Health Policy and Kalusugan Pangkalahatan

Health PolicyandKalusugan Pangkalahatan

What is Health Policy?

0 10025 x 1,000 km 75

Parameter 25 75 100Life Event Manufacture to

PrimeMiddle Age Resale / Trade-in /

ScrapCare

Provider“Casa” “Talyer” / Self-

repair?

Dx, Tx, Rx Preventive Maintenance

(e.g., Oil Changes)

Brake Pad Replacements, Recalibrations

Overhauls

Costs of Care

+ +++ +++++

Financing Co-pay Co-pay, Insurance Co-pay, InsuranceCatastrophe MV “Crash” (Damage)

Regulation LTO, LTFRDB, MMDA, etc.

0 10025 x 1 year 75

Parameter 25 75 100Life Event Birth to Early

AdulthoodMiddle to Old Age (Very) Old Age

Care Provider

Clinics(OB, Pedia, Surg)

Clinics / Hospitals(IM, Surg)

Hospitals(IM, Surg, Patho)

Dx, Tx, Rx Outpatient > Inpatient

(Vaccines, Vitamins, etc)

Outpatient = Inpatient

(“Maintenance” Meds, etc)

Outpatient << Inpatient

(ACLS, Critical Care, etc)

Costs of Care

+ +++ +++++

Financing OOP vs. Insurance OOP vs. Insurance OOP vs. InsuranceCatastrophe MV “Crash” (Trauma)

Regulation PRC – Board of Medicine, DOH (incl. FDA), PHIC, etc.

Demystifying and De-medicalizing

The allocation of resources must be explicit Decision-making at all levels must be open Medicine must be de-mystified and health de-

medicalized, for professionals, patients, the general public and politicians alike

Public health / health policy is thus multi-disciplinary, and multi-stakeholder

Reference: Gray, 2004 (pp. 317-318), modified

“Pharmacology” of Health Policy

DYNAMICS and the mechanism of action: Will an intervention reduce the risk?

KINETICS and the response of the system: Will the intervention for the main concern increase other

risks? (i.e., adverse effects)

THERAPEUTICS and delivery: Is it operationally possible to introduce the intervention?

Reference: Gray, 2004 (p. 296), with modification

Health Policy:Scope, Scale, and Stakeholders

Point of

Care

Service Delivery Networks

National and Local

Governments

Private Sector

Dynamics

International/Global Health

Factors in Health Policy Change

OLD POLICY

NEW POLICY

Ideologicalinspirations

Change in circumstances

Evidence

Common sense

From research

From experience

Reference: Gray, 2004 (Fig 7.8, p. 291; p. 292)

NOTE: Policy makers operate on a timescale that does not generally admit of delays that research will take.

How has health policy developed over timein the Philippines?

Historiography of PH Public Health

Spanish era: reordering of Philippine society American era: a civilizing mission to prepare Filipinos

for independence; governance through sanitation, health, hygiene, medical and scientific institutions, medical and health professions Public schools and school children as agents for public

health work Educational, medical, and scientific research institutions as

training and preparation “laboratories”

Leading to “Filipinization” of the bureaucracyReference: Planta, 2008

History of Philippine Health Reform

1960s: Medicare 1970s: Population Policy 1980s: Generics Act of 1988 1990s:

Local Government Code of 1991 National Health Insurance Act of 1995

2000-present: HSRA F1 KP

Reference: Romualdez, 2011

FINANCING

SERVICE DELIVERY

Epidemiological Transition

1954

'55

'56

'57

'58

'59

'60

'61

'62

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'65

'66

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'69

'70

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'01

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'07

2008

0

100

200

300

400

500

600

0

10

20

30

40

50

60

70

80

90

100

110

Communicable Diseases Malignant Neoplasm Diseases of the Heart

Year

Dea

ths

per 1

00,0

00 p

opul

atio

n (c

omm

unic

able

dis

ease

s)D

eaths per 100,000 population (non-com

municable diseases)

Source: Philippine Health Statistics, various years

Is Universal Health Caremore fun in the Philippines?

Are

you

gett

ing

wel

l?

Can you pay for the services?Reference: Berman, 2012

Improved Health

Outcomes and Minimal

Financial Risk

PhilHealth Coverage

Access to Professional Healthcare

Use of Quality

Services

Payment of PhilHealth

Claims

Value of PhilHealth Benefits

Reduction of Exposure to Health Risks

2

32

2

1

16

Start with the Poor and Vulnerable

Q1 Poorest Q2 Poor Q3 Middle

Income Q4 Rich Q5 Richest

39 M poor individuals 59 M non-poor individuals

Note: Population counts projected for FY 2013 (except for DSWD numbers); rounded off to the nearest million.• Poverty incidence by NEDA/NSO is only a statistical

estimate• DSWD’s NHTS-PR and 4Ps/CCT, while with data on names,

faces, and places, may not have enlisted all the “real poor”

• The DOH thus uses Q1 + Q2 for planning estimates, with reliance on the DSWD’s NHTS-PR and 4Ps/CCT for targeting/identification

27 M individuals (NEDA)30 M individuals (NHTS-PR)18 M (4Ps/CCT)

Identified by DSWD

1.0Public Health

MDGs Achieved

1.1 - Reduce Maternal and

Child Mortality

1.2 - Control and Eliminate

Infectious Diseases

1.3 - Promote a Healthy

Lifestyle and Prevent NCDs

2.0Financial Risk

Protection Improved

2.1 - Expand PhilHealth Coverage

2.2 - Improve PhilHealth

Benefit Package

3.0Quality Care

Delivery System

Accessible

3.1 - Upgrade and Improve Health Units

and Hospitals

3.2 - Deploy Human

Resources for Health

4.0Health

Governance Improved

4.1 – Improve/ Reform Health

Systems

4.2 – Maintain an Effective

Health Regulatory

System

Outcomes and Strategies1 2 3

How will we achievepublic health MDGs?

1

1.0Public Health

MDGs Achieved

1.1 - Reduce Maternal and

Child Mortality

1.2 - Control and Eliminate

Infectious Diseases

1.3 - Promote a Healthy

Lifestyle and Prevent NCDs

Package of actions

and population coverage:

• Increase facility-based deliveries and family planning services, commodities and counseling for Q1 and Q2 mothers & women of reproductive age

• Immunize all infants according to the Expanded Program on Immunization (EPI) & provide pneumococcal and rotavirus vaccines among susceptible communities

• Immunize poor senior citizens (influenza and pneumococcal vaccines)

• Provide vitamins & minerals to all children (<5 y/o)

Carpio

RPRH Law?

April 8, 2014 (Tuesday)

1.0Public Health

MDGs Achieved

1.1 - Reduce Maternal and

Child Mortality

1.2 - Control and Eliminate

Infectious Diseases

1.3 - Promote a Healthy

Lifestyle and Prevent NCDs

Package of

actions and

population coverage:

• Treat all diagnosed TB cases• Eliminate malaria in endemic

provinces• Improve HIV/AIDS prevention,

screening, diagnosis, and treatment • Provide rabies vaccine for dog bite

victims and coordinate with DA for dog vaccination

• Eliminate filaria and other intestinal parasites

Susceptible Population

Infection

Screening and Confirmation

Treatment

(DOTS)

Not detected or false negatives on screening,

hence not treated;Or self-medicated

MDR TB Mortality

Treatment Success

Rate (TSR)

Case Detection Rate (CDR)

PrevalenceRateIncidence

Rate

TB Infection Cycle

Failed treatment

Spontaneous remission

Case Notification Rate (CNR)

Cure Rate (CR)

1.0Public Health

MDGs Achieved

1.1 - Reduce Maternal and

Child Mortality

1.2 - Control and Eliminate

Infectious Diseases

1.3 - Promote a Healthy

Lifestyle and Prevent NCDs

Package of

actions and

population coverage:

• Promote key health messages (on Healthy Lifestyle, preventing disease and injury, available health services)

• Establish, link, and maintain non-communicable disease registries in provinces

• Provide access to screening services for NCDs for the poor through PhilHealth Primary Care Benefit package

How will we improveFinancial RisK Protection?

2

Who pays for the cost of health care?National Government

12%Local Government

15%

Social Health Insurance

(PhilHealth)9%

Private OOP53%

Others11%

Source: 2011 Philippine National Health Accounts

2.0Financial Risk

Protection Improved

2.1 - Expand PhilHealth Coverage

2.2 - Improve PhilHealth

Benefit Package

Package of actions and

population coverage:

• Expand coverage of all Filipinos, especially the poor and near-poor (14.7M)

• Inform and guide all members on PhilHealth availment procedures and benefits

• Improve access to primary care benefit package for the poor (drugs & diagnostics)

• Increase PhilHealth share in total health care costs, to minimize out-of-pocket payments

Increased Fiscal Space: “Tuwid na Daan” Sin Tax Reform of 2012 National Health

Insurance Act of 2013

How do we make a Quality Care Delivery System Accessible?

3

3.0Quality Care

Delivery System

Accessible

3.1 - Upgrade and Improve Health Units

and Hospitals

3.2 - Deploy Human

Resources for Health

Package of actions and

population coverage:

• Upgrade, build, and enhance:

• Barangay health stations as well as rural and city health units to deliver preventive health services

• LGU district and provincial hospitals for quality outpatient and inpatient care

• DOH regional hospitals and medical centers to make specialized care more affordable

• Distribute complete treatment packs (for common diseases like infections, diabetes, hypertension, heart diseases, etc) to poor patients

3.0Quality Care

Delivery System

Accessible

3.1 - Upgrade and Improve Health Units

and Hospitals

3.2 - Deploy Human

Resources for Health

Package of actions

and population coverage:

• Deploy human resources for health (Physicians, Nurses, and Midwives) nationwide, properly distributed with priority to NHTS and other priority areas

• Train and deploy Community Health Teams (CHTs) to reach families with key messages and basic preventive care

Public/Gov’t Health Facilities

Office of Secretary of Health

Attached Agencies

Regional Offices

Provincial Health Offices

City Health Offices(Component Cities)

Inter-local Health Zones

City Hospitals

Health Centers

Barangay Health

Stations

District hospitals

Municipal health offices/ Rural Health Unit

Barangay Health Stations

Provincial Hospitals

Regional hospital Medical Centers

Sanitaria

City Health Offices(Chartered Cities)

City Hospitals

Health Centers

Barangay Health

Stations

References: Kelekar and Llanto, 2013; Khemani, 2010

The Five-Star Doctor

Roles Health Care Provider Teacher Researcher Social Mobilizer Manager / Policy

Maker

Examples of Leaders Expert Clinicians Deans and

Professors Principal

Investigators Health Advocates DOH Officials / Staff

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