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An Approach to Financing Universal Health Care. Orville Solon UP School of Economics June 29, 2010. Key Arguments. The money already being spent in the health system is sufficient to pay for a critical package of health services for all Filipinos. - PowerPoint PPT Presentation
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An Approach to FinancingUniversal Health Care
Orville SolonUP School of Economics
June 29, 2010
Key Arguments
• The money already being spent in the health system is sufficient to pay for a critical package of health services for all Filipinos.
• The challenge is to be able to pool and manage the funds to: (a) address inequities, and (b) remove inefficiencies
How Much is Being Spent for Health (2006 Philippine National Health Accounts)
• Total health care spending is at least P225 billion
• Health spending by national and local government units total P52.4 billion
• Social health insurance accounts for P19.1 billion
• Family out-of-pocket spending is P128 billion
Sources and Uses of Health Expenditures – Health Reform Targets
USE OF FUNDS
SOURCE OF FUNDSTOTAL BY USE
GOVERNMENT2/ SOCIAL INSURANCE3/ PRIVATE SECTOR
Target Actual Target ActualOut of Pocket Others4/
Target ActualTarget Actual Target Actual
Personal Health Care
10 9 25 8 20 57 7 8 62 83
Public Health Care
20 10 0 0 0 0 0 0 20 10
Others 10 4 5 1 0 0 3 2 18 7
TOTAL BY SOURCE
40 23 30 9 20 57 10 10 100 100
Reliance on Family Out-of-Pocket Spending Perpetuates Inequities
Addressing Inequities – Progressive NHIP Premium Contributions
Addressing Inefficiencies – Raising Value for Money in the NHIP
• Family out-of-pocket must be converted to additional premium payments of roughly P6 billion per year in premium payments
• But value for money from existing expenditures must be raised before pouring in additional premium payments
Leakages in NHIP Implementation
Target = 100 Fully ProtectedFilipinos
53eligible to file claims
53
22 avail of services covered in accredited facilities
22 8
The 22 who availed of benefits is only equivalent to 8 fully protected Filipinos
A Performance Yardstick for NHIP Implementation: Benefit Delivery Rate• Only 8% of Filipinos are fully protected by the
NHIP. They are:– Eligible to claim (registered, paid contributions)– Knows entitlements, able to access and avails
health services from accredited providers– Total health care expenditures fully reimbursed
• This is what we refer to as the PhilHealth Benefit Delivery Rate
BDR, All Population, 2008Region Coverage Availment Rate Support Value BDR
Philippines 52.8% 42.3% 34.4% 7.7%I-Ilocos Region 64.8% 19.4% 28.7% 3.6%II-Cagayan Valley 48.0% 10.4% 37.6% 1.9%III - Central Luzon 54.0% 24.0% 28.5% 3.7%IVA - CALABARZON 62.3% 34.6% 26.5% 5.7% IVB - MIMAROPA 36.0% 25.5% 31.9% 2.9%V - Bicol Region 45.7% 60.5% 40.0% 11.1%VI - Western Visayas 44.0% 41.1% 37.7% 6.8%VII - Central Visayas 53.8% 60.8% 26.6% 8.7%VIII - Eastern Visayas 37.6% 71.8% 31.6% 8.5%IX - Zamboanga Peninsula 36.3% 91.1% 40.2% 13.3%X - Northern Mindanao 73.9% 51.3% 41.8% 15.8%XI - Davao Peninsula 43.2% 64.5% 41.2% 11.5%XII - SOCCSKSARGEN 35.2% 91.5% 37.1% 11.9%NCR 77.0% 32.9% 21.2% 5.4%CAR 56.7% 36.7% 35.6% 7.4%ARMM 13.6% 87.0% 37.2% 4.4%CARAGA 50.8% 28.4% 42.2% 6.1%
Potential BDR: 77% * 91% * 42% = 29%
BDR by component: Sponsored, non-Sponsored, and by age group
Coverage Availment Support BDR
National 53% 22% 34% 8%
Sponsored 49% 33% 50% 8%Non-Sponsored 55% 41% 28% 6%
Under 21 60% 32% 36% 7%
Under 5 50% 27% 36% 5%
Elderly 52% 58% 27% 8%Note: BDR for the SP owes to higher support value while that for the elderly is due to higher availment.
BDR by special benefit package
Coverage Availment Support BDR
TB DOTS 53% 0.05% 76% 0.02%
MCP 43% 0.85% 73% 0.27%
Direct estimate for OPB BDR is 0.3%
Re-organizing the Financing of Health Care
• National Government: coordination, regulation, surveillance, and national public health threats
• Local Government (preferably provincial): localized public health threats and basic clinical care
• National Health Insurance: critical personal health care
• Individual family finances: preference driven health services