PHILIPPINE HEALTH-RELATED STATISTICS: HEALTH EXPENDITURE PER CAPITA GOVERNMENT AND PRIVATE HOSPITALS ECON REPORT

GROUP 10 Allanigue, Alexandra Marie Bungay, Maria Paula Gamboa, Lyzel Garcia, Ynna Franzchelska Napalit, Bea Nikkisia Santos, Micoh Ivan Suchadoll, Celena Mae Tiu, Nico Eulogio

Brenda B. Policarpio R.N., R.M., M.N. July 11, 2013

Philippines - Health expenditure per capita Health expenditure per capita (current US$) The value for Health expenditure per capita (current US$) in Philippines was $96.51 as of 2011. As the graph below shows, over the past 16 years this indicator reached a maximum value of $96.51 in 2011 and a minimum value of $28.16 in 2002. Definition: Total health expenditure is the sum of public and private health expenditures as a ratio of total population. It covers the provision of health services (preventive and curative), family planning activities, nutrition activities, and emergency aid designated for health but does not include provision of water and sanitation. Data are in current U.S. dollars.

Year Value 1995 $36.92 1996 $41.43 1997 $41.15 1998 $31.20 1999 $35.44 2000 $33.63 2001 $28.96 2002 $28.16

2003 $33.11 2004 $34.73 2005 $42.10 2006 $48.41 2007 $65.51 2008 $74.63 2009 $76.55 2010 $88.74 2011 $96.51

Source: World Health Organization National Health Account database

HEALTH CARE DELIVERY SYSTEM The Philippine health care system has rapidly evolved with many challenges through time. Health service delivery was devolved to the Local Government Units (LGUs) in 1991, and for many reasons, it has not completely surmounted the fragmentation issue. Health human resource struggles with the problems of underemployment, scarcity and skewed distribution. There is a strong involvement of the private sector comprising 50% of the health system but regulatory functions of the government have yet to be fully maximized. Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary health care facilities. Hospitals are classified based on ownership as public or private hospitals. In the Philippines, around 40 percent of hospitals are public (Department of Health, 2009). Out of 721 public hospitals, 70 are managed by the DOH while the remaining hospitals are managed by LGUs and other national government agencies (Department of Health, 2009). Both public and private hospitals can also be classified by the service capability (see DOH AO 2005-0029). A new classification and licensing system will soon be adopted to respond to the capacity gaps of existing health facilities in all levels. At present, Level-1 hospitals account for almost 56 percent of the total number of hospitals (Department of Health, 2009; Lavado, 2010) which have very limited capacity, comparable only to infirmaries.

Figure 3 show that the private hospitals outnumbered the government hospitals in all categories. The disparity is more noticeable in tertiary hospitals where the number of private hospitals is four times that of the government hospitals. Figure 4 shows the distribution of hospitals by level. Levels 1 and 2 hospitals are relatively well-distributed across the country (though there are few provinces with limited level 2). However, hospitals with higher service capabilities are highly concentrated in Region 3 and National Capital Region (NCR) (Lavado, 2010)

The number of hospital beds is also a good indicator of health service availability. Per WHO recommendation, there should be 20 hospital beds per 10,000 population. Table 4 describes the Level 1 Level 2 Level 3 Level 4 distribution of private and public hospital beds by region. Almost all regions have insufficient beds relative to the population except for NCR, Northern Mindanao, Southern Mindanao and CAR. Among the seventeen regions, Autonomous Region for Muslim Mindanao (ARMM) has the lowest bed to population ratio (0.17 beds per 1000 population), far lower than the national average.

Utilization of Health Facilities In the 2008 National Demographic and Health Survey (NDHS), 50 percent of the clients who sought medical advice or treatment consulted public health facilities, 42 percent went to private health facilities, and almost 7 percent sought alternative or traditional health care. Rural Health Units (RHUs) and Barangay Health Centers (33 percent) were the most visited health facilities in almost all the regions except for NCR and CAR, where most of the clients visited private hospital/clinic for medical advice or treatment. The most common reasons for seeking health care were illness or injury (68 percent), medical checkup (28percent), dental care (2 percent), and medical requirement (1 percent) (NSO, 2008). With regard to child delivery, more than thirty-six percent of infants are still delivered by hilots despite aggressive efforts of the

Department of Health to promote facility-based delivery (National Statistics Office, 2008). The hospital sector in the Philippines is highly segmented in nature. Utilization of hospitals may be driven by PhilHealth insurance coverage and socio-economic determinants as shown in Table 6. People with PhilHealth insurance are more likely to be confined in a private hospital (56 percent), than those without Philhealth insurance (28 percent). Similarly, patients living in urban area (52 percent) and belonging to the richest quintile (74 percent) are also more likely to be confined in private hospitals. (Lavado et al., 2010).

Available data shows that on the average, travel time to a health facility is 39 minutes; where travel time is longest in ARMM (83 minutes) and shortest in NCR and Northern Mindanao, (28 minutes). Travel time is relatively longer in rural areas (45 minutes) than in urban areas (32 minutes); and longest for persons in the lowest wealth quintile (47 minutes) and shortest for those in the highest wealth quintile (35 minutes). Older persons seeking care (60+ years old) have longer average travel times than younger persons (National Statistics Office, 2008) Satisfaction with Health Facilities Based on a survey by the Social Weather Station in 2006, majority of Filipinos specifically the low income households prefer to seek treatment in a government hospital if a family member needs confinement.

Affordability is the main reason for going to a government medical facility, while excellent service is the main reason for going to a private medical facility (Department of Health, 2010). The net satisfaction with services given by government hospitals has slightly improved from +30 in 2005 to +37 in 2006. Excellent service and affordability are the main reasons for being satisfied whereas poor service is the main reason for being dissatisfied with the services given by government hospitals (Social Weather Stations, 2006).

Source: http://www.doh.gov.ph/sites/default/files/3%20Chapter1.pdf