Section 2 summarizes the organization and governance of the health
system, including the underpinning governance and regulations. Under the
current decentralized structure, the Department of Health (DOH) serves as
the principle governing agency of the health system, mandated to provide
national policy direction and develop national plans, technical standards
and guidelines on health.
Decentralisation was first introduced in 1991, when Local Government
Units were granted autonomy and responsibility for their own health
services, and provincial governments given responsibility for secondary
hospital care. Initially, the quality of services deteriorated due to low
management capacity and lack of resources. A health sector reform
programme introduced in 2005 helped to address some of these issues and
improve overall health sector performance. It focused on expanding public
and preventative health programmes and access to basic and essential
health services in underserved locations. However, the involvement of three
different levels of government in the three different levels of health care has
created fragmentation in the overall management of the system. Local and
provincial authorities retain considerable autonomy in their interpretation
of central policy directions, and provision of the health services is often
subject to local political influence. As a result, the quality of health care
varies considerably across the country.
Section 3 describes the financing of the health sector in the Philippines; it
includes an overview of the system, levels of spending, sources of financing
and payment mechanisms. It finds that total health expenditure per capita
has grown slowly in real terms: by 2.1% per year between 1995 and 2005.
Total health spending now stands at 3.9% of GDP – low compared to the
Western Pacific regional average of 6.1%.
The major health financing concern in the Philippines is the high level of
out-of-pocket payments, which account for 48% of total health expenditure.
The Philippines has a national health insurance agency – PhilHealth –
however the level of financial protection it provides is limited as patients
are often liable for substantial copayments. In 2010, the newly-elected
government launched a major reform effort aimed at achieving ‘universal
coverage’ which focused on increasing the number of poor families enrolled
in PhilHealth, providing a more comprehensive benefits package and
xx
reducing or eliminating co-payments. So far the results are promising.
As of April 2011 almost 4.4 million new poor families had been enrolled in
PhilHealth, equivalent to a 100 per cent increase in enrolment for the real
poor. In 2011, PhilHealth introduced a no-balanced-billing policy for these
sponsored households