Decentralization and National Health Accounts
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Transcript of Decentralization and National Health Accounts
Decentralization 1
Decentralization and National Health
AccountsMa. Paz G. De Sagun
Office of Population, Health & Nutrition
USAID/Philippines
October 9, 2002
Decentralization 2
LGU
Local planning
HealthSocial welfare services
Environmental Management
Agricultural extension
Tourism
Housing
Investment support
Decentralization 3
By 1993:
595 hospitals
12,859 rural health units
46,080 personnel
78 provinces
1,543 municipalities
41,924 barangays
LGUs
Decentralization 4
Selected Indicators
1993 1998 1999 2000Fully Immunized Child 72% (1) 65% (2) 65% (3) 66% (4)
Mothers having 3 or more Prenatal Care Visits
81% (5) 77% (2) 81% (3) 81% (4)
Children receiving Vitamin A capsule Supplementation
90% (7) 78% (7) 74% (7) 82% (7)
Contraceptive Prevalence Rate 40% (1) 47% (2) 49% (6) 47% (6)
1 National Demographic Survey 1993
2 National Demographic and Health Survey 1998
3 Maternal and Child Health Survey 1999
4 Maternal and Child Health Survey 1999
5 Philippine National Safe Motherhood Survey 1993
6 Family Planning Survey
7 FETP-DOH Cluster Survey
Decentralization 5
DEVOLUTION OF HEALTH SERVICES
Department of Health
Regional Health OfficesDOH Retained Hospital
Provincial Hospitals
Provincial Health Offices
City Health Offices
City Hospital
District Hospitals
District Health Offices
Barangay Health Stations
Municipal Health Offices
Rural Health Units
Barangay Health Stations
Municipal LGU
DOH
Province/City LGUs
Decentralization 6
Average Total Cost of Devolved Functions, 1993
(Million Pesos)
LGU
Cost of Devolved Health Functions (CHDF)
Total Cost of
Devolved Functions
(CDF)
Share of CHDF to
Total CDF (%)Personal
Services
Maintenance and
Operating Expenses
Total
Overall Average 4.75 3.39 8.14 10.83 56.18
Province 20.32 13.59 33.9 41.64 81.49
City 1.07 2.11 3.18 6.11 52.05
Municipality 0.66 0.52 1.18 2.3 49.21
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Decentralization 8
Workbook and Manual: Management and Organizational Options for Devolved Hospitals
A Manual for Regional Health Coordination
National Health Accounts
Provincial Health Accounts: Selected LGUs
National Health Insurance Act
Provincial Health Insurance Program: A Manual of Operation
Operational Health Planning under a Decentralized Set Up (Training Modules)
Health Budgeting and Financial Management under a Decentralized Set Up (Training Modules)
Decentralization 9
Share of Health Expenditure to GNP
2.86 2.88
3.16 3.14
3.33 3.37 3.44 3.4 3.43
3.25
0
0.5
1
1.5
2
2.5
3
3.5
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
P
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Year
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SOURCE OF FUNDS
PERCENT SHARE
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
GOVERNMENT 38.51 35.17 36.60 37.24 35.32 36.31 38.30 38.65 37.91 41.08
National 34.66 30.80 24.07 21.26 19.33 19.93 20.52 20.53 20.04 21.51
Local 3.85 4.37 12.53 15.98 16.00 16.37 17.78 18.13 17.87 19.57
SOCIAL INSURANCE 5.44 5.97 6.36 5.70 4.54 5.06 5.13 3.74 4.86 7.10
Medicare 5.17 5.71 6.07 5.37 4.25 4.79 4.87 3.46 4.61 6.87
Employees' Compensation
0.27 0.26 0.30 0.34 0.28 0.27 0.26 0.27 0.25 0.22
PRIVATE SOURCES 56.05 58.86 57.03 57.06 60.14 58.63 56.58 57.61 57.23 51.81
Out-of-Pocket 47.69 49.58 47.75 47.47 50.43 48.71 46.88 47.96 46.26 41.01
Private Insurance 2.88 2.83 2.41 2.09 1.77 1.68 1.94 1.98 2.14 2.03
HMOs 1.25 1.31 1.42 1.64 1.98 2.28 2.50 2.88 3.84 3.86
Employer-based Plans
3.41 4.18 4.53 4.89 4.98 5.06 4.42 3.95 4.01 3.76
Private Schools 0.82 0.95 0.92 0.97 0.97 0.91 0.84 0.85 0.99 1.13
ALL SOURCES 100 100 100 100 100 100 100 100 100 100
DISTRIBUTION OF HEALTH EXPENDITURE BY SOURCE OF FUND
Decentralization 11
Personal 79.95%
Others 12.00%Public 8.05%
1991 Distribution of Health Expenditure by Use
2000 Distribution of Health Expenditure by Use
Personal 73.85%
Others 12.18%Public
13.98%
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And so …..Devolution is complex and challenging but it is desirable.
NHA is a useful tool and framework for health sector reform.
Remaining key challenges:
Financing of essential public health services including FP/RH
Covering poverty groups via risk sharing and social health insurance