Technical Reports

Reform Areas

SOCIAL HEALTH INSURANCE

The health financing reforms expanded the National Health Insurance Program (NHIP) towards universal coverage, thus substantially increasing the NHIP's share in financing the country's health care expenditures. The following strategies were identified by the DOH in the area of health financing reform:

1. Improvement of benefits to make the NHIP more attractive
2. Aggressive enrolment of members which included redirection of the indigent program to focus on the urban areas and widespread enrolment of individually-paying member (i.e., self-employed, casuals and contractual employees)
3. Introduction of measures such as increasing sources of funding and developing accreditation and treatment guidelines to improve program performance
4. Development of administrative infrastructure that can handle the increased workload

HOSPITAL REFORMS

Hospitals, because of their crucial role as direct providers of care, are most often perceived by the public to be the vanguards of the health care delivery system. Moreover, hospitals are considered as vital resources for health manpower development and research. On the other hand, hospital care remains to be the most expensive component of health care because of the high cost needed for its operations. A large portion of the national budget is eaten up by this segment of the health sector, depleting other equally important health services.

Forty years ago, the country witnessed the development of a great number of government hospitals as a response to the growing demands for hospital care of the middle class population. Through the years, however, the image of public hospitals became that of free care institutions, depending too much on government subsidies that are, more often than not, insufficient to maintain maximum operation. The state of government hospitals became worse after devolution. The intention of bringing health services closer to the people was overshadowed by the problems it brought, particularly to the health sector and to hospitals.

Provincial and district hospitals were poorly equipped and manned. Patients were driven to seek primary and secondary hospital care in regional and national hospitals, which were retained by the national government. The irrational delivery of care in tertiary hospitals resulted to problems of congestion. Consequently, other serious problems like understaffing, drugs and medicine shortages, cost inefficiencies and the like surfaced. Further, the preventive-promotive aspects of care in these facilities were paralyzed. At both the central and local levels, the quality of health services was compromised.

The poor state of our hospitals became the springboard for the government to initiate reforms. Strategies are adopted to put these institutions at a competitive edge in providing effective, efficient, and equitable hospital care services. These are as follows:

• Conversion of government hospitals into fiscally autonomous entities

• Exploration and adoption of alternative organizational forms for hospitals

• Integration of preventive-promotive health programs in hospital services.

These strategies go hand in hand with centrally or locally initiated efforts to upgrade government hospitals.

Invariably, hospital reforms operate in tandem with other reform areas to successfully create an enduring impact in the entire health sector.

DRUG MANAGEMENT SYSTEMS

The Philippine drug management system has been perennially plagued by the problems of poor quality, unaffordable drugs and of irrational drug use.

The Drug Management System component of the Management Sciences for Health (MSH) HSRTAP was tasked to assist the DOH in resolving these problems. The goals of reform for the Philippine drug management system were:

1. to improve the quality of pharmaceuticals;
2. to strengthen the practice of rational drug use, and
3. to increase the affordability of pharmaceuticals.

The MSH-HSRTAP attempts to achieve these goals through the strategies of assisting the DOH, the Philippine Health Insurance Corporation (PhilHealth), and the local government units (LGUs) in the rational selection of drugs and in enhancing the efficiency of drug procurement systems.

LOCAL HEALTH SYSTEMS

In the area of local health system, HSRTAP specifically assisted in district health system or inter-local health system development. The goals of this reform area was to address the problem of fragmentation of health services brought about by devolution and restore the integration of health services (hospital and public health) at the intermediate level of care (district level) through the mechanism of Inter-LGU partnership. The DOH through the Bureau of Local Health Development handled this reform initiative in close coordination with the Centers for Health and Development (CHD). Along this line, HSRTAP strategic activities were formulated to assist DOH in preparing the groundwork for establishing functional inter-local health zones (ILHZs). These involved the development of tools for advocacy and ILHZ management system, development of training design and modules for advocacy and ILHZ establishment, capacity building of implementers such as CHD and Provincial Health Office (PHO) staff and direct assistance of trained CHD and PHO staff in establishing ILHZs in 16 LGU advance implementation sites.

Previous Page | Continue Narrative