premid Flashcards
1
Q
In the national level, which is represented by the DOH Regional Ofice will have the authority over the
A
A. City Health Office, (Chartered cities).
B. Provincial Health Office
2
Q
• These chartered cities have more robust economy that is why they could separate their identities from the respective provinces.
A
City Health Office, (Chartered cities).
3
Q
City Health Office, (Chartered cities).
• Also, they have their own health service delivery systems.
CHB
A
(e.g. City hospitals, health centers, and Barangay Health
Stations)
4
Q
• has Provincial and District hospitals.
•Inter-local Health Zones
A
B. Provincial Health Office
5
Q
Inter-local Health Zones which are the
A
Municipal and City Health Office.
6
Q
, the mast common stigma is that these are
cities that are striving to be first-class. While the
A
The Municipal Health Office
7
Q
has its own barangay health stations, health centers, and City hospitals. Characterized by:
A. Communicable Diseases
B. Non-communicable Diseases
C. Diseases of Industrialization
A
Component cities
8
Q
• Provide health insurance to Filipinos
• Financial protection is limited
Premiums for the poor are subsidized by the government Specialty and Regional Hospitals
• Funded by DOH
A
Philippine Health Insurance Corporation (PhilHealth)
9
Q
• Funded by LGU’s
A
Provincial and Municipal Hospitals
10
Q
• measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.
• Most common are non-communicable diseases.
A
Disability adjusted life years
11
Q
• By order timeline to improve healthcare delivery
A
Health reform initiatives
12
Q
• “Adoption of Primary Health Care”
• Promoted participatory management of the local health care system.
A
1979
13
Q
• EO 851
• “Reorganization of DOH”
• Integrated public health and hospital services.
A
1982
14
Q
• “The Generics Act”
• Prescriptions are written using the generic name of the drug.
A
1988
15
Q
• RA 7160
• “Local Government Code”
• Transfer of responsibility of health service provision to the local government units.
A
1991
16
Q
• “National Health Insurance Act”
• Aims to provide all citizens a mechanism for financial protection with priority given to the poor.
• No balance billing.
A
1995
17
Q
• Health Sector Reform Agenda
• Major organizational restructuring of DOH to improve the way health care is delivered, regulated, and financed.
A
1999
18
Q
• FOURmula One (F1) for Health.
• Adoption of operational framework to undertake reforms with speed, precision, and effective coordination.
A
2005
19
Q
• RA 9502
• “Access to Cheaper and Quality Medicine Act”
• Promote and ensure access to affordable quality drugs and medicines for all.
• AO 2010-0036 • “Kalusugan Pangkalahatan” • Universal health coverage and access to quality healthcare for all Filipinos.
A
2008
2010
20
Q
• RA 9502
• “Access to Cheaper and Quality Medicine Act”
• Promote and ensure access to affordable quality drugs and medicines for all.
A
2008
21
Q
• AO 2010-0036
• “Kalusugan Pangkalahatan”
• Universal health coverage and access to quality healthcare for all Filipinos.
A
2010
22
Q
Major Areas of Reform
A
✔ Health service delivery
✔ Health regulation
✔ Health financing
23
Q
Health Reforms Targeted to Address Issues Such As:
A
• Poor accessibility
• Inequity
• Inefficiency
24
Q
THE PHILIPPINES HAS A FRAGMENTED HEALTH SYSTEM
A
• National Government
• Local Government units
• Private Sector
- Preventive
- Promotive
- Curative
25
➤ Access to comprehensive, quality health care services is
important for promoting and maintaining health, preventing and
managing disease, reducing unnecessarydisability and premature death,and
Health Services
26
Health Services
➤achieving health equity for all, which discusses:
Both access to health services and the quality of health services can impact health. Healthy People 2020 directly addresses
access to health services as a topic area and incorporates quality of health services throughout a number of topic areas.
➤ Lack of access, or limited access, to health services greatly impacts an individual’s health status. For example, when individuals do
nothave health insurance, they are less likely to participate in preventive care and are more likely to delay medical treatment.
insurance coverage, health services, and timeliness of care.
27
LEVEL OF GOVERNMENT HEALTH SERVICES
LEVELS OF CARE AND SERVICES PROVIDED
Primary Care Services
Secondary and Tertiary Services
Rehabilitative Services
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• Includes immunization, health and nutrition education, family planning services, treatment for minor illnesses and accidents, outpatient, dental, and laboratory services.
Primary Care Services
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• Includes
outpatient,
inpatient
hospital care
laboratory and special procedures
acute and emergency care
dental care
mental care.
Secondary and Tertiary Services
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• Includes acute inpatient rehabilitation, long-term care, and programs for the elderly and disabled, and palliative care.
Rehabilitative Services
31
HEALTH SERVICES
Hospitals
• General hospitals
• Level 1 hospitals
• Level 2 hospitals
• Level 3 hospitals
• DOH-retained hospitals
• Specialty hospitals
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Other Health Facilities
• Primary Care Facility
• Custodial Care Facility
• Diagnostic / Therapeutic Facility
• Specialized Outpatient Facility
33
ACCESS AND QUALITY OF HEALTH SERVICES
• WHO recommended ___beds per 10,000 population
20
34
ACCESS AND QUALITY OF HEALTH SERVICES
• Philippines has ___beds per 10,000 population.
10.7
35
PERCEPTION TOWARDS GVT HEALTH SERVICES
o Perceived as low quality
o Poor diagnosis resulting to repeated visit
o Health human resources are not available and sometimes lacking in medical people skills
o Long waiting time
o Inconvenient facility schedule
o Run down or worn out facilities
36
• “Why people go to private facilities”
Quality
37
• “Why people go to public facilities”
affordable
38
Health workforce
Human resource for health
Migration
Density
Distribution
39
• Essential for efficient management and operation of the public health system.
• Enormous but unevenly distributed in the country (most are in Metro Manila and urban centers)
Human respurce for health
40
• Philippines is a major source of health professionals in the world. • Fluency in English and skills and training received.
• Compassion and patience in caring.
• Leading exporters of nurses to the world.
• Second major exporter of physicians but migrates as nurses.
• Socio-economic and political situations do not contribute to retaining of
licensed and skilled professional in the country.
MIGRATION
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Healthcare Delivery Systems Based on Funding Source
1. The Beveridge Model "Public Model" - “Socialized Medicine Model”
2. The Bismarck Model "Mixed Model" - “Sickness Funds”
3.The National Health Insurance Model
4. The Private Insurance Model
5.Out-of-Pocket Model
43
The Beveridge "public" model was inspired by the ________ Report for social insurance presented in the English Parliament in 1942. Funding is based mainly on taxation and is characterized by a centrally organized National Health Service where the services are provided by mainly public health providers (hospitals, community GPs, specialists and public health services).
William Beveridge
44
Characteristics:
Healthcare is provided and financed by the government, through tax payments
There are no medical bills
Medical treatment is a public service Providers can be government employees
Lows costs because the government controls costs as the sole payer
The Beveridge Model "Public Model" - “Socialized Medicine Model”
45
The Bismarck “mixed” model was inspired by the 1883 Germany Social Legislation and National Health Insurance Plan for workers introduced by _____, the Chancellor of Germany.
Otto von Bismark
46
Characteristics:
Providers and payers are private
Private insurance plans – financed jointly by employers and employees through payroll deduction
The plans cover everyone and do not make a profit
Tight regulation of medical services and fees (cost control)
The Bismarck Model "Mixed Model" - “Sickness Funds”
47
➤ This is also a single-payer healthcare system which are popular in Asian countries which combines aspects of both Beveridge and Bismarck. Healthcare is paid through higher taxation; however, patients are free to choose any doctor or hospital for their care. Like for Beveridge and Bismarck, there is no profit incentive, prices tend to stay lower, and health outcomes are better. Japan uses this system with a heavy emphasis on preventative care, and such, have some of the highest life expectancies in the world.
The National Health Insurance Model
48
is also known as the model of “independent customer”. Funding of the system is based on premiums, paid into private insurance companies, and in its pure form actually exists only in the USA. In this system, individuals are either covered by their employers, covered by a private policy the policyholder purchases themselves or they go without coverage at all. 28 million Americans currently have no health insurance coverage and given the introduction of the American Health Care Act (“Trumpcare”), the number has a strong potential to go higher. The US stands alone among developed nations in not providing health care coverage to all its citizens as a right. Sick citizens without health insurances have nowhere to go for care other than the emergency rooms of hospitals. In some particularly poor areas, citizens go their entire lives without ever seeing a doctor once.
The “private” insurance model
49
➤ In this system, the funding is predominantly private, with the exception of social care through Medicare and Medicaid. The great majority of providers in this model belong to the private sector.
The “private” insurance model
50
There is also a 5th type of health system ( No System) called " the out-of-pocket-model
Only the developed, industrialized countries -- perhaps 40 of the world's 200 countries -- have established health care systems. Most of the nations on the planet are too poor and too disorganized to provide any kind of mass medical care. The basic rule in such countries is that the rich get medical care; the poor stay sick or die.
In rural regions of Africa, India, China and South America, hundreds of millions of people go their whole lives without ever seeing a doctor. They may have access, though, to a village healer using homebrewed remedies that may or not be effective against disease
Out-of-Pocket Model
51
Characteristics:
Only the rich get medical care; the poor stay sick or die
Most medical care is paid for by the patient, out-of-pocket No insurance or government plan
Out-of-Pocket Model
52
What is the best System?
➤ All models of health care systems are imperfect and there is no model which is the best and broadly accepted
and
recommended. There are big differences among countries
in relation to the goals, structure, organization, finance and the other characteristics of the health care systems.
➤These differences are influenced by history, traditions, socio-cultural, economic, political and other factors. But, regardless of all present differences, there are same common characteristics, typical for all organized health care systems
53
Challenges in the Health System
1. Disjointed health system
2. High out-of-pocket (OOP)expenditure
54
Conflicting mandates between the DOH and LGU’s
• “Over” decentralization
• Flow of funds are complicated and inequitable
1. Disjointed health system
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• More than 50% of the expenditure are OOP
• Inadequate scope and amount of PhilHealth packages
• Expensive drugs and services
2. High out-of-pocket (OOP)expenditure
56
Barriers to quality health care
➤ Barriers to accessing health services include:
• High cost of care
• Inadequate or no insurance coverage
• Lack of availability of services
• Lack of culturally competent care
57
• Track the activities of the health sector through its health expenditure and guide future decisions and actions.
• Php 585.3B – Total Expenditure (2014)
NATIONAL HEALTH ACCOUNTS
58
SOURCES OF HEALTH FINANCING
Out-of-pocket spending
National and Local Government
National Health Insurance Program
59
• Burden of financing health care is still heaviest on individual families.
Out-of-pocket spending
60
• Government health budgets are insurance funds.
National and Local Government
61
• Movement towards a single-payer premium-based financing or insurance system.
National Health Insurance Program
62
• There are existing information gaps, misleading statements, and redundancies.
Health Information
63
• Closely reflects the larger health system.
HEALTH INFORMATION SYSTEM
64
ISSUES WITH HEALTH INFORMATION IN THE PHILIPPINES
Redundancies and Duplication
INFORMATION GAPS
Lack of Information Standards
65
• Source software: A free and open electronic health record system for local government health centers in the Philippines.
INFORMATION GAPS
66
• Information systems are fragmented and lack interoperability among systems.
• Vertical disease surveillance systems.
Redundancies and Duplication
67
• Private sector forms a large bulk of actual transactions with family physicians and general practitioners.
• Lacking or absent from DOH information system.
Lack of Information Standards
68
•Early detection, reporting, investigation, assessment, and prompt response to emerging diseases, epidemics, and other public health threats.
•Monitors epidemic diseases.
Philippine Integrated Disease Surveillance and Response Project (PIDSR)
69
*Integrated electronic system for storing and sharing vital health indicators.
• Collects data for DOH.
Philippine Health Information System
70
• Official information system of the Department of Health.
• Enables the collection and translation of information from local to national level.
• Information for policy formulation and decision-making.
Field Health Service Information System (FHSIS)
71
• Supports the functions of a clinic, i.e., barangay health station, rural health unit, or other healthcare facility primarily devoted to the care of outpatients by storing electronic records of health-related data or information on an individual.
• In line with the PHIE and is interoperable with PhilHealth Health Information System, HOMIS (for hospitals), and DSWD (4Ps and WOMB).
Integrated Clinic Information System (iClinicSys)
72
• A telemedicine device capable of capturing medical signals through built-in medical sensors, storing data in an electronic medical record, and transmitting health information via the Internet to a clinical specialist in the Philippine General Hospital for expert advice.
RxBox
73
• National and local health information systems are poorly integrated and weakly managed.
Real-time Monitoring of Vital Maternal and Child Health Indicators through the Community Health Information Tracking System (rCHITS)
74
• Mobile- and Internet-based disease surveillance system for disasters by the DOH HEMS and WHO.
• Conceptualized to provide real-time health information reporting after a disaster
Surveillance in Post Extreme Emergencies and Disasters (SPEED)
75
• An act protecting individual personal information in information and communication systems in the government and the private sector.
DATA PRIVACY ACT (2012)
76
• A platform for secure electronic access and efficient exchange of health data and/or information among health facilities, healthcare providers, health information organizations, and government agencies in accordance with set national standards in the interest of public health.
PHILIPPINE HEALTH INFORMATION EXCHANGE
77
Medicines and Technology
PHARMACEUTICALS
• Filipinos are one of the highest consumers of pharmaceuticals in Southeast Asia ____ annually on medicine and drugs per person).
₱750-800
78
Philippine Pharmaceutical Market
• Segmented market
• Asymmetric Information
• Income Disparities
• Inadequacy of the regulatory system
79
• DOH Administrative Order 2016-0038
• “All for Health Towards Health for All” rally point for its vision of a healthy Philippines by 2022.
• Expanded the scope of the Universal Health Care (UHC) directions, particularly through a whole-of-government approach.
Directions of the Philippine Health Sector
80
• Financial risk protection when accessing these interventions through Universal Health Insurance.
THREE KEY HEALTH GUARANTEES
81
THREE KEY HEALTH GUARANTEES
THE PHILIPPINE DEVELOPMENT PLAN 2017-2022
NEDA AmBisyon Natin 2040
SUSTAINABLE DEVELOPMENT GOALS 2030
82
• First of the four key medium-term plans to translate the vision and aspirations for the Filipinos and the country.
THE PHILIPPINE DEVELOPMENT PLAN 2017-2022
83
• A collective long-term plan that envisions a better life for Filipinos and the country in the next 25 years.
NEDA AmBisyon Natin 2040
84
• A compilation of 17 development goals that target to end poverty, fight inequality and injustice, and confront issues involving climate change and its effects.
SUSTAINABLE DEVELOPMENT GOALS 2030
85
- Is a commitment to a goal and a guide for action.
- It provides a framework within which the activities of the pharmaceutical sector can be
coordinated.
National Drug Policy
86
- It is presented and printed as an official government statement.
- There are factors that are interplaying:
o The availability of the medication
o Rational use of medications on a particular disease
National Drug Policy
87
Medicines in the Country
• Represent the largest single item of healthcare expenditures
• Second largest component of government expenditures
(42%)
88
• ____% of Filipinos lack regular and sustainable access to medicines
• One of the 64 countries worldwide with low to medium access to essential medicine
30
89
• Almost ____% of medicine spending are out-of-pocket spending
• One of the highest drug prices in Asia
90
90
•First pillar of PMP that includes policies and strategies to assure SEQ
Safety, Efficacy and Quality
91
To ensure the continuous availability of essential medicines in the healthcare system.
Availability and Affordability
92
To promote quality use of drugs in the public and private sectors.
Rational Use of Medicine
93
The SARAH Medicines Access Framework
Safety, Efficacy, and Quality (SEQ)
Affordability and Availability
Rational Drug Use
Accountability and Transparency
Health Systems Support
94
