national government retains management of a number of tertiary level
facilities. The private sector delivers services at all three levels of the
system. Private primary services are provided through freestanding clinics,
private clinics in hospitals and group practice or polyclinics.
Though a referral system which aims to rationalize heath care use has
been in place since 2000, it is common practice for patients to bypass the
primary level and go direct to secondary or tertiary level facilities. Hospital
admissions data from PhilHealth suggests that specialized facilities are
continuously treating primary and ordinary patients. Dissatisfaction with
the quality of services, lack of supplies in public facilities, and the absence
of a gate-keeping mechanism are among the reasons that patients bypass
lower levels of care.
The principle health care reforms are described in Section 6. Over the last
30 years a series of reform efforts have aimed to address poor accessibility,
inequities and inefficiencies of the health system, with mixed results. The
three major areas of reform are health service delivery, health regulation,
and health financing. The service delivery component of the health sector
reform agenda included provision of a multi-year budget for priority
services, upgrading of the physical and management infrastructure at all
levels, and the strengthening of technical expertise in the DOH.
Health financing reforms have focused on expanding health insurance –
including a recent push toward universal health coverage as mentioned
above. Experience from past reform efforts suggests that higher levels of
enrollment of “sponsored” families (premiums paid by the government)
has not automatically translated into greater use of services – most likely
because of the concerns about service quality and high co-payments. The
government is therefore now looking at options to reduce or eliminate
co-payments. Attracting the self-employed has also proved a difficult
challenge in the past.
Regulatory reforms were implemented in the pharmaceutical sector in
the late 1980s. An essential drugs list was established, a Generics Act
promoted and required greater use of generic medicines – 55-60% of
the public now buy generics – and capacities for standards development,