Extracted from Papers of the Universal Health Care Study Group

Equity in health fair, just, and equal access to health care by all individuals, families and communities.

Constitutional guarantee: Article II Section 15 – “The State shall protect and promote the right to health of the people and instil health consciousness among them.”

Overall health status – Lower than Thailand, Malaysia, Japan and Korea

The 70 years average life expectancy at birth is more than 15 years shorter than those of developed countries.

The infant mortality rate of about 35 per thousand live births translates into 80,000 Filipino babies dying of preventable causes each year

Maternal mortality ratio that has remained well above 150 per 100,000 live births – meaning more than 3,000 Filipinas dying unnecessarily every year.

Status of Health Equity in the PhilippinesIndicator High Income /

urban areasLow Income / Rural areas

Life Expectancy

at Birth>80 <60

Infant Mortality

Rate<10 >90

Maternal

Mortality Ratio<15 >150

Childhood Death Rates by Mothers’ Level of Childhood Death Rates by Mothers’ Level of Educational AttainmentEducational Attainment

33 32

42

9 73

0

5

10

15

20

25

30

35

40

45

Neonatal Mortality Postneonatal Mortality Child Mortality

no education

>college

Childhood Deaths Childhood Deaths By Wealth Index, 2003 NDHSBy Wealth Index, 2003 NDHS

2125

21

136 1

0

5

10

15

20

25

30

Neonatal Mortality

Postneonatal Mortality

Child Mortality

poorest

richest

Comparison of Maternal Health Indicators

by Wealth Index (Source: 2008 NDHS and 2006 FPS)

Wealth Index

Quintile

Percentage of delivery by

Skilled Health Professionals

C-Section

Rate

Total Fertility

Rate

Unmet Need for Family

planning

Contraceptive Prevalence Rate

(modern)Currently

married women age 15-49)

% of women15-19 who

begun childbearing

Richest 94 28 2 21 33

(22)

3

Poorest 26 1 5 28 26 9

* The 2008 NDHS data on antenatal care (4 visits) is 83% for urban and 73% for rural residents. Average is 78%.

* The 2008 NDHS data on antenatal care (4 visits) is 83% for urban and 73% for rural residents. Average is 78%.

Six Building Blocks of a Health SystemOrganization of Health Services – fragmented and

inaccessibleHuman Resources for Health -Regulatory Mechanisms -weak and ineffectiveHealth Information Systems– antiquated and

inappropriate for policy-making and management

Governance Structures– limited participation of individuals, families and communities

Health Care Financing

Healthcare worker distribution

• 70% of ALL health workers employed in the private sector serving 30% of the population

• 30% employed in government services catering to the majority…– …of whom many are also engaged in the private

sector licitly or illicitly

Output of a Flawed System

• Health providers for whom service is a lower priority than personal professional advancement.

• They are ill-prepared for dealing with health problems in the Philippine setting.

Inadequate, inefficient, and inequitable Health Care FinancingTotal Health Expenditure (2005)

PHP 200 billion% of GNP < 3 %

% of GNP per WHO > 5 %

NHA2004: Sources of FundsGovernment (local & national) 30.3%

Social Health Insurance 9.5%

Private Shared Risk 12.5%

Out of Pocket 47.7%

Only those with money (i.e., the Only those with money (i.e., the rich) can fully pay for out of pocket rich) can fully pay for out of pocket payments and often they have payments and often they have generous health insurancegenerous health insurance

The near-poor and the lower The near-poor and the lower middle classes can become middle classes can become impoverished to meet out of impoverished to meet out of pocket payments for health care.pocket payments for health care.

The very poor don’t The very poor don’t even have pocketseven have pockets

Recommendation: Aim for Universal Health Care Increase in level and coordination of government

spending by national government (including DOH and PHIL Health as well as other sources such as PAGCOR, PCSO) and local government to reduce out of pocket spending to <30%

Restructure HRH production of government institutions to target government and other service oriented organizations to emphasize service over self-interest

Strengthen regulation of private sector to include, where appropriate, cost containment measures

Six Building Blocks of a Health SystemOrganization of Health Services – fragmented and

inaccessibleHuman Resources for Health -Regulatory Mechanisms -weak and ineffectiveHealth Information Systems– antiquated and

inappropriate for policy-making and management

Governance Structures– limited participation of individuals, families and communities

Health Care Financing