PHILIPPINE NURSES ASSOCIATION 90th Foundation Anniversary 55th Nurses Week Celebration and National Annual Convention 2012

Theme: Inspiring the Filipino Nursing Workforce towards Equity and Access to Health Care

Plenary Session III: Models of Health Care

Josephine D. Lorica, RN, DPA Faculty, School of Health Sciences St. Paul University Phils. Tuguegarao City

Session Objectives
1. Describe the four basic models of health care system relating this to equity and access to health 2. Discuss the social model of health and its goal of preventing and reducing illness and addressing inequalitites and disadvantage that exist within the community. 3. Discuss challenges and opportunities of nurses in the present model of health care system in the Philippines.

Health is a basic human right!

The Universal Declaration of Human Rights
The General Assembly of the United Nations adopted and proclaimed these principles in 1948 Article 25

Constitution of the Philippines

Article 2 Section 15

Health Care System

Consist of individuals and organizations designed to meet the health needs of target populations

Health Care System

.. the measure of a responsive and effective health system is its ability to contribute to good health. (WHO, 2000) - main function of the national health care system is to promote health among the countrys citizens (McKinsey & Company, 2006)

Health Care System

(Sibu Saha)

Each nations health care system is a reflection of its:

History Politics Economy National values

They all vary to some degree However, they all share common principles There are four basic health care models around the world

Health Care System

Almost 200 countries in the world but only about 40 of those are organized, rich and industrialized enough to have a developed health care system

four basic models of health care system (Reid, 2009)

1. The Beveridge Model 2. The Bismarck Model 3. The National Health Insurance Model 4. The Out-of-the Pocket Model

The Beveridge Model

Named for William Beveridge
Social reformer who designed Britains National Health Service (NHS)

The Beveridge Model

Health care provided and financed by government through tax payments Most hospitals and clinics are owned by the government Some doctors are government employees; some private doctors collect their fees from the government

The Beveridge Model

British people never get a doctor bill Medical treatment is public service Beveridge systems tend to have low cost per capita because government controls what doctors can charge

The Beveridge Model

Countries using Beveridge Plan or variations from it:
Great Britain, Spain, Scandinavia, New Zealand a. Hongkong has its own Beveridge style system since populace refused to give it up when China took over in 1997 b. Cuba represents extreme application of Beveridge probably worlds purest example of total government control

The Bismarck Model

System named for Prussian Chancellor Otto von Bismarck
Invented welfare state as part of Germanys unification during 19th century

The Bismarck Model

System uses insurance system
Insurers are called sickness funds

Private insurance system usually financed jointly by employees and employees through payroll deductions

The Bismarck Model

Providers and payers are private Health insurance plans have to cover everybody
a. Multi-payer model b. Does not make a profit

Tight regulation of medical services and fees (cost control)

The Bismarck Model

Countries using it:
Germany, France, Belgium, The Netherlands, Japan, Switzerland, and to a degree Latin America

The National Health Insurance Model

Single payer system has elements of both Beveridge and Bismarck Single payer systems tend to have more market power to negotiate lower health care prices Uses private sector providers, but payments come from a government-run insurance program that every citizen pays into

The National Health Insurance Model

No need for marketing because there is no financial motive to deny claims and profit National insurance collects monthly premiums and pays medical bills

The National Health Insurance Model

NHI plans also control costs by: 1. limiting medical services they will pay for or 2. by making patients wait to be treated

The National Health Insurance Model

Countries using it:
Canada, Taiwan, South Korea

The Out-of-the-Pocket Model

plan used by most nations because they are too poor and too disorganized to provide any mass medical care no system countries

The Out-of-the-Pocket Model

Most medical care is paid for by the patient, out-of-pocket No insurance or government plan

The Out-of-the Pocket Model

In these poor countries, only rich can afford medical care a. Rural regions of Africa, India, China and South America, hundred of millions of people go their whole life without ever seeing a doctor b. Tend to rely on village healers and home remedies c. May pay a doctors bill with potatoes or other produce

COMMON PRINCIPLES OF ALL MODELS

Coverage
Coverage for every resident (old or young, rich or poor) Moral principle of all developed countries Every country rations care not everything is covered!

Quality
Other developed countries produce better quality results.

COMMON PRINCIPLES OF ALL MODELS Cost

All other systems are cheaper except OOTP Foreign employers pay far less for health coverage Effect?

Choice
Many countries offer greater choice

The SOCIAL MODEL of HEALTH

the health of individuals and communities is seen as the result of complex and interacting social, economic, environmental and personal factors

The Social Model of Health

Carefully considers the wider determinants of health i.e. the range of factor that impact on peoples health and well being.

Social Model of Health (Dahlgren & Whitehead, 1991)

Social Model of Health (Dahlgren & Whitehead, 1991)

Dahlgren and Whitehead (1991) talk of the layers of influence on health. They describe a social ecological theory to health.

Social Model of Health (Dahlgren & Whitehead, 1991)

The first layer is a personal behavior and ways of living that can promote or damage health. eg. Choice to smoke or not individuals are affected by friendship patterns and the norms of their community.

Social Model of Health (Dahlgren & Whitehead, 1991)

The next layer is social and community in unfavorable conditions, but they can also provide no support to have a negative effect.

Social Model of Health (Dahlgren & Whitehead, 1991) The third layer includes structural factors: housing, working conditions, access to services and provisions of essential facilities

Social Model of Health (Dahlgren & Whitehead, 1991) Individual and community experience and knowledge becomes relevant empowered Health becomes a social phenomenon

PHILIPPINE HEALTH CARE SYSTEM

Health development effort have aimed to address the problem of inequity for almost 4 decades
1979 Selective PHC implementation 1992 Devolution of health services 2000 health sector reforms 2005-2010 National objectives for health 2011-2016 Kalusugang Pangkalahatan

Stated Objectives of our Health System

2005-2010 (National Objectives for Health 2010 Monograph) 1. Better health outcomes 2. More equitable financing 3. Increased responsiveness and client satisfaction

Stated Objectives of our Health System

2011 2016 Kalusugang Pangkalahatan Main Goal:

Achieving Universal Health Care

Goal of the Health System

the main function of the national health care system is to promote health among the countrys citizens (McKinsey & Company, 2006), this does not remain to be just health; it has to put at the end view the equity, efficiency, effectiveness of the chosen paths (WHO, 2007).

Extent of the Goals being Achieved? (WHO, 2011)

Improvement in the delivery of public health services -> improved overall health outcomes
BUT PROGRESS towards the health MDGs appears to have slowed

Extent of the Goals being Achieved? (WHO, 2011)

Regulations of goods and services has been strengthened
BUT commercial interests continue to dominate regulatory processes

Extent of the Goals being Achieved? (WHO, 2011)

DESPITE strong efforts in the implementation of Philippine Health Insurance Law, OUT-OF-THE POCKET costs have continued to increase

Extent of the Goals being Achieved? (WHO, 2011)

Reforms in the governance continue to be stymied by a flawed Local Government Code -> increased fragmentation in the management of health services

Philippine Health Care Systems

EQUITY

ACCESS TO SERVICES is limited by financial and social barriers Low coverage rates found in poorest quintiles of the population, among rural areas and among families with uneducated mothers

Philippine Health Care Systems

EQUITY

Disparities in the distribution of human and physical resources Utilization patterns are affected by financial barriers, negative perceptions about quality of care and lack of awareness of services

Philippine Health Care Systems

COST

Public financing levels have steadily increased, however remain low in regional terms High and steadily increasing out of the pocket spending exposes large financial risks from illness PhilHealth is only financing about a tenth of the countrys total health expenditure

Philippine Health Care Systems

ALLOCATIVE AND TECHNICAL EFFICIENCY More health resources are spent on personal care than public health Drug expenditure consume 70% of out-of the pocket expenditures and are largely spent on heavily marketed non-essential and mostly ineffective medicaions

Philippine Health Care Systems

ALLOCATIVE AND TECHNICAL EFFICIENCY Health facilities and human resources are concentrated relatively affluent areas Devolution of health service widened the gap in health resource allocation Health workforce production is geared towards a perceived lucrative international market rather than national health needs

Philippine Health Care Systems

ALLOCATIVE AND TECHNICAL EFFICIENCY National government facilities providing expensive tertiary care have budgets that are disproportionately high in relation to local primary care programmes NHIP also follows the trend by favoring hospitalized care

Philippine Health Care System

QUALITY OF CARE

Efforts to improve quality are typically adhoc and uncoordinated due to lack of data on quality and the lack of incentives for best practice Most hospitals and professional practitioners meet the quality standards set by licensing requirements and PhilHealth accreditation standards

Philippine Health Care System

QUALITY OF CARE

Data on quality outcomes are few and unreliable

Primary care facilities and lower level hospitals are bypassed perceptions of low quality

SOLUTION PERFORMANCE INCENTIVES INCREASING CLIENTS VOICE THROUGH EFFECTIIVE CONSUMER PARTICIPATION STRATEGIES

Philippine Health Care System HEALTH

IMPROVEMENTS

Noticeable health outcomes in communicable disease control, and child health programs because of substantial participation of national government and strong coordination with LGUs while adverse health results where national policy is not directly supportive of LGU action

Philippine Health Care System HEALTH

IMPROVEMENTS

Major weakness failure to address the large disparities in health outcomes between the rich and the poor

The PHCS
model is basically out of pocket for most of the population except for the employed which is similar to the German(Bismarck) model.

In the PHCS
The coverage of Philippine Health Insurance Corporation is too limited to be considered as a national health insurance program as what exists in Canada.

What nurses can do? - Opportunities

Personally, each registered nurse should work and save for his/her own health care needs as one grows older, ones saving must also grow.

What nurses can do? - Opportunities

Call for A Nurse in every Barangay - to implement primary health care concepts and principles Each registered nurse to implement and utilize the social health model in their practice, make each one or each family /community empowered

What nurses can do? - Opportunities

Empower the community through:
Community-based health care financing or come up with a sustainable health care financing health and wellness promotion action

What nurses can do? - Opportunities

Conduct Researches consumer feedback of stakeholders; quality data for utilization of services , evidence-based health promotion strategies and or come up with a system that is based on health needs of our country Participate in health systems analysis and research

What nurses can do? - Opportunities

All nurses need to do their social responsibility from providing their basic health skills to referral,to being actively involved in the community (Barangay Nutrition Committee, Community Health Council etc.) , and to being advocates for the community people

What nurses can do? - Opportunities

Empower ourselves by:
Social marketing showing what we can do Lobbying for a more innovative and evidenced-based information models that nurses can implement Stronger nursing role in health policy enter politics? Or become involved in policy and decision making

So, CAN WE DO
SOMETHING FOR OUR COUNTRYS HEALTH CARE EQUITY AND ACCESS?