04 Health Inequiites - The Urgent Need for Health System Reforms in the Philippines - Dr. Alberto G. Romualdez Jr

8/14/2019 04 Health Inequiites - The Urgent Need for Health System Reforms in the Philippines - Dr. Alberto G. Romualdez Jr.

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By Dr. Alberto Romualdez

Dean, Graduate School of Health Sciences

Pamantasan ng Lungsod ng Maynila



Overall health status – Lower than

Thailand, Malaysia, Japan and Korea

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

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

Maternal mortality ratio that has remained well above150 per 100,000 live births – meaning more than 3,000Filipinas dying unnecessarily every year.



LEB over 80 yearsIMR less than 10

MM less than 15

LEB under 60 years

IMR over 90

MM over 150



Inequity in Health Outcomes Average Fertility Rate by Income Quintiles

Income Group Average Fertility

Rate (Desired)

A 2.0 (1.9)

B 2.4C 3.7

D 4.7

E 5.6 (3.1)



Organization of Health Services Public- Private Sector imbalance

Highly resourced private sector servicing 20-30 % of population

Health promotion/Disease prevention lag behindCurative Service provision

Fragmentation of Services

Overspecialization of curative services (private sectorcherry-picking of lucrative specialties)

Devolution of health services - national and local

Weak regulatory mechanisms



Result: Inequitable Access to

Health Services Less than 50% of poor women get vitamin

supplements compared to 80% of high income women

2% of lowest quintile women and 20% of highestquintile have caesarean sections

Less than 50% of children from lowest quintile homescompared to 80% from highest quintile are

immunized Each year, less than 5% of the estimated 3000 new

Filipino end-stage renal disease cases can have kidney transplants



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.



Health Care FinancingTotal Health Expenditure (2005)

PHP 200 billion

% of GNP < 3 %

% of GNP per WHO > 5 %





Only those with money (i.e., the rich) can

fully pay for out of pocket payments andoften they have generous health insurance

The near-poor and the lower middleclasses can become impoverished tomeet out of pocket payments for healthcare.

The very poor don’t evenhave pockets



Top Ten Hospitals (PhilHealth Claims) 2006

1. The Medical City

2. St. Luke’s Medical Center

3. Chong Hua Hospital

4. Chinese General Hospital

5. Dr. Pablo O. Torre, Sr. Memorial Hospital

6. Makati Medical Center

7. Davao Medical Center*

8. Davao Doctors’ Hospital

9. Cebu Doctors’ Hospital

10. Perpetual Succour Hospital

* - The only government hospital on the list



Recommended Reforms for

Universal Health Care Information System – Create a national council

mandated to craft a health information -

education-communication master plan that isdesigned to maximize the use of informationtechnology for health service delivery.

Regulation - Regulatory functions of DOH andlocal governments should be further strengthenedto promote the double objectives of health sectorreform -- equity and efficacy .




Universal Health Care Governance – DOH should effectively wield its

influence on the different health sector actors –government, private and nongovernment – towardsuniversal access.

Organization of Services - Government facilitiesshould be reorganized and integrated in accordance

with the principles of primary health care based on anupdated version of the Alma Ata Declaration. They should provide integrated health services eitherdirectly or through a unified and formalized referralsystem.




Universal Health Care Human Resources for Health - Restructure health

workforce production system to emphasize service overself-interest by integration of regulation under DOH.

Health Care Financing - Quantum increase in tax-basedcoordinated government spending and reorientation of

Philhealth as a true social health insurance program thatmaximally spends its health fund on benefits to fully support the health requirements of all Filipinos.



It is time to elevate the level of politicization of health from that of parochial self-interests and petty patronage to a national issue of

common concern.



End of Presentation

Thank

you!



Cost of medicines and other

health supplies

The prices of medicines in the Philippinesare among the highest in the world – higher

than Europe and America and most of Asiaand certainly too high in relation tohousehold incomes of most Filipinos. Given

the high prices, most medicines are beyondthe paying capacity of most Filipinos.



Number of day’s wages needed to purchase

a 30 days treatment with Ranitidine

- Philippines, 30 days

- Sri Lanka, 10 days

- Brazil, 10 days

- South Africa, 5 days



Source: WHO, World Health Survey, 2002

Average 4-week Medicine Expenditures within

Household Expenditure Quintiles

$0

$10

$20

$30

$40

Ghana Cote

d'Ivoire

Senegal

Morocco

Tunisia

India

Pakistan

Philippines

M e d i c i n e

E x p e n d i t u r e s

i n L a s t 4

W e e k s b y Q u i n t i l e s

Quintile 1 Quintile 2 Quintile 3 Quintile 4 Quintile 5

$88$153

Result: Poor families cannot afford to pay for medicines



Characteristics of Reforms for

Universal Health Care Coordination

Integration

Regulation

Participation

Documents

04 Health Inequiites - The Urgent Need for Health System Reforms in the Philippines - Dr. Alberto G. Romualdez Jr