthethirdphaseoftheproject.Thelocalverificationcommitteeatthemunicipalcitylevelassessedthecomplaintsmade.There-assessedhouseholdsweresubjectedtothePMTmodeltogeneratethefinal listofpoor. Final results of the assessment were shared through generation of national andregionalprofilesofthepoor,whichwasthelastphaseoftheproject.Through this process, there were 5,166,351 identified as poor households out of15,242,397 households assessed in the second round of assessment. The regionalbreakdown showed ARMM remains the most number of poor households followed byRegionXandRegionVII.Thestatisticswerefurtheraggregatedbasedonbasicinformationlikename,address,socio-economicfactorssuchashousingandwater,andprogramrelatedinformationsuchaspersonswithdisabilityandoverseasworkers.Several datasets can also be generated from the database such as Magnitude of Poor,HousingCondition,Health,Education,LaborandEmploymentandothers.Listahanan2isarichdataresource,whichcontainsabout70%ofthe22millionestimatedhousehold populations. It is recommended that maximizing this database can extendPhilHealth’s services to thosewith income slightly above the poverty threshold. Also, tovalidateone’ssocio-economicstatus,namematchingbetweenPOSclientsandListahanan2isrecommended.Lastly,effortsdirectedtoextendingcoveragetodaycareworkersin4th,5thand6thclassmunicipalitiesthathavedifficultiesinpayingforhealthinsuranceofstaffduetoinadequateinternalrevenueallotmentshouldbemade.

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UNIVERSALPOPULATION:SQUEEZINGTHEMIDDLEANDOTHERSOURCESOFFUNDSByDr.EduardoP.BanzonPrincipalHealthSpecialist,SectorAdvisoryServiceCluster,SustainableDevelopmentandClimateChangeDevelopment,AsianDevelopmentBankHealthwasconsideredahumanrightafterWorldWarIIandtheWHOConstitutiontalksaboutuniversalaccess.TheAlmaAtaDeclaration in1987comes fromaunifieddesireofuniversalaccess,whichisoneofthecoreelementsofUHC.Universal Health Coverage provides all people with access to needed health services ofsufficientqualitytobeeffective. Itensuresthattheuseoftheseservicesdoesnotexposetheusertofinancialhardship.UHCbecamepartoftheUnitedNations’SustainableDevelopmentGoals:GoodHealthandWell-being,whichtalksaboutnotonlyfinancialprotectionbuttohavequalityhealthcareservices,medicinesandvaccines.Extending coverage to the middle layer of the population is one hindrance in attaininguniversalpopulationcoverage.Theformalpublicprivatesectoremployeesanddependentsareonthetop layer.Payingpremiumsisaneasywaytogetmoney.Andthissectorpayspremiumsbasedontheirjobandincomequintile.The bottom layer includes the poor families, measured by poverty or other arbitrarymeasures.This layeristhegovernment-subsidizedsectorofthepopulation.Thequestionwasneverwhetherwesubsidizethepoorintohealthinsuranceornot;itwasalwayswhoisthepoor,whichisacontinuingdebateuntilnow.Themiddle layer consistsof the informal sector, theborderlinepoorandnon-poor.Thissector consists of about 35% from the top layer and about 65% from the bottom layer.Subsidizingthissectorispoliticallydifficultbecausewhenthenon-poorissubsidized,theeducated people will start to question the method and it becomes a non-health issue.Hence,theDisabilityActandSeniorCitizensActwerecreated,amongothers.TheWHO’suniversalpopulation-basedgeneralbudgetrevenuesfundedforallisonewayof achieving UHC, and this includes funding the coverage of the informal sector fromgeneral budget revenues. The formal sector is covered by compulsory health insurancescheme.Giventhis,theapproachisrelativelynotgoodasthePhilippineswillnotattaintheUHC,andatthesametime,itwillendupindirectlysubsidizinginaveryinefficientmanner.Another thing is, fund coverage for poor and other vulnerable informal population fromgeneral budget revenues: the non-poor informal sector voluntarily pays. Anotherconsideration is selective universalization of budget-funded services in order to achieveUHC.There are two necessary and sufficient conditions for UHC: subsidize and compel -subsidizationbecausesomepeoplewillbetoopoortobeabletoaffordvoluntarycoverage

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andcompulsionbecausesomeofthemwhocanafforditareunwillingtobuyit.Subsidiesalonearenotsufficientbecausetherichandhealthwillnot joinandcompulsionwithoutsubsidies imposesaheavyburdenonthepoorandsick.Compulsion isamajorchallengeforLowandMiddleIncomeCountries(LMICs).The Philippines should utilize and adopt evidence-based coverage of needed healthservices.Also,theuseandimplementationofhealthtechnologyassessmentwillbehelpfulinachievingUHC.Anotherthingis,alwaysensurefinancialriskprotection.Itisnotalwaysenough to cover people; there should always be financial protection. According to theWorld Health Assembly Resolution 58.33 (2005), a method for prepayment of financialcontributions for health care, with a view to sharing risk among the population andavoiding catastrophic health-care expenditure and impoverishment of individuals as aresult of seeking care shouldbe includedand the transition touniversal coverageof thecitizensshouldbeplanned.ThePhilippinesdoesnotoperateasanindividualcountry.UHCshouldnotonlybecountry-specificbutglobalaswell.Gettingcountries towork togetherandhavingaccess to theseservices when most of the population is working overseas should be put in place.PhilHealth should put in resources and demand the receiving countries to work withPhilippinestomakesurethatUHCisglobal.

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OPENFORUMModeratedByMr.ManolitoNovales

Professor,AteneoSchoolofGovernanceAteneodeManilaUniversity

Q1(Fromtheaudience):“ActuallyIjustwantedtostressagainwhatDodoBanzonsaid‘toomuch talkandnotenoughaction.’ Iwasgonnaask - IheardDr.ErickTayag.We’ve talkedaboutgatekeepers. IsPhilHealthreadytosay that theywillnotpay forbenefitsunless theypass gatekeepers; if patients go straight to the tertiary hospitals, who’s gonna put this alltogether?BecauseI’vegonethroughsomanymeetingsandreallytoomuchtalkandyouseetheideasbutthey’reall fragmented,sothequestionis, isPhilHealthreadynottopayunlessyoupassthroughagatekeeper?Itwillalsosolvealotoffraud.Itwillalsosolvealotliketheportabilityclause that must be re-examined. This has gone too far because it gives excuses forcommunitiesnottoberesponsiblefortheirpeople.A1 (Dr.EduardoBanzon): “Gatekeeping, sorry. It’showweunderstandgatekeeping. Idon’tknowwhetherI’mtheonlyonehere,butwethistraditionalviewthatagatekeeperisasinglephysician. If thatwere the case, then youwould imaginewider resistance.We should startseeinggatekeepingreallyaslikepolyclinics.Let’stalkCuba,Cubabasicallytheirstrengthisthepolyclinics,somewherepeopleareactuallycomfortable,thatwhentheygothere,theygetallthenecessaryprimarycareservices.Thenyour resistance why people won’t go to the gatekeeper will not be there. Because as Iunderstand,before,peoplereasoned,‘whywouldIhavetogotothemidwife;whywehavetogo to the single physician doctorwho’s not there?’ So if the primary care providers in thePhilippinescansortofenvisionbeingwellequipped,thentheycanactuallymanagea lotofconditionsalready.Icanimaginethegatekeepingsystemwillactuallywork.It’seasytomakethat happen in the Philippines. So you that service delivery aspect can be managed quiterapidly.”A point raised here was the readiness of the PhilHealth not to pay and pass through agatekeeper,andifso,itwillsolvealotoffraud.Dr.BanzondiscussedthattheGatekeepingsystem in the Philippines will actually work and would be easy to implement. But theproblemdiscussedwasthattherewouldbeawiderresistanceofthepatientsnottogotohealthcarefacilities,unlessthephysiciansarefullyequippedtomanagealotofconditions.Consequently, the service delivery system in the Philippines would be managed quiterapidlyaswell.The Sin Tax Law Reform is a milestone. The NHTS-PR or the Listahanan 2 was alsohighlightedbyProf.Novales.Also, itwasmentionedthat lookingintothebiggerchunkofthepopulation,specificallytheinformalsector,isveryimportantanditiscompellingthemtocontributetothesystem.

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ThechallengeattheendofthediscussionwasPhilippinesshouldmakethefinaldecisiontoachieveuniversalhealthcareandmoveforward.

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SYNTHESISByProf.KonradObermann,MD,PhD

SeniorLecturer,MIPHMannheimInstituteofPublicHealth–HeidelbergUniversityTherearethreesuggestionsthatProf.Konraddiscussed.Firstisfocus.Therearesomanyissues thathavebeendiscussedand itwouldbehelpful ifPhilHealthwould focuson thethingsthatitcandoasacorporationandleastonthethingsthatitcannotdoonitsown,butratherrequiressupportfromothergovernmentinstitutions.Secondistheissueofmonitoring.PhilHealthshouldknowinwhichareastheyaregettingbetter and getting worse. The income quintile is a very good starting point and thesuggestionistocoverfromtherichesttothepoorest.TheListahanan2isalsoaverygoodapproachtomonitorwhoamongthepopulationispoor.Lastisresearch.Thereistheideaofsettinguparesearchinstitution.Theneedtoconductresearchinhealthfinancing,healthinsurance,andbenefitpackagingistremendousandtheneed is constant. It would be worthwhile to develop a facility and let people, who areexperts,provideanswerstoquestionsthatarepostedbypolicymakers.

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CLOSINGREMARKSBySVPGregorioRulloda

OICSeniorVicePresident,FundManagementSector,PhilHealthChairperson,AnniversaryCommittee

“Thank you Nina, themost awaited. I’m not here to present to you the financial status ofPhilHealth.Achieved!Today’sactivitycomes toanendandbasedon theproceedingsof theactivities, itwasaproductiveand challengingone. Sharingof ideasbasedon internationalandlocalexperiencesandperspectives.Thedynamicdiscussionmostprobablygaveus,we,inPhilHealthandourstakeholderspointstoconsideronhowwemoveforwardinattainingandsustaining Universal Health Coverage. Right now, we are challenged by change and thischangewill translatepolicydevelopment,evidence-basedresearchersandholisticapproachonhowwewillprovideareasonableleveloffinancialriskprotectiontoallFilipinos.BawatFilipino,Protektado.IhopePhilHealthwasabletorespondyourexpectationsonthissymposium.Andourprayerthis morning was realised as we were given the opportunity to learn and deepen ourunderstanding on the opportunities and challenges in the implementation on the nationalhealth insurance program. Special thanks to our development partner, the EU, PhilHealthBoard of Directors, the Department of Health, national and local agencies, ConstitutionalCommissions, other government and private institutions and organisations. Maramingmaramingsalamatpo!PhilHealthexecutivemanagementwouldlikealsothankthemembersofthe22thAnniversaryCommittee, the technicalworking group headed by SeniorManager Gilda Salvacion (Diaz)andSeniorManagerEvelynBangalan,theregistrationstaff,staffofHFPS,SMD,ACRE,BDRD,QA, the ILED, Corporate Marketing, Internal Audit, Corporate Affairs Group, CorporateCommunication, HRD, FMS, and of course the transportation, ushers and usherettes,PhilHealth Chorale, maraming maraming salamat and of course the Shangri-La HotelManagement.IwillendbyaquotationbyHelenKeller, ‘Alonewecandoso little.Together,wecandosomuch.’Ladies andgentlemen let us be one inmaking thePhilHealth agenda specificallyUniversalHealth Coverage a reality to our country. Once again maraming maraming salamat atmabuhaytayongmgaPilipino!”