Philippine Health Perspective

Determinants of Health
System
 Objectives:

Define Healthcare Delivery

System
Discuss the determinants of the
health System
Discuss the Philippine health
situation and the factors that
lead to its current state
 Healthcare
Delivery System
Determinants of Health
System

1. Demographics
2. Epidemiology
3. Economics
4. Politics
5. Culture
6. Health Insurance Policies
I. DEMOGRAPHICS

Population:
1980- 48,316,503
2000-76,348,114
2005-84,241,341
2010-91,868,309
Population Growth
Rate:
1995-2000: 2.32%
2000-2005: 1.99 %
Population Density:
Average:255/sq km
NCR: 15,617/ sq
km (61X ave)
CAR: 95/sq km
Cagayan Valley:
105/sq km
 POPULATION GROWTH
 Japan 0.3%
 Thailand 1.4%
 Malaysia 2.2%
 Philippines 2.1 – 2.3%*
*UNICEF puts the population growth rate at 2.1% while the
Philippine Population Management Program Directional Plan
puts it at 2.3%.
(www.popcom.gov.ph/pdf/PPMPDirectionalPlan.pdf)
PHILIPPINE HEALTH OUTCOMES

Median age: 21 y/o POPULATION

Dependency ratio: 69.04 PYRAMID
PHILIPPINES
2004
 LIFE EXPECTANCY at Birth
(in Years, 2004 figures)
Male/Female
 Japan 78/85
 Malaysia 70/75
 Vietnam 68/74
 Thailand 67/73
 Philippines 64/70
 Cambodia 50/57
Source: The World Health Report 2005
Philippine Health Statistics Update 2004 Philippine Health
Picture.Last Update: February 12, 2008
Health Status
Philippines 2001 2002 2003 2004

Life Expectancy At Birth 69.25 69.55 69.9 67

Crude Birth Rate 26.24 25.7 20.6 20.5
Crude Death Rate 5.83 5.80 4.9 4.8

Infant Mortality Rate 13.7 13.2

Total Fertility Rate 3.23

Maternal Mortality Rate 1.1 1.1

II. EPIDEMIOLOGY

State of the Nation’s Health

 Every 6 min 1 child dies of Measles

 Every hour: 6 die of heart disease
4 die of Cancer
 Everyday: 28 babies die of Tetanus
1277 children die of
Pneumonia
217 children die of diarrhea
55 die of TB
 Everyday: 15 die of Renal disease
300 develop Malaria
 12M at risk for Malaria
 2.5M children are malnourished
 >50% of pregnant/lactating have
anemia
Causes of Mortality and
Morbidity
-Diseases of poverty
-Lifestyle diseases
-Preventable
 Leading Causes of Morbidity
1999 2001 2003 2004

1. Diarrhea 1. Diarrheas 1. LRTI and 1.Acute Lower RTI

Pneumonia and Pneumonia
2. Bronchitis 2. Bronchitis 2. Diarrhea 2. Bronchitis/
bronchiolitis
3. Pneumonia 3. Pneumonias 3. Bronchitis/ 3. Diarrhea
Bronchiolitis
4. Influenza 4. Influenza 4. Influenza 4. Influenza

5. Hypertension 5. Hypertension 5. Hypertension 5. Hypertension

6. TB, all forms 6. TB, all forms 6. TB, Respiratory 6. TB Respiratory

Source:  2004 Philippine Health Statistices

Last Update: February 11, 2008
 Degenerative and other
Non-Communicable Diseases
•Cardiovascular Diseases
•Cancer
•Diabetes Mellitus
•Kidney diseases
• Asthma
• Osteoporosis
• Mental Health & Mental
Disorders
• Diet and Nutritional Disorders
• Accidents and Injuries
PHILIPPINE HEALTH OUTCOMES
INFANT
MORTALITY
RATE
120
PHILIPPINES 1960-2002
Rate per 1,000 Live Births

100

80

60

40

20

0
1960 1963 1966 1969 1972 1975 1978 1981 1984 1987 1990 1993 1996 2000 2002
Year
 INFANT MORTALITY RATE
(per 1000 live births)

 Japan 3.1 (2001)

 Thailand 6.5 (2001)
 Malaysia 8.1 (1998)
 Philippines 18.8 (1998)
13.2 (2004)
 Vietnam 36.7 (1999)
Source: SEAMIC Health Statistics 2002
 Causes of Infant Mortality
Source:  The 2004 Philippine Health Statistics
Last Update: February 12, 2008

Cause Number Rate Percent

1. Bacterial sepsis of newborn 3,402 2.0 15.1
2. Respiratory distress of newborn 2,500 1.5 11.1
3. Pneumonia 1,940 1.1 8.6
4. Disorders related to short gestation and
1,750 1.0 7.8
low birth weight, not elsewhere classified
5. Congenital Pneumonia 1,501 0.9 6.7
6. Congenital malformation of the heart 1,451 0.8 6.4
7. Neonatal aspiration syndrome 1,256 0.7 5.6
8. Other congenital malformation 1,082 0.6 4.8
9. Intrauterine hypoxia and birth asphyxia 1,030 0.6 4.6
10.Diarrhea and gastro-enterities of
914 0.5 4.1
presumed infectious origin
MATERNAL MORTALITY RATE
(per 100,000 livebirths)

 Japan 6.7 (2001)

 Thailand 12.9 (2001)
 Malaysia 20 (1998)
 Vietnam 95 (1999)
 Philippines 100 (1998)
Source: SEAMIC Health Statistics 2002
 Causes of Maternal Mortality
46
38

28.4
26 27

17.2

9
8.3

Number Rate/1000 Livebirths & Percentage Distribution. Philippines, 2004

 ADULT MORTALITY
(per 1000, 2003 figures)
Male/Female
 Japan 96/45
 Malaysia 195/108
 Vietnam 205/129
 Thailand 267/153
 Philippines 271/149
 Cambodia 441/285
Source: The World Health Report 2005
Ten Leading Causes of Mortality, 2000- 2004

NEC: 5.4

3.6
4.8

8.6
8.1

Source: Department of Health,

III. ECONOMICS
1. Poverty:
 Rural- Landlord dominated agri
-High cost of living
-Lack of education
- Superstition & poverty
Urban- migration due to economy
- inflation rates are higher
- Housing takes up 20% of
expenses
- income is skewed
2. Balance of Trade: Cost of
importations higher than exports
3. Setbacks- Oil price hikes and
Labor unrest
4. Migration- 10% of population
5. Child labor
7. Disaster situation
 Maldistributed Health
Services

Year 2000
Personnel Total Ratio
Physicians 2943 1:25993
Nurses 4724 1:16194
Midwives 16451 1:4650
Hospital Beds 81200 1:942
Hospitals 1712 1:44684
Unemployment 11.4% 9.5% 10.1
Rate Jan 2001 Jan 2000 Oct 2000

Source: National Statistical Coordination Board (2001) Statwatch

 IV. POLITICS

Health Care Delivery System

 1960’s “trickle-down” theories on health
development
 1978 Alma Ata Declaration
- Comprehensive Strategy
- People-centered approach to health services
(Strong community participation,
accountability of health workers)
Health Care Delivery System

 1980’s Marcos Administration

- Ministry of Health
 Aquino Administration
- NGOs
 Ramos Administration
- DOH Philippines 2000;
- Privatization of GOCC
 Estrada and Arroyo Administration: Philhealth
 Devolution of Health Services
National Government
Office of the
Secretary of Health
 Articulate national
objectives for health
Executive Committee Retained by DOH
 Direct service provider for
for Field Operations Devolved to Province specific programs
Devolved to City
Regional Health Offices  Health emergency
Devolved to Municipality
Regional Hospitals response services
and Medical Centers
Provincial Health  Technical authority in
Offices disease control &
Provincial Hospitals
prevention

City Health Offices District Health Offices  Policy formulation,

standards development
and regulations to ensure
City Hospitals Health Centers District Municipal equity, access and quality
Hospitals Health Offices
of health care services
BHS
BHS  Technical oversight agency

Local Government: Direct Health Service Provider  Administrator of selected

sub-national facilities
Health Care Reform Objectives

Capability or means of entry

into the health care system

Presence / obtainability
of the product or service

Match needs with satisfaction

of needs
 Who Has No Access?
 31.88% live below
poverty threshold (P377)

 13% live below food

threshold (P107)

 Poverty Incidence
– Rural: 48.8 vs Urban:
18.6

Source: National Statistical

Coordination Board (2001) Statwatch
 What is NOT Available?
Light Land
Environmental
and Tenure
Protection
Power Security

Health
Peace
Services Educational
and
and Opportunities
Security
Nutrition

Other
Vital
Transportation Government
Infrastructure
Services
 2x2 Equity Table
AVAILABILITY
of healthcare
YES* NO

Yes Access Yes Access

YES
Yes Availability No Availability

ACCESS
to healthcare
No Access
NO
Yes Availability

* Availability can be limited by SATURATION

FINANCIAL FAIRNESS

FINANCING
FOR
HEALTH
GNP (in billion pesos current
prices, 2002) 4,290.2
GDP (in billion pesos current
prices, 2002) 4,022.7

2002 Total Health Expenditures as a % share of GNP 2.7%

Health is Under Funded and Inequitable
FINANCIAL FAIRNESS

S HARE of
HEALTH
EXPENDITURES 1991-20

4.0
3.4 3.4 3.5
3.2 3.2 3.4 3.3 3.2
3.5 2.9 3.0
2.9
3.0 2.7

2.5
Percent

2.0

1.5

1.0

0.5

0.0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Year
FINANCIAL FAIRNESS

HEALTH
CARE
EXPENDITURES
Percentage Distribution of Expenditures for Health
Philippines 2002
Public Health
11.0%

Others
12.1%
Personal Health
76.9%
V. CULTURE
 Colonial mentality still prevalent
 85% Catholic, 10 % Protestant, 4% Muslim 1%
others
 Filipino traditional
healers still
patronized
 Extended family
system
 Padrino system
 Crab mentality
 VI. HEALTH INSURANCE POLICIES

•Only those hospitalized are

reimbursed
•Very limited out patient care
•While 60% of the population are
already insured, utilization rate of
PhilHealth by indigents less than
10%.
•PhilHealth major health insurance
corporation
•HMOs (health maintenance
organizations) only cover 4%
of the population
Philippine Health Insurance
Corporation (PhilHealth)

the government agency

mandated by law to administer
the NHIP.
 PhilHealth

Universality – The NHIP shall provide

all citizens with the mechanism to gain
financial access to health services, in
combination with other government
health programs.
Equity – the NHIP shall provide for
uniform basic benefits. Access to care
must be a function of a person’s health
needs rather than ability to pay
 PhilHealth

Responsiveness –The NHIP shall

adequately meet the needs for personal
health services at various stages for a
member’s life
 Present Situation

1
Rich(few)
Poor(majority)
0
Incidence of Accessibility
Sickness to Care
1. Enumerate the 6 determinants
of the Health system
2. Discuss each determinant in 1
or 2 sentences
THANK
YOU
VERY
MUCH