2011年-世界发展银行全球_Philippine_Health_Sector_Review_151页_8mb

Philippine Health Sector Review Summary

Core Content

This document provides an in-depth analysis of the transformation of the Philippine health sector, focusing on its current performance, challenges, and future directions. It outlines the key findings and proposes priority policy actions to improve financial protection, access to care, and overall health outcomes.

Main Views and Key Information

I. Overview of the Report

• The report is a comprehensive review of the Philippine health sector, highlighting the progress made and the remaining challenges.
• It was prepared by the World Bank, with contributions from various health sector experts and stakeholders.
• The review assesses the impact of health reforms implemented over the past two decades and identifies areas for improvement.

II. Health Sector Performance

• Population Health Outcomes:

  • Life expectancy in the Philippines increased from 53 years in 1960 to 72 years in 2008.
  • Infant and under-five mortality rates declined from 29 and 40 per 1000 live births in 2003 to 25 and 34 per 1000 live births in 2008.
  • The country is on track to meet MDG 4 (reducing under-five mortality by two-thirds by 2015).

• Maternal and Reproductive Health:

  • Maternal Mortality Rate (MMR) improved but still lags behind expected targets.
  • The country is unlikely to meet MDG 5 (reducing MMR by three-quarters by 2015) and achieve universal access to reproductive health services.
  • There are significant regional and income disparities in health outcomes, with poorer provinces like Sulu and Tawi-Tawi having life expectancy levels similar to low-income countries.

• Non-Communicable Diseases (NCDs):

  • NCDs are emerging as a major health challenge.
  • By 2030, NCDs are projected to account for 85% of the disease burden in the East Asia and Pacific region.
  • Cardiovascular diseases and injuries are among the top causes of death, with road traffic accidents increasing.

• Financial Protection:

  • Out-of-pocket (OOP) spending remains high, accounting for over 50% of total health spending in 2008.
  • Despite the introduction of universal health insurance (UHI), financial protection is still lacking.
  • Poor households spend a higher share of their disposable income on health care compared to wealthier households.

• Health Spending:

  • Health spending in the Philippines was 3.9% of GDP in 2008, below the regional average.
  • Public health spending accounted for only 6.5% of total government expenditures, compared to an average of 10% in the East Asia and Pacific region.
  • The elasticity of public health spending to GDP from 1995–2008 was about 0.9, indicating a slower growth rate than GDP.

• Service Delivery:

  • There are large disparities in the utilization of health services, particularly in rural and low-income areas.
  • Skilled birth attendance is only 25% among the lowest income quintile, compared to 94% among the highest.
  • Only 13% of births in the lowest quintile occur at health facilities, compared to 84% in the highest.
  • Immunization coverage is 70% for the lowest quintile and 84% for the highest.
  • Geographic access to health services has not improved significantly in the last five years.

• Health Insurance Coverage:

  • Health insurance coverage is low, with only 42% of the population insured overall and 38% covered by PhilHealth.
  • Coverage among indigent households is only 20%.
  • PhilHealth's benefits are limited, and access to these benefits is difficult, making it an inadequate guarantee of financial protection.

III. Reasons for Gaps in Health Sector Performance

• Public Financing:

  • Public financing remains low, fragmented, and inequitable.
  • Government revenue constraints limit its ability to fund public health expenditures.
  • The informal sector (nearly 50% of the population) is not effectively mobilized into PhilHealth.
  • LGUs in underserved regions face fiscal constraints and are not adequately supported.
  • There is a lack of coordination among different funding streams (PhilHealth, DOH, LGUs), leading to inefficiencies.

• PhilHealth Performance:

  • PhilHealth, established in 1995, was intended to be a single-payer system to improve equity and efficiency.
  • However, it has not fulfilled its transformative potential due to limited benefits, poor payment mechanisms, and weak provider incentives.
  • It is not a guarantee of financial protection or access to quality health services.

• Service Delivery Capacity:

  • There are significant gaps in service delivery capacity, especially in rural and underserved regions.
  • The health infrastructure has not kept pace with population growth.
  • The private sector, which provides over 50% of health services, focuses on urban areas, leaving rural populations underserved.

• Sector Stewardship:

  • The Department of Health (DOH) has a mandate for stewardship but lacks the authority to enforce it effectively.
  • The DOH cannot require LGUs or private providers to submit health data, limiting its oversight role.
  • Despite these challenges, the DOH has introduced innovative mechanisms like LGU scorecards and Province-Wide Investment Plans (PIPH) to improve accountability and performance.

IV. Priority Policy Actions

• Policy Priority #1: Increase Public Financing:

  • The government needs to increase public health financing, especially from national budget allocations.
  • This requires improving inter-sectoral efficiency and reallocating resources from other sectors to health.
  • Ensuring that health spending is efficient and equitable is crucial for long-term improvements.

• Policy Priority #2: Strengthen PhilHealth:

  • PhilHealth should be held accountable for its performance.
  • Expanding health insurance coverage and improving payment mechanisms for providers are essential.
  • Enhancing the benefits and accessibility of PhilHealth can lead to better financial protection and service utilization.

• Policy Priority #3: Expand Health Insurance Coverage:

  • Expanding coverage to underserved and poor populations is necessary to address health inequities.
  • A proactive strategy is needed to address capacity gaps in service delivery, especially in rural areas.

• Policy Priority #4: Improve Service Delivery and Access:

  • There is a need for a more integrated and coordinated approach to service delivery.
  • Enhancing the availability of skilled birth attendants and improving immunization coverage should be prioritized.
  • Addressing the challenges of geographic access and quality of care is critical for improving health outcomes.

• Policy Priority #5: Address Non-Communicable Diseases (NCDs):

  • The health sector must prepare for the growing burden of NCDs.
  • This includes strengthening health systems to address chronic conditions and injuries.
  • A shift in focus from communicable diseases to NCDs is necessary for long-term health planning.

Conclusion

The report highlights the need for a more integrated, equitable, and efficient health system in the Philippines. It emphasizes the importance of increasing public financing, improving PhilHealth performance, and addressing service delivery gaps to ensure better health outcomes and financial protection for all. The review calls for a binding commitment to these policy actions within the context of a constrained macroeconomic environment.