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Kalusugan Pangkalahatan

Updates

Enrique T. Ona, MD,FPCS, FACSSecretary of Health

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Filipino Income Quintiles

Monthly income Families per quintile

Q1 3,460 5.2 Million

Q2 6,073 4 Million

Q3 9,309 3.9 Million

Q4 15,064 3.7 Million

Q5 38,065 3.4 Million

Source: Family Income and Expenditure Survey, 2006 andNational Health and Demographic Survey, 200

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Income tiers relevant for differential pricing effortsSocio-economic classes according to Philippine monthly family income

(10% of the population) no reason or place for access initiative

DP plus (60 plus % of the population)even at-cost provision of drugs would be

beyond purchasing power of this tier additional deliverables through inclusion

of government and NGO-stakeholder as well as pro bono contributions of companies

needed to improve access in this income class; the focus on maternal and under 5 mortality as well as on other primary health care issues (e.g. strengthening health systems by health

education, logistics, training, etc.) will alsohelp political acceptability of the whole project.

differential pricing (18- 25% of the population)opportunities to improve access via differential

pricing

1.1%

8.9%

6.6%

1.1%

47.5%

31.3%

10%

4

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Kalusugan Pangkalahatan

1. Financial Risk Protection for the Poor Expansion coverage of the poor and informal sector

(Q1 and Q2)

Increase availment of PhilHealth benefits Increase support value of PhilHealth

2. Providing access to quality health services Enhancement and modernization of public hospitals

and health centers Public-Private Partnership to mobilize additional

financing

3. Attainment of health related MillenniumDevelopment Goals

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Increase Coverage of Poor Families

Full National Government subsidy for the poorestfamilies identified by the NHTS (Q1); LocalGovernment subsidy for non-NHTS poor (Q2)

Interpret the National Government-LocalGovernment sharing requirement of the PHIC Law/IRR not to an individual but in the number of

families to be enrolled; if not possible, amend lawentirely to allow this type of sharing

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Status of Enrollment for the Poor in

2011 As of 19 July, all of the 5.2 million families identified

by the NHTS-PR are now enrolled in PhilHealthunder the Sponsored Program. This represents 100%of the families classified by NHTS-PR as the poorest

Filipino families. Qualified members can avail of PhilHealth from April

December 2011

The next poor 3.8 million families already enrolled inPhilHealth using local government funds andPhilHealth reserve fund

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949,818

NHTS MATCHED NON-NHTS

5,219,936 - 949,818

4,270,118

949,818 4,777,700- 949,818

3,827,882

MATCHINGRESULTS

ENROLLMENT OF THE POOREST

FAMILIES

Total number of Filipino families: 18.4million (NSCB, 2009)

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POLICYINTERVENTIONS for

2011

ENSURE COVERAGE SUSTAIN COVERAGE

Special Premium Rates

NG: P 3.5 B

Applicable LGU Share + PhilHealth Reserve Funds

LGU: P 1.7 B

PhilHealth reserve: P 1.7 B

SP enrollmentDSWD NHTSPR-Poor Matched

3,827,882949,8183,943,988

Philhealth BoardResolution nos. 1478

ENROLLMENT OF THE POOR

FOR 2011

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Improve Coverage of the Informal Sector(Q3-Q4)

Mandate enrollment in PhilHealth of those whocan afford to pay higher premiums (informal,self-employed sector) as mandated by PhilHealth

law (RA 7875 as amended)

PhilHealth membership as a requirement for

NG/LG transactions such as licenses, businesspermits, etc.

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Increase Availment of PhilHealth

Benefits (1) Streamline requirements for availment of benefits Removal of the 9 month waiting period to avail of PhilHealth

benefits Investment of P350M in IT to fast-track PhilHealth

transactions such as membership, accreditation,claims processing, etc.

Set-up PhilHealth desks in public hospitals tofacilitate enrollment and other processes

Integration of DOH and PHilHealth licensing andaccreditation processes

Assignment of poor families to particular healthproviders

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Increase Availment of PhilHealth

Benefits (2) Intensify enrollment and information on PhilHealthbenefits and entitlements Capacitate Community Health Teams to assist PhilHealth

members in the communities on information about

PhilHealth PhilHealth Sabado 1 (2 October 2010): Registered

192,049 members for the Sponsored Program; 27, 813members for the Individually Paying Program

PhilHealth Sabado 2 (25 June 2011):

distribution of 719,930 PhilHealth membership cards for thosebelonging in the NHTS-PR and the registration of 7,238 members from the informal sector. 40,536 members also participated in the orientation of PhilHealth

entitlements and responsibilities on the same day

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Increase support value ofPhilHealth (1)

Case Rates for 22 of the most common in-patientservices (requires confinement) with no-balancepayment/ out of pocket payment in public

hospitals for the poorest identified by NHTS-PR

Streamline the use of capitation fund by

establishing a Health Trust Fundfor exclusiveuse of improving health services in all governmenthealth facilities

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Case Rates

Surgical Cases

Case

Rates

(Php)

Surgical Cases

Case

Rates

(Php)

1 Radiotherapy 3, 5 Cholecystectomy 31,

2

Maternity Care Paca!e

"MCP#

8,

$ %ilatation and C&retta!e 11,

'(% Paca!e in )e*el 1

+ospitals 8, 7 hyroidectomy 31,

'(% Paca!e in )e*els

2 to 4 +ospitals !,5 8 +erniorrhaphy 21,

3 Caesarean (ection 19, 9 Mastectomy 22,

4 -ppendectomy 24, 1 +ysterectomy 3,

11 Cataract (&r!ery 1!,

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Case Rates

". Me#ical Cases

Case

Rates(Php)

Me#ical Cases

Case

Rates(Php)

1

%en!&e / "%en!&e

0e*er and %+0 rades

/ //#

8,

$ Cereral /narction "C-

/#28,

7Cereral +emorrha!e"C- //#

38,

2%en!&e //

"%+0 rades /// /#1!,

8 -c&te astroenteritis

"-6#!,

9 -sthma 9,

3 Pne&monia / "Moderate

Ris#15, 1 yphoid 0e*er 14,

4 Pne&monia // "+i!h

Ris#32,

11

'eorn Care Paca!e

in +ospitals and )yin! in

Clinics1,$55

6ssential +ypertension 9,

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Increase support value of

PhilHealth (2) Develop and establish a separate CatastrophicHealth Fundto support expenses of patientswith highly expensive illnesses based on cost-

effectiveness (heart disease, cancer, stroke,complications of diabetes, etc)

Gradually increase out-patient coverage ofdiagnostic procedures and medicines especiallyfor non-communicable diseases.

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Future Directions in PhilHealth

DOH Budget Proposal of P 12.028 B in the 2012budget to enroll the poorest 5.2 million familiesbelonging to the NHTS-PR at annual premium of

P 2,400.00/family (from the current P 1,200.00). Local government units to enroll Q2.

Strengthen research on health financing and

health systems development by establishing amulti-disciplinary advisory unit

Establish specific timelines and targets for the

implementation of health reform interventions

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Future Directions in PhilHealth

Higher support of coverage for catastrophicillnesses

Develop second level of additional services based

on a separate premium Provide legislative support to improve enrollment

especially of the informal sector who can pay ahigher premium

Expand case rate payments and no-balancebilling (no out of pocket expenses)

Establish role of private insurance and HMOs inKalusu an Pan kalahatan

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Health Facilities Enhancement

Upgrading of selected health facilities Procurement of modern medical equipment and

construction of modern infrastructure in 24strategically located DOH Regional Medical Centers

Financial and technical assistance to localgovernment in enhancing the capabilities of ruralhealth units, district and provincial hospitals

Public-Private Partnership for Health Deployment of Mobile Clinics (Bus, Air and WaterAmbulances) for 4Ps Areas and GeographicallyIsolated and Depressed Areas

Complete Treatment Packs in 4Ps Areas

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4

2

2

2

3

CCT areas w/ nofacility upgrade

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Health Human Resources

Deployment of additional 12,000 nurses

in far flung areas through the RegisteredNurses for Health Enhancement andLocal Services (RNHeals) for 2012 to befunded through the 2012 DOH Budget inaddition to the 10,000 currentlydeployed nurses in 4Ps areas

To assist in delivery of health care in thecommunity

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Health Human Resource

Doctors to the Barrios (DTTBs) Item Projection

By October 2011, there will be 137DTTBs:

42 current DTTBs 53 Pinoy MD scholars

42 First Gentlemen Scholars Batch 4

By October 2012, there will be 300 DTTBs:

95 current DTTBs

73 Pinoy MD scholars

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Attaining the

Millennium Development Goals Efforts to increase PhilHealth benefit delivery andenhance health facilities is directed to theattainment of MDG Commitments

PhiHealth Benefit Delivery Rate (BDR) - to improveaccess to health services for families

Enhancement of health facilities - to ensureavailability of quality services particularly onmaternal and child health and other common causesof morbidities

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Attaining the

Millennium Development Goals Scale up public health interventions and

promotive health services

Regional task forces to implement, monitor andevaluateKalusugan Pangkalahatan thrusts

MDGMax for Non-Communicable Diseases as wellas Injuries and Disaster Risk Reduction

Focused approach resources on 12 areas withhighest concentration o NHTS poor, women withunmet need for family planning, mothers giving

birth outside of facilities, children not given Vit A

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Development of Accelerated Plan

on Health Reform for ARMM Recognition of the need to give special attentionto ARMM given its poor health outcomes andinequitable access to health services;

Plan includes:

Upgrading facilities that can immediately delivercritical life-saving health care services

Provision of adequate security to health personneland health assets

Direct and transparent transactions to ensure that

new investments translate to real improvements in

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2011 Targets

For PhilHealth: to enroll the 5.2 million familiesin the NHTS-PR list by December 2011

For enhancement of hospitals and health centers:

PPP projects in Philippine Orthopedic Center andResearch Institute for Tropical Medicine approvedby October 2011

For MDGs: establish 2011 infant, child and maternal

mortalities through Community Health Teamsusing telehealth

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Thank you!