PRELIMS: Healthcare Delivery Systems, Rehabilitation Delivery Models, and Philippine National healthcare Delivery Flashcards
What is the Universal Declaration of Human Rights?
Adopted by the UN General Assembly on December 10, 1948
First global expression of inherent human rights
Arose from the experiences of World War II
What factors drive continuous change in the Health Care Delivery (HCD) system?
Continuous education
Provider payment structures
Capitation payment expenditure
Payment-based performance
Cost & growth of new technology
De-emphasis on institutional care
Aging population
Increased ethnic & cultural diversity
Changes in supply & education of health professionals
Information production & management
Globalization of the world economy
What are the four basic models of health care systems?
Beveridge Model – Government-funded and controlled (e.g., UK, Veterans Affairs in the US)
Bismarck Model – Employer-based insurance, no profit (e.g., Germany, Japan)
National Health Insurance Model – Publicly funded, privately delivered (e.g., Canada)
Out-of-Pocket Model – Paid directly by individuals (common in developing countries)
What is the difference between Home-Based Care and Community-Based Care?
Home-Based Care: Individual appointments in the patient’s home, separate from a community program.
Community-Based Care: PTs are embedded in the community, visiting multiple homes as part of a program.
What is the Continuum of Care in health care?
A system that ensures a seamless transition of patients through different levels of care, such as:
Primary care → Specialist care → Rehabilitation → Home-based care
Often integrated into an Integrated Delivery Network (IDN)
What are the two types of health care coverage?
Public Coverage – Government-subsidized (e.g., Medicare, Medicaid, PhilHealth)
Private Coverage – Employer-sponsored or individually purchased insurance
What is the Universal Health Care Act in the Philippines?
Signed October 10, 2019, took effect November 21, 2019
Aims for equitable access to quality & affordable health care
Ensures progressive realization of universal health care
Provides systemic solutions instead of “band-aid” fixes
What are the key health insurance programs in the US?
Medicare: Public insurance for citizens 65+ years old
Medicaid: Government-funded insurance for low-income individuals
Veterans Affairs (VA) Health System: Military health care (follows the Beveridge Model)
Affordable Care Act (ACA): Expanded insurance coverage (also called Obamacare)
What are the Managed Care Organizations (MCOs)?
Health Maintenance Organization (HMO): Limited network, must use PCP as a gatekeeper.
Preferred Provider Organization (PPO): More flexibility, no referrals needed for specialists.
Independent Practice Association (IPA): Contracts with a group of physicians for service.
Point of Service (POS): Combination of HMO and PPO.
What are the Seven Pillars of Universal Health Care in the Philippines?
Universal health insurance coverage
Expanded health infrastructure
Organization of the health services sector
Health financing
Human resources for health
Cheaper medicines for all
Governance of the health sector
What is PhilHealth?
Government-run National Health Insurance Program (NHIP)
Provides coverage to different groups:
Employed/Self-Employed
Individually Paying Members
Lifetime Members
Took over Medicare functions from GSIS and SSS in 1997
What are key Philippine health policies?
Generics Act of 1988 – Promotes generic drug use
National Health Insurance Act of 1995 – Created PhilHealth
Traditional and Alternative Medicine Act of 1997 – Promotes alternative medicine
Reproductive Health Act of 2008 – Ensures access to reproductive health services
What are the economic challenges of health care?
High number of uninsured & underinsured individuals
Rising health care costs per person
Overconsumption of health care services
Legal & liability concerns requiring safety nets for medical professionals
