The fee-for-service payment system and the limited regulation of provider
behavior have also contributed to financial burden on patients. Financial
reform in the Philippines is made more complicated by the presence of a
large private sector which has incentives towards over-provision. Thus,
the introduction of reforms intended to provide stronger incentives for the
rational allocation of resources is operationally challenging.
Physical and human resources available to the health sector are described
in Section 4. There has been a general upward trend in the number of both
private and government hospitals over the last 30 years, with the biggest
growth noted in the 1970s, and a flattening off of growth in the last ten
years. Most hospitals are privately-owned, though there are roughly equal
numbers of public and private beds. The expansion of private hospitals
has been principally centred in urban or near-urban areas leading to an
inequitable distribution of health facilities and beds across the country.
The largest categories of health workers are nurses and midwives.
Currently, there appears to be an oversupply of nurses relative to national
needs – as many are trained with the intention of working overseas – and
an underproduction in other professional categories, such as doctors,
dentists and occupational therapists. In 2009, over 13 000 Filipino nurses
took up positions overseas. Migration is internal as well as external – with
a growing private sector absorbing an increasing number of health staff.
HRH planning is thus particularly challenging in the Philippines.
Section 5 describes the health services delivery mechanisms, explaining
the various facilities available at each level and the referral system.
Public health services are delivered by Local Government Units, with
the Department of Health providing technical assistance. In addition,
specific campaigns and dedicated national programmes (such as TB)
are coordinated by the Department of Health and the LGUs. Provincial
governments manage secondary and tertiary level facilities, and the