By Dr.

Alberto Romualdez
Dean, Graduate School of Health Sciences
Pamantasan ng Lungsod ng Maynila
 Overall health status – Lower than
Thailand, Malaysia, Japan and Korea
 The 70 years average life expectancy at birth is more
than 15 years shorter than those of developed countries.

 The infant mortality rate of about 35 per thousand live

births translates into 80,000 Filipino babies dying of
preventable causes each year

 Maternal mortality ratio that has remained well above

150 per 100,000 live births – meaning more than 3,000
Filipinas dying unnecessarily every year.
 LEB under 60 years
IMRover 90
MM over 150

LEB over 80 years

IMRless than 10
MM less than 15
 Inequity in Health Outcomes
Average Fertility Rate by Income Quintiles
Income Group Average Fertility
Rate (Desired)

A 2.0 (1.9)
B 2.4
C 3.7
D 4.7
E 5.6 (3.1)
Organization of Health Services
 Public- Private Sector imbalance
 Highly resourced private sector servicing 20-30 % of
population
 Health promotion/Disease prevention lag behind
Curative Service provision
 Fragmentation of Services
 Overspecialization of curative services (private sector
cherry-picking of lucrative specialties)
 Devolution of health services - national and local
 Weak regulatory mechanisms
Result: Inequitable Access to
Health Services
 Less than 50% of poor women get vitamin
supplements compared to 80% of high income women
 2% of lowest quintile women and 20% of highest
quintile have caesarean sections
 Less than 50% of children from lowest quintile homes
compared to 80% from highest quintile are
immunized
 Each year, less than 5% of the estimated 3000 new
Filipino end-stage renal disease cases can have kidney
transplants
 Healthcare worker distribution

• 70% of ALL health workers employed in the

private sector serving 30% of the population

• 30% employed in government services

catering to the majority…
– …of whom many are also engaged in the private
sector licitly or illicitly
 Output of a Flawed System
• Health providers for whom service is a lower
priority than personal professional
advancement.

• They are ill-prepared for dealing with health

problems in the Philippine setting.
 Health Care Financing
 Total Health Expenditure (2005)
PHP 200 billion
 % of GNP <3%

 % of GNP per WHO >5%

Only those with money (i.e., the rich) can
fully pay for out of pocket payments and
often they have generous health insurance

The near-poor and the lower middle

classes can become impoverished to
meet out of pocket payments for health
care.
The very poor don’t even
have pockets
Top Ten Hospitals (PhilHealth Claims) 2006
1. The Medical City
2. St. Luke’s Medical Center
3. Chong Hua Hospital
4. Chinese General Hospital
5. Dr. Pablo O. Torre, Sr. Memorial Hospital
6. Makati Medical Center
7. Davao Medical Center*
8. Davao Doctors’ Hospital
9. Cebu Doctors’ Hospital
10. Perpetual Succour Hospital

* - The only government hospital on the list

Recommended Reforms for
Universal Health Care
 Information System – Create a national council
mandated to craft a health information -
education-communication master plan that is
designed to maximize the use of information
technology for health service delivery.

 Regulation - Regulatory functions of DOH and

local governments should be further strengthened
to promote the double objectives of health sector
reform -- equity and efficacy .
Recommended Reforms for
Universal Health Care
 Governance – DOH should effectively wield its
influence on the different health sector actors –
government, private and nongovernment – towards
universal access.
 Organization of Services - Government facilities
should be reorganized and integrated in accordance
with the principles of primary health care based on an
updated version of the Alma Ata Declaration. They
should provide integrated health services either
directly or through a unified and formalized referral
system.
Recommended Reforms for
Universal Health Care
 Human Resources for Health - Restructure health
workforce production system to emphasize service over
self-interest by integration of regulation under DOH.

 Health Care Financing - Quantum increase in tax-based

coordinated government spending and reorientation of
Philhealth as a true social health insurance program that
maximally spends its health fund on benefits to fully
support the health requirements of all Filipinos.
It is time to elevate the level of
politicization of health from that of
parochial self-interests and petty
patronage to a national issue of
common concern.
End of Presentation

Thank
you!
Cost of medicines and other
health supplies
 The prices of medicines in the Philippines
are among the highest in the world – higher
than Europe and America and most of Asia
and certainly too high in relation to
household incomes of most Filipinos. Given
the high prices, most medicines are beyond
the paying capacity of most Filipinos.
Number of day’s wages needed to purchase
a 30 days treatment with Ranitidine
- Philippines, 30 days
- Sri Lanka, 10 days
- Brazil, 10 days
- South Africa, 5 days
 Average 4-week Medicine Expenditures within
Household Expenditure Quintiles
Result: Poor families cannot afford to pay for medicines
$153 $88
Medicine Expenditures in Last 4

$40
Weeks by Quintiles

$30

$20

$10

$0
Ghana Cote Senegal Tunisia Pakistan
d'Ivoire Morocco India Philippines

Quintile 1 Quintile 2 Quintile 3 Quintile 4 Quintile 5

Source: WHO, World Health Survey, 2002
Characteristics of Reforms for
Universal Health Care
 Coordination

 Integration

 Regulation

 Participation