Kalusugan Pangkalahatan Updates Enrique T.

Ona, MD, FPCS, FACS Secretary of Health

Filipino Income Quintiles

Monthly income Q1 3,460 Q2 6,073 Q3 9,309 Q4 15,064 Q5 38,065 Families per quintile 5.2 Million 4 Million 3.9 Million 3.7 Million 3.4 Million

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

Income tiers relevant for differential pricing efforts

Socio-economic classes according to Philippine monthly family income
1.1% 8.9% 6.6% 1.1% 10% 47.5%

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

differential pricing (18- 25% of the population) opportunities to improve access via differential pricing 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 also help political acceptability of the whole project.

31.3%

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 Millennium Development Goals

Increase Coverage of Poor Families

Full National Government subsidy for the poorest families identified by the NHTS (Q1); Local Government subsidy for non-NHTS poor (Q2) Interpret the National Government-Local Government sharing requirement of the PHIC Law/ IRR not to an individual but in the number of families to be enrolled; if not possible, amend law entirely to allow this type of sharing

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 PhilHealth under 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 in PhilHealth using local government funds and PhilHealth reserve fund

ENROLLMENT OF THE POOREST FAMILIES MATCHING

RESULTS
949,818

Total number of Filipino families: 18.4 million (NSCB, 2009) NHTS 5,219,936 - 949,818 4,270,118 MATCHED 949,818 NON-NHTS 4,777,700 - 949,818 3,827,882

ENROLLMENT OF THE POOR FOR 2011

ENSURE COVERAGE SUSTAIN COVERAGE

DSWD NHTSPR-Poor 3,943,988

Matched

SP enrollment 3,827,882

949,818

Special Premium Rates

Applicable LGU Share + PhilHealth Reserve Funds

NG: P 3.5 B

LGU: P 1.7 B PhilHealth reserve: P 1.7 B

POLICY Philhealth Board for INTERVENTIONS Resolution nos. 1478 2011

Improve Coverage of the Informal Sector (Q3-Q4)

Mandate enrollment in PhilHealth of those who can 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, business permits, etc.

Increase Availment of PhilHealth Benefits (1)

Streamline requirements for availment of 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 to facilitate enrollment and other processes Integration of DOH and PHilHealth licensing and accreditation processes Assignment of poor families to particular health providers
Removal of the 9 month waiting period to avail of PhilHealth benefits

Increase Availment of PhilHealth Benefits (2) Intensify enrollment and information on PhilHealth

benefits 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, 813 members for the Individually Paying Program PhilHealth Sabado 2 (25 June 2011):

distribution of 719,930 PhilHealth membership cards for those belonging 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

Increase support value of PhilHealth (1)

Case Rates for 22 of the most common in-patient services (requires confinement) with no-balance payment/ 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 Fund for exclusive use of improving health services in all government health facilities

Case Rates
Surgical Cases
1 2

Case Rates (Php) 3, 5 $ 7

Surgical Cases Cholecystectomy %ilatation and C&retta!e ,hyroidectomy

Case Rates (Php) 31, 11, 31,

Radiotherapy

Maternity Care Pac a!e 8, "MCP# '(% Pac a!e in )e*el 1 8, +ospitals '(% Pac a!e in )e*els 2 to 4 +ospitals

!,5 19, 24,

8 9

+erniorrhaphy Mastectomy

21, 22, 3 , 1!,

3 4

Caesarean (ection -ppendectomy

1. +ysterectomy 11 Cataract (&r!ery

Case Rates
".

Me#ical Cases

Case Rates (Php) $ 7 8 1!, 9 1.

Me#ical Cases

Case Rates (Php)

%en!&e / "%en!&e 0e*er and %+0 1rades 8, / 2 //# %en!&e // "%+0 1rades /// 2 /5#

Cere3ral /n4arction "C528, /# Cere3ral "C5- //# -c&te "-16# -sthma +emorrha!e 1astroenteritis 38, !, 9, 14,

2 3 4 5

Pne&monia / "Moderate 15, Ris # Pne&monia Ris # // "+i!h 32,

,yphoid 0e*er

6ssential +ypertension 9,

11

'e73orn Care Pac a!e in +ospitals and )yin! in 1,$5 Clinics

Increase support value of PhilHealth (2)

Develop and establish a separate Catastrophic Health Fund to support expenses of patients with highly expensive illnesses based on costeffectiveness (heart disease, cancer, stroke, complications of diabetes, etc) Gradually increase out-patient coverage of diagnostic procedures and medicines especially for non-communicable diseases.

Future Directions in PhilHealth

DOH Budget Proposal of P 12.028 B in the 2012 budget to enroll the poorest 5.2 million families belonging 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 a multi-disciplinary advisory unit Establish specific timelines and targets for the implementation of health reform interventions

Future Directions in PhilHealth

Higher support of coverage for catastrophic illnesses 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 a higher premium Expand case rate payments and no-balance billing (no out of pocket expenses) Establish role of private insurance and HMOs in Kalusugan Pangkalahatan

Health Facilities Enhancement

Upgrading of selected health facilities

Procurement of modern medical equipment and construction of modern infrastructure in 24 strategically located DOH Regional Medical Centers Financial and technical assistance to local government in enhancing the capabilities of rural health units, district and provincial hospitals

Public-Private Partnership for Health Deployment of Mobile Clinics (Bus, Air and Water Ambulances) for 4Ps Areas and Geographically Isolated and Depressed Areas Complete Treatment Packs in 4Ps Areas

CCT areas w/ no facility upgrade

Matano! 9arira 9&ldon

Province of Maguindanao
(+&,retaine# &osp Pro'incial &osp (istrict &osp Muni%Me#i &osp Paran! +ther 0o'. &osp. R&) (&ltan ;&darat "'&lin!# *&S -or &-.P enhance/ent ;a3&ntalan ",&m3ao#

4
%at& :din (ins&at "%inai!#

2 3
8pi ,alayan (&ltan sa 9aron!is ")am3ayon!# (hari44 -!&a "Ma!anoy#"Capital# %at& Pian! Pa!al&n!an

2
(o&th 8pi -mpat&an

1en. (. ;. Pendat&n

2
9&l&an

%at& Pa!las

Health Human Resources

Deployment of additional 12,000 nurses in far flung areas through the Registered Nurses for Health Enhancement and Local Services (RNHeals) for 2012 to be funded through the 2012 DOH Budget in addition to the 10,000 currently deployed nurses in 4Ps areas

To assist in delivery of health care in the community

Health Human Resource

Doctors to the Barrios (DTTBs) Item Projection

By October 2011, there will be 137 DTTBs:

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

Attaining the Millennium Development Goals

Efforts to increase PhilHealth benefit delivery and enhance health facilities is directed to the attainment of MDG Commitments

PhiHealth Benefit Delivery Rate (BDR) - to improve access to health services for families Enhancement of health facilities - to ensure availability of quality services particularly on maternal and child health and other common causes of morbidities

Attaining the Millennium Development Goals

Scale up public health interventions and promotive health services

Regional task forces to implement, monitor and evaluate Kalusugan Pangkalahatan thrusts MDGMax for Non-Communicable Diseases as well as Injuries and Disaster Risk Reduction

Focused approach resources on 12 areas with highest concentration o NHTS poor, women with unmet need for family planning, mothers giving birth outside of facilities, children not given Vit A

Development of Accelerated Plan on Health Reform for ARMM

Recognition of the need to give special attention to ARMM given its poor health outcomes and inequitable access to health services; Plan includes:

Upgrading facilities that can immediately deliver critical life-saving health care services Provision of adequate security to health personnel and health assets Direct and transparent transactions to ensure that new investments translate to real improvements in

2011 Targets

For PhilHealth: to enroll the 5.2 million families in the NHTS-PR list by December 2011 For enhancement of hospitals and health centers:

PPP projects in Philippine Orthopedic Center and Research Institute for Tropical Medicine approved by October 2011 establish 2011 infant, child and maternal mortalities through Community Health Teams using telehealth

For MDGs:

Thank you!