Current Policy / Issues UHC Provision

Universal Health Coverage

• Classify into public health and personal based • Classify into population-based and individual-based health
Roles of agencies Entitlements
interventions interventions

• No clear delineation on accountability with • DOH: finance population-based services, set standards, integrate a
overlapping of financing and delivery functions whole-of-society & whole-of-government approach
• PhilHealth: finance all individual-based level services as a single,
national purchaser
• National and local governments: deliver population-based
interventions
• PhilHealth-contracted networks of public and private facilities: deliver
individual-based interventions
Philippine Health Insurance Corporation
• Population oversegmentized into 5 sectors leading to • Simplified membership into two: contributory (with capacity
Population
Coverage

difficulty in capture and retention of membership
• Poor continuity in informal sector members due to
voluntary basis
• Complex eligibility rules confusing to members
• Different benefit package eligibilities per member
Services Coverage
to pay), and non-contributory (subsidized through tax
revenues by the national government)
• Eligibility through automatic inclusion to the National Health
Security Program
• Uniform benefits for all

type, leading to confusion • Prioritize using a fair, and transparent priority setting process
• Arbitrary selection and development of benefit guided by Health Technology Assessment (HTA).
packages • Development of a single, comprehensive, primary care
• Insufficient and selective coverage for outpatient package (include medicines), for all
(only for indigents) • Creation of supplementary coverage by HMOs and private
• Non-coverage for emergency cases health insurance
• Network-based licensing, contracting, & accreditation of
facilities
• High, uncontrolled co-payment levels leading to high • Ensuring No Balance Billing (NBB) for the non-formal members
Cost
Coverage

OOP for patients or ward admissions and fixed co-payment for formal sector
• Lack of regularly collected cost data to guide members or private room accommodation
payment rates • Mandate to regularly collect cost data from facilities
Department of Health
• Compensation for public health workers are not • Competitive compensation, with those serving in GIDA areas
Health Human Resource

competitive versus the private sector
• No clear guidelines on distribution of PhilHealth
reimbursements for professional fees, leading to
large variations
• Insufficient number of plantilla items in public
facilities, for both general practitioners, specialists,
and allied health professionals
• High cost of health professional education translating
to barrier to needed level of production
• Insufficient number of professionals entering into
service for public facilities
• Curriculum oriented towards tertiary care
• Number of private beds overtaking number of public
Health Care
Institutions
receiving national salary rates plus additional premiums and
allowances as necessary
• Set-up explicit guidelines for distribution of PhilHealth
reimbursements for professional fees to strategically
complement salaries
• Ensure that public funding for health professional education is
available to deserving students
• Mandatory return service for all publicly-funded health
professionals
• Curriculum shift towards greater emphasis on primary care
• Rigorous monitoring and upholding of NBB beds ratio in

beds in government facilities limiting available beds hospitals (90% for government, 60% for GOCC, 10% for private)
for poor and near-poor • Establishment only of network-based facilities that provide
• Arbitrary mushrooming of health care facilities which comprehensive care in accordance with a national plan
worsens equity of access • 100% income retention for all government health facilities
• Partial or non-retention of income leading to health • Prescribing standard admission/discharge procedures in all
funds not reinvested in health health facilities
• Different hospitals, different procedures
• Fragmented and irregularly updated surveillance and • Establishment and monitoring of disease registries
Information
Systems

health systems data • Establishment of an integrated health human resource

• Manual, paper-based systems database
• Mandating submission of encoded administrative, clinical and
costing data by health care providers
• Sparse attention to health policy and systems • Establishment of a Health Policy and Systems Research
Knowledge
Generation

strengthening-oriented research Institute

• Lack of standards setting body for treatment and • Establishment of a CPG clearinghouse
care provision