Healing the Nation: A Critical Look at Health Care Policy in the Philippines

• Introduction

The state of health care in the Philippines is a critical issue that affects millions of people.
Despite efforts to improve access to care and health outcomes, many Filipinos still struggle to
receive quality medical treatment. It is important to evaluate current local and national policies
to determine how they are addressing these issues and what improvements can be made.

The urgency of this issue cannot be overstated. Access to quality health care is a fundamental
human right, and it is essential for the well-being and prosperity of individuals, communities,
and the nation as a whole. In this presentation, we will examine the current state of health care
in the Philippines, evaluate local and national policies, and identify key challenges and
opportunities for improvement.

• Current Health Care Situation in the Philippines

According to the World Health Organization, the Philippines has made significant progress in
improving access to health care in recent years. However, there are still major disparities in
access to care between urban and rural areas, as well as between different socioeconomic
groups. In addition, the quality of care varies widely, with many Filipinos receiving inadequate or
substandard treatment.

Health outcomes in the Philippines also remain a concern. The country has high rates of
maternal and child mortality, as well as a growing burden of non-communicable diseases such as
diabetes and cardiovascular disease. Addressing these issues requires a comprehensive
approach that includes both prevention and treatment strategies.

• Local Health Care Policy

Local healthcare policies in the Philippines are primarily implemented by local government units
(LGUs), which have the responsibility of providing basic health services to their constituents.
Recent policy changes include the implementation of the Universal Health Care Law, which aims
to provide all Filipinos with access to quality healthcare services.

However, there are still challenges in implementing these policies effectively. Many LGUs lack
the resources and capacity to provide adequate health services, particularly in rural areas. In
addition, there is a need for greater coordination between national and local governments to
ensure that policies are aligned, and resources are distributed equitably.

The delineation of functions between the Local Government Units (LGUs) and National
Government Agencies (NGAs), and decentralization of powers, authority and resources to Local
Government Units in 1991, pursuant to Republic Act (RA) No. 7160 (Local Government Code of
1991) resulted in the fragmentation of the public health system. To address the lack of
coordination across the different levels of care and continuity in services provided, and to meet
 the demands and needs of constituents, there is a need to reintegrate hospital and public health
services for a holistic delivery of health care. In January 2000, Executive Order No. 205 was
issued by the President which provided for the establishment of Inter-Local Health Zones (ILHZ)
throughout the country. This was inspired by the concept of the District Health System that was
introduced by the WHO. The ILHZs were created by clustering several adjacent municipalities
and cities. Each ILHZ has a defined population within a defined geographical area and is
composed of a core referral hospital and several primary levels facilities, such as Rural Health
Units (RHUs) and Barangay Health Stations (BHS).

RA NO. 1082, JUNE 15, 1954

AN ACT STRENGTHENING HEALTH AND DENTAL SERVICES IN THE RURAL AREAS

RURAL HEALTH UNIT (RHU)-is an outpatient care facility that provides rural health services, such
as primary care and routine laboratory services, to rural and often underserved communities.

RURAL HEALTH UNITS CONSIST OF:

One (1) municipal health officer as head of the unit,

One (1) public health nurse

One (1)midwife

One (1) sanitary inspector

Barangay Health Station (BHS)- is a community-based health center that provides first aid,
maternal and child health care, communicable diseases and other basic health services to all the
constituents of the barangay. It is a basic, first-hand health care facility that can cater vital
health services to the community

• National Health Care Policy

The Philippine government has implemented a number of national health care policies aimed at
improving access to care and health outcomes. These include the Philippine Health Agenda,
which outlines the government's priorities for health care, and the National Objectives for
Health, which set targets for improving health outcomes.

Despite these efforts, there are still challenges in implementing these policies effectively. There
is a need for greater investment in health infrastructure and human resources, as well as better
coordination between different government agencies and stakeholders. In addition, there is a
need to address the root causes of poor health, such as poverty and inequality.

Universal Health Care (UHC) Law

The Philippine healthcare system is shared between the public and private sectors.

The Philippine Government signed Republic Act 11223 or the Universal Health Care (UHC) Law in
2019, allowing all Filipinos, including Overseas Filipino Workers (OFWs), access to healthcare
services under the Government’s health insurance program (PhilHealth). The UHC aims to cover
at least 50% of medical expenses to encourage Filipinos to visit specialty doctors and undergo
advanced medical procedures.

In November 2021, the Philippine House of Representatives approved House Bill (HB) No.
10245, otherwise referred to as the proposed “eHealth System and Services Act.” HB 10245
aims to make healthcare data accessible for evidence-based decision-making. A Senate version,
under Senate Bill (SB) 1618, otherwise known as the “Philippine eHealth Systems and Services
Act,” which aims to provide a policy framework, dictate the direction, and regulate the practice
of eHealth in the country was submitted for discussion.

The 2030 Agenda for Sustainable Development as well as other landmark resolutions all
champion the crucial role of PHC in achieving responsive and resilient country health systems.
The UHC Law is anchored on the three main pillars of PHC in the following way:

PHC and the UHC Law

Primary care and essential public health functions as the core of integrated health services:

The UHC Law seeks to re-integrate the Philippines’ highly devolved governance system into
province-wide health systems. These integrated provincial health systems promise more
efficient use of resources and delivery of comprehensive care. Providers are encouraged to
consolidate into health care provider networks, capable of delivering a range of services,
grounded on a strong primary care base. PhilHealth is expanding its currently limited primary
care benefit to a new package called “Konsulta”², with expanded rates and service inclusions,
accessible to all membership types. Health care provider networks will be contracted by
PhilHealth as one entity, aligning their incentives and accountabilities, and promoting continuity
of care. Regrettably, the law does not mandate this re-integration. Resistance to change, and
politics of intervening laws such as the Local Government Code stand in the way. Municipal
mayors stand to lose authority over their health spending, personnel, and resources, and will
only influence these as a member of the health board. Adequacy and supply-side readiness of
health facilities, as well as financial constraints and the sustainability of PhilHealth are still
prevailing realities.

Empowered people and communities:

With the UHC Law, all Filipinos are automatically members of PhilHealth, and are immediately
entitled to benefits. Families and households are also given the freedom to choose the primary
care provider they prefer and trust. Patient involvement in key decision areas is enhanced
through representation in the Health Technology Assessment Committee that decides on
benefit inclusions, and in the provincial health board that develops and monitors the province
health plan.These opportunities for patients to directly influence matters concerning their own
health contribute to a system that is truly responsive. However, patient knowledge is coming
from a rather weak base. Data shows that for PhilHealth covered indigent families, only 53%
knew of their entitlement for no balance billing, and around 39.6% are misinformed of their
sponsorship. This and other knowledge gaps present real challenges in affording people genuine
participation even in institutionalized processes.
HEALTH SERVICE DELIVERY NETWORK

The Implementing Rules and Regulations (IRR) of RA No. 10354 (Responsible Parenthood and
Reproductive Health Act of 2012) and RA No. 10351 (Sin Tax Law) in 2013 and
2014, respectively, provided for the establishment of Service Delivery Networks (SDNs) which
aimed for an integrated, coordinated, and efficient provision of health care services.

Consequently, as part of the Guarantees of the Philippine Health Agenda 2016-2022,

Administrative Order No. 2017-0014 on Service Delivery Networks was issued in August 2017 by
the Department of Health, through the Bureau of Local Health Systems Development (BLHSD).
This AO served as a guide in the organization and operationalization of SDNs.

With the passage of RA No. 11223 (Universal Health Care Act) in 2019, the provision of
continuous, coordinated, and integrated care will be further facilitated through the organization
and functionality of Health Care Provider Networks (HCPNs). The HCPN has three (3)
frameworks/ types as reflected in the image below.

The Philippine Health Insurance Corporation (PhilHealth) was created in 1995 to

implement universal health coverage in the Philippines. It is a tax-exempt, government-owned
and controlled corporation (GOCC) of the Philippines and is attached to the Department of
Health. Its stated goal is to "ensure a sustainable national health insurance program for all",
according to the company.

The No Balance Billing (NBB) is a policy of the government—implemented through PhilHealth—

which ensures that qualified members shall not be charged or be forced to spend out-of-pocket
for services that had been rendered to them in government hospitals and selected private
hospitals that are PhilHealth-accredited.
 Qualified members who are covered by NBB are:
* Indigents
* Senior citizens
* Sponsored members and those who are classified under Pantawid Pamilyang Pilipino Program
(4Ps); and
*Kasambahay

The following are the cases covered by NBB:

* All case rates
* Case Type Z benefits
* TB-DOTS package
* Outpatient Malaria Package
* Animal Bite Treatment Package
* Voluntary Surgical Contraception Package
* Outpatient HIV/AIDS Treatment (OHAT) Package

NBB is only applicable in service beds and charity/PhilHealth wards in PhilHealth-

accredited government hospitals and selected private hospitals that have agreements
(MOAs) with PhilHealth.
NBB is being implemented as part of the mandate of the National Health Insurance Act of
2013 (Republic Act 10606).

PROGRAM PROFILE

Public Health Care Provider Network

The Public Health Care Provider Network (HCPN) is a type of HCPN that is owned and managed by
the public sector. It is created by linking a group or cluster of public primary care providers and
facilities with secondary and/ or tertiary care providers within defined geographic or political
boundaries. The Public HCPN has two (2) sub-types, the Province-Wide Health System (PWHS) and
City-Wide Health System (CWHS).

 The Province-Wide Health System (PWHS) consists of the provincial, municipal, and
component city health offices; provincial, district, and municipal hospitals; health centers;
barangay health stations; and other LGU-managed health facilities and services.

 The City-Wide Health System (CWHS) includes the city health office, hospitals, health
centers, barangay health stations, and other city-managed health facilities and services in
highly urbanized cities (HUCs) and independent components cities (ICCs).

The organization of the P/CWHS shall be first implemented in LGUs that expressed their
commitment, otherwise known as the Universal Health Care Integration Sites (UHC IS), to determine
the impact of an integrated local health system in improving overall health outcomes and to have
readily available models that the rest of the LGUs can use as a guide to organizing their P/CWHS
when nationwide roll-out is implemented. The status of each UHC IS in progressively realizing the
integration reform will be tracked using the Local Health Systems Maturity Levels (LHS ML). The LHS
ML outlines the ten (10) key integration characteristics, one of which is the Unified System of
Governance of the Local Health Systems.

Unified System of Governance

It is a standardized structure of unified corporate governance at the provincial/ city level managing
and aligning the efforts, resources, and other cooperations to organize and operate the Health Care
Provider Network (HCPN) for the main purpose of efficiently and effectively delivering continuous
and integrated health care services. This entity consists of representatives from relevant
organizations in the delivery of health services at the local level, including service providers and
communities. In the case of the Public HCPN, the UHC Act identified the Provincial/ City Health
Boards (P/CHBs) which will be supported by their respective Provincial/ City Health Offices (P/CHOs)
and Management Support Units (MSUs).

Management Structure under the Unified System of Governance

 The Provincial/City Health Board (P/CHB) is the steward of the integrated local health
systems and responsible for setting the policy and strategic directions of the P/CWHS.

 The Management Support Unit (MSU) is the administrative secretariat of the health board
and is responsible for assisting in its operations, in close coordination with the P/CHO.

 The Provincial/City Health Office (P/CHO) is the technical secretariat of the health board and
is responsible for the technical integration and supervision of the P/CWHS.

 In provinces that opted to create Sub-Provincial Health Systems (SPHS), Technical

Management Committee (TMC) is to be created to assist the P/CHO in supervising each
SPHS. It is composed of technical staff from the member health facilities, DOH
representatives, patient representatives, and others, and to be assisted by administrative
staff designated by participating provincial, city, or municipality.

Need to establish a Unified System of Governance for the P/CWHS

A Unified System of Governance is needed to facilitate efficiency and responsiveness of the health
care delivery system, specifically to:

 Re-integrate hospital and public health services;

 Improve and rationalize the coverage and utilization of health services;

 Strengthen technical supervision and management of health activities;

 Set up a structure to anchor the integrated health information system, referral system,
primary health care initiatives, among others;

 Improve responses to disaster and emergencies; and

 Identify areas of resource complementation, including human resources, facilities, and

budget, among the municipal, component city, provincial, and regional health systems (e.g.,
sharing of personnel, transport/ambulance, common health trust fund).
Private Sector Engagement

The country has a dual health system composed of public and private sectors. The importance of the
private sector cannot be overemphasized since the public sector alone cannot provide all the needed
health services of the whole population. Both the public and private sectors have their own
strengths and capabilities which must be recognized.

Given that certain health or health-related services may not always be available in public-owned and
managed health facilities, the UHC Act highlighted the importance of complementation of resources
and efforts between the public and private sectors to ensure the availability of quality health care
services to all Filipinos, particularly the underserved and unserved areas. Thus, the public health
facilities or networks may contract out certain services to the private sector to complete their health
services.

In addition, the private sector can also establish their own health care provider networks to be
contracted by PhilHealth for individual-based health services, which are mostly driven by market-
based forces rather than geo-political boundaries. Thus, it is also important to study and understand
the existing and emerging models of purely private health care provider networks, which can serve
as a guide for other private providers to form their networks.

Strengthening of Primary Care

The UHC Act has given due emphasis on strengthening primary care, especially that the Primary Care
Provider Networks (PCPNs) serves as the foundation of the HCPNs. The PCPNs are coordinated
groups of public, private, or mixed primary care providers that act as the navigator, initial and
continuing point of contact of clients to the health care delivery system. It is, therefore, important
that all Filipinos will be registered to their own Primary Care Provider of choice, whether public or
private. These PCPNs shall:

 Serve as the gateway to the HCPN and coordinate the delivery of a continuum of services;

 Guarantee the equitable access of the entire population to essential health and health-
related services through the provision of these services in health centers and other care
settings, such as homes, schools, and workplaces;

 Facilitate social participation and inter-sectoral action through the development of ties with
individuals, their families, and their community/ies, and with other social sectors; and

 Ensure flow of information throughout the entire network, regardless of where care was
delivered.

For these PCPNs to perform these expected functions, primary care strategies focus on ensuring the
delivery of integrated and comprehensive primary care services, the presence of more strategic
financing for primary care, and availability of safe, quality, and affordable primary care.

• Challenges and Opportunities

 Improving health care policy in the Philippines requires addressing a range of complex
challenges. These include inadequate funding and resources, poor infrastructure, and a shortage
of trained health professionals. In addition, there are social, cultural, and political barriers to
accessing care, particularly for marginalized groups.

However, there are also opportunities for progress. The Universal Health Care Law represents a
significant step forward in expanding access to care, and there is growing recognition of the
need for a more comprehensive approach that addresses the root causes of poor health. By
working together and leveraging existing resources, it is possible to make meaningful
improvements in the state of health care in the Philippines.

• Conclusion

In conclusion, the state of health care in the Philippines is a critical issue that requires urgent
attention. By evaluating current local and national policies, identifying key challenges and
opportunities, and working together to implement effective solutions, we can improve access to
quality health care for all Filipinos.

This is not just a matter of policy, but of basic human dignity and well-being. Let us commit
ourselves to this important task, and work towards a future where all Filipinos have the
opportunity to live healthy, fulfilling lives.