LOCAL HEALTH ACCOUNTS IN THE LOCAL HEALTH ACCOUNTS IN THE PHILIPPINES PHILIPPINES Understanding the Sources and Uses of Funds in Understanding the Sources and Uses of Funds in a Decentralized Health Systema Decentralized Health System

Philippine National Health Philippine National Health AccountsAccounts Developed in 1991 to provide basis

for health reforms

Provides information for evidence-based decision-making

- setting targets and goals - monitoring the progress and outcomes

of policy interventions

Office of Secretary of Health

Executive Committee for National Field Operations

Regional Offices

Provincial Health Offices

City Health Offices District Health Offices

City Hospitals Rural Health Units

Barangay Health Stations

District Hospitals Municipal Health Offices

Barangay Health Stations

Provincial Hospitals

Regional Hospitals Medical Centers

Sanitaria

• Devolved to provincial government• Devolved to city government • Devolved to municipal government

Health Reform in the Health Reform in the PhilippinesPhilippines

National Health Insurance Program Law 1995

Local Government Code 1991

Despite these reform initiatives..

Questions remain unanswered

how much is being spent on health carewho pays for health carewhat health care services are being spent on

Lack of sector-specific expenditure data at the local level made it difficult to analyze local spending for health

Local Health AccountsLocal Health Accounts

• Mid 1990s: LHAs in selected provinces not sustained

• Lack of capacity to do estimation• Inadequate appreciation and use of LHA

information in local policy-making

• 2008: - Local purpose felt with the PIPH

Data needed for use for setting targets and goals, monitoring progress, and evidence-based decision-making

- DOH spearheading building capacities and institutionalization

INSTITUTIONALIZING LHA ESTIMATION

• National LHA team/TWG overseeing the institutionalization of LHA estimation in the provinces

• LHA estimation methodology developed, based on international methods of estimating health accounts. Manuals and other guide materials developed.

- Methodology is simple, doable

- Uses secondary data

Local Health Accounts: Local UseLocal Health Accounts: Local Use

Province of CapizKnown for successful health reforms: e.g. implementation of pooled procurement and revolving drug funds

2006 LHA became the basis to triple enrollment of indigent population in the National Health Insurance Program

Source: Province of Capiz, 2010

Capiz Budget for PhilHealth Enrollment of Indigent Families

Source: Preliminary Capiz Local Health Accounts, 2006-2010

Capiz Health Expenditures by Financing Agent, 2006-2010

Local Health Accounts: Local UseLocal Health Accounts: Local Use

Province of Bukidnon

All indigents enrolled by Province in PhilHealth. Facilities are equipped to deliver curative services.

Province to use LHA results to discuss and leverage with municipalities the delivery and financing of preventive and public health services.

Source: Preliminary Results of Bukidnon Local Health Accounts, 2006-2010

Health Expenditures by Financing Agent, Bukidnon, 2006 -2010 (in Percentage)

Source: Preliminary Results of Bukidnon Local Health Accounts, 2006-2010

Health Expenditures by Health Care Function, Bukidnon, 2006 -2010 (in PhP)

Source: Annual Health Report, Bukidnon, 2010

Local Health Accounts: Local UseLocal Health Accounts: Local UseMakati City• Makati Health Program (MHP)/Yellow Card

Program: City subsidizes hospitalization expenses of constituents in the

city hospital

• LHA results flag areas to make the MHP more sustainable by minimizing unnecessary subsidies: - need to properly identify services due for reimbursement from the National Health Insurance Program - need to cost hospital service properly, to be able to charge the paying patients correctly

Source: Preliminary Results of Makati City Local Health Accounts, 2006-2010

PhilHealth Claims in Makati City and in Ospital ng Makati, 2006 -2010 (in PhP)

CHALLENGESCHALLENGES

Data Collection

Mainstreaming in the functions of the local personnel: planning, budgeting

LHA: WAY FORWARDLHA: WAY FORWARDAt the local level Mainstreaming in the planning and budgeting

processes PIPH and LGU Scorecard

At the national level Mainstreaming in the monitoring systems - LGU Scorecard

More responsive financing support to LGUs

Partnering with a training institution to offer LHA training courses