Philippine National Health Accounts: Estimates For 2007-2010

Philippine National Health Accounts:
Estimates for 2007-2010
Presented by:
ESTRELLA R. TURINGAN
OIC Chief, Social Sectors A Division
National Statistical Coordination Board
Country Workshop on Health Accounts

19 March2013
0 NATIONAL STATISTICAL COORDINATION BOARD

Outline of the presentation
1. Background on the PNHA
2. Efforts of the NSCB towards improvement of the

PNHA
3. PNHA estimates for 2007-2010
4. Remaining issues and areas for improvement
5. Next steps

I. Background on the PNHA
What is the PNHA?

A framework for the compilation of information on the
countrys health expenditures
Health accounts mainly answers

how much is being spent on health care
who pays for health care
Importance of health accounts

provides insights on the efficiency and effectiveness of
health care financing
helps determine appropriate interventions to improve
delivery of health care

Actual policy uses of the PNHA

Serves as inputs and/or basis for the following:
Analysis of public-private sector roles in health care

financing
Formulation of the Bridge Plan for the New
Administration
Updating the National Objectives for Health and the
PDP Chapter on Health
Preparation of the PhilHealth Universal Insurance
Program
Preparation of advocacy materials on health care
financing

PNHA conceptual framework
Concepts and definitions

Health care expenditure
Health care goods
Health care services
Health care expenditure

Expenditures on goods and services for the preventive,
curative, therapeutic and rehabilitative care of the human
population for the primary purpose of improving health.
Excludes programs which have health effects but whose
primary goal is not health improvement (e.g., sewerage
projects)
Health care goods

Drugs and medicines
Other medical and health goods which include medical
non-durables and durables
Medical and health equipment

Health care services

Services provided by
hospitals
medical and dental clinics (including those based in
business firms, private schools and non-DOH government
agencies)
own-account health professionals and traditional healers
medical missions and mobile surgical/laboratory units
the DOH (other than those by DOH health care facilities)
non-DOH government agencies such as nutrition
programs, health information campaigns and drinking
water testing

BASIC PNHA DESIGN/MATRIX

SOURCE OF FUNDS
USE OF TOTAL
GOVERNMENT SOCIAL
FUNDS INSURANCE PRIVATE REST OF
NATIONAL LOCAL SECTOR THE
WORLD
PERSONAL
HEALTH CARE
PUBLIC
HEALTH CARE
OTHERS
TOTAL

PNHA operational framework
Uses of funds - use of facility-based definition as a proxy measure
Personal health care Public health care Others
Government Hospitals Expenditure of General

Private Hospitals DOH administration
Non-hospital Medical other national and operating
Care Facilities government costs
Dental Care Facilities agencies
LGUs Research and
Other Professional donor agencies Training
Care Facilities NGOs
Traditional Health
Care for the production
Self-care and/or provision of
health care goods
and services with
economic
externalities or which
are characterized as
public goods
PNHA operational framework
Sources of funds persons or institutions that directly pay the

health care providers (final payor)
Government
Social Insurance
Private sources
Rest of the world

II. Efforts of the NSCB towards
improvement of the PNHA

II. Efforts of the NSCB towards improvement of the PNHA
To address the issues and concerns confronting the PNHA

in 2009, the NSCB Technical Staff undertook an overall
review and improvement of its sectoral estimation
methodologies
Agencies/Bodies involved:
- With direct guidance from the NSCB Secretary General
and the members of the NSCB Directorate;
- In coordination with data source agencies;
- In close collaboration/coordination with the Department
of Health;
- With support/assistance from the WHO; and
- In consultation with the Interagency Committee on
Health and Nutrition Statistics (IACHNS), chaired by the
DOH, thru Asst. Sec. Eric Tayag.

Activities undertaken from 2010-2012:
Identification of alternative data sources and estimation

methodologies and conduct of computational
exercises to test the alternative methodologies,
including data cleaning
Conduct of bilateral meetings with the data source

agencies (e.g., GSIS, PCSO, IC, ECC, etc.)
Series of deliberations and meetings within the NSCB for

a detailed review of the results of the computational
exercises and revision activities

Activities undertaken from 2010-2012 (cont.):

Presentation of the revised PNHA estimation
methodologies in various local and international
meetings/forums/conferences
6th and 7th Joint OECD Korea Policy Centre-APNHAN
Meeting of Regional Health Accounts Experts (July 4, 2010
and June 28, 2011)
IACHNS (July 5, 2010)
11th and 12th National Forum on Health Research for Action
(July 29, 2010 and November 14, 2011)
DOH Executive Committee (August 23, 2010)
Release of the 2005-2007 PNHA updates (as

preliminary estimates, August 3, 2010)

Presentation to the NSCB Executive Board (November

9, 2010 and May 24, 2011) - approved through NSCB
Resolution No. 8, Series of 2011
Estimation of the PNHA 2007-2010 using the revised
estimation methodologies
Further work done by the NSCB Technical Staff to
address the PNHA data limitations
Estimation of the local government health
expenditure using BLGF data
Revision of the estimates for private schools based
on supplementary data provided by DepED
Revision of the estimates for other private
establishments based on supplementary data
provided by NSO

Presentation to the IACHNS of the 2007-2010 PNHA
estimates in December 2012
Coordination with DOH re: PNHA estimates for 2007-
2010
Release of the PNHA estimates for 2007-2010 on
December 20, 2012
(http://www.nscb.gov.ph/stats/pnha/default.asp)

III. PNHA estimates for 2007-2010

Total health expenditure, 2007-2010
The country's total health expenditure showed improvements from 2007
to 2010, but the growth rates revealed an uneven trend for both current
and constant prices.
At current prices, the total outlay for health went up from PhP268.9 billion
in 2007 to PhP379.3 billion in 2010, registering an average annual growth
rate of 12.1 percent between 2007 and 2010.
Average Annual
Growth Rate
ITEM 2007 2008 2009 2010 (2007-2010)
Total Health Expenditure

(in million pesos, at current prices)
268,928 302,043 342,510 379,328

Growth Rate (%) at current 12.3 13.4 10.7 12.1
prices
(in million pesos, at constant 2000 189,653 194,867 214,069 228,373
prices)
Growth Rate (%) at constant 2.7 9.9 6.7 6.4
2000 prices
Per capita health spending, 2007-2010
With the total health expenditure growing faster than

population, per capita health spending at current prices went
up by PhP316 in 2008, PhP386 in 2009, and PhP333 in 2010.
Average Annual
ITEM 2007 2008 2009 2010 Growth Rate
(2007-2010)
PhP 316 PhP 386 PhP 333
Per Capita Health Expenditure (in
3,061 3,377 3,763 4,096
pesos, at current prices)
Per Capita Health Expenditure (in

2,159 2,179 2,352 2,466
pesos, at constant 2000 prices)
Population (million) 87.9 89.4 91.0 92.6 1.8

Per Capita Health Expenditure
10.3 11.4 8.9 10.2
Growth Rate (%) (at current prices)
Per Capita Health Expenditure
Growth Rate (%) (at constant 2000 0.9 7.9 4.9 4.5
prices)
Total health expenditure by source of funds
Social insurance and the rest of the world were the fastest growing
sectors in terms of health expenditure from 2007 to 2010, but.
Average Annual
SOURCE OF FUNDS
2007 2008 2009 2010 Growth Rate 2007-
2010
GOVERNMENT 74,036 74,875 88,722 100,403 10.7
National 32,749 36,554 36,949 42,400 9.0
Local 41,288 38,320 51,773 58,003 12.0
SOCIAL INSURANCE 19,972 21,434 27,897 33,925 19.3
NHIP 19,838 21,345 27,791 33,799 19.4
Employees' Compensation 134 88 107 126 (2.2)
PRIVATE SOURCES 173,986 202,054 218,210 238,617 11.1
Out-of-Pocket 147,873 171,116 182,370 199,983 10.6
Private Insurance 4,175 5,108 6,083 6,401 15.3
HMOs 13,123 15,638 18,545 20,542 16.1
Employer-Based Plans 5,996 7,043 7,809 7,937 9.8
Private Schools 2,820 3,148 3,404 3,755 10.0
REST OF THE WORLD 933 3,682 7,681 6,384 89.9
Grants 933 3,682 7,681 6,384 89.9
ALL SOURCES 268,928 302,043 342,510 379,328 12.1
Distribution of health expenditure by source of funds
But their actual contributions remained way below those of
government and private sources.
SOURCE OF FUNDS
2007 2008 2009 2010
GOVERNMENT 27.5 24.8 25.9 26.5
National 12.2 12.1 10.8 11.2
Local 15.4 12.7 15.1 15.3
SOCIAL INSURANCE 7.4 7.1 8.1 8.9
NHIP 7.4 7.1 8.1 8.9
Employees' Compensation 0.0 0.0 0.0 0.0
PRIVATE SOURCES 64.7 66.9 63.7 62.9
Out-of-Pocket 55.0 56.7 53.2 52.7
Private Insurance 1.6 1.7 1.8 1.7
HMOs 4.9 5.2 5.4 5.4
Employer-Based Plans 2.2 2.3 2.3 2.1
Private Schools 1.0 1.0 1.0 1.0
REST OF THE WORLD 0.3 1.2 2.2 1.7
Grants 0.3 1.2 2.2 1.7
ALL SOURCES 100.0 100.0 100.0 100.0

While Filipino households still bore the bulk of spending for their health
needs (surpassing 50 percent of the total health expenditure), private
out-of-pocket expenditures showed a generally decreasing trend from
55 percent in 2007 to 52.7 percent in 2010.
SOURCE OF FUNDS
2007 2008 2009 2010
GOVERNMENT 27.5 24.8 25.9 26.5
National 12.2 12.1 10.8 11.2
Local 15.4 12.7 15.1 15.3
NHIP 7.4 7.1 8.1 8.9
Out-of-Pocket 55.0 56.7 53.2 52.7
HMOs 4.9 5.2 5.4 5.4
Grants 0.3 1.2 2.2 1.7
ALL SOURCES 100.0 100.0 100.0 100.0
The government came in a far second in health spending contribution, with the
national government and local government units (LGUs) footing 11.2 percent and
15.3 percent in 2010, respectively.
The LGUs consistently spent more than the national government from 2007 to 2010.
SOURCE OF FUNDS
2007 2008 2009 2010
GOVERNMENT 27.5 24.8 25.9 26.5
National 12.2 12.1 10.8 11.2
Local 15.4 12.7 15.1 15.3
NHIP 7.4 7.1 8.1 8.9
Out-of-Pocket 55.0 56.7 53.2 52.7
HMOs 4.9 5.2 5.4 5.4
Grants 0.3 1.2 2.2 1.7
ALL SOURCES 100.0 100.0 100.0 100.0
Health care financing indicators: Target vs. actual levels, 2007-2010
Out of eight health care financing indicators with targets set as part of the
National Objectives for Health 2005-2010, only two were within the targets
from 2007 to 2010-total health expenditure as percentage of GNI and per
capita health expenditure.
PNHA Estimates
Indicator Target 2007 2008 2009 2010
Total health expenditure as percentage of GNI 3 to 4 3.1 3.1 3.2 3.2
Per capita health expenditure (in pesos) 2,000 3,061 3,377 3,763 4,096
Total government health expenditures as percentage of total 40 27.5 24.8 25.9 26.5
health expenditure National government 18
Local government
12.2 12.1 10.8 11.2
12 15.4 12.7 15.1 15.3
Total social health insurance expenditures as percentage of total 15
health expenditure 7.4 7.1 8.1 8.9
Total public health care expenditure as percentage of total 20 10.5 9.7 12.6 10.7
health expenditure National government 6
Local government
3.3 2.9 3.6 2.2
14 6.9 5.7 6.8 6.9
Total public health care expenditure as percentage of total 50 36.9 34.7 40.1 34.3
government health expenditure National government 20
Local government
11.9 11.7 13.7 8.3
30 25.0 23.0 26.4 25.9
Out-of-pocket health spending as percentage of total health 20
expenditure 55.0 56.7 53.2 52.7
IV. Remaining Issues and Areas
for Improvement

IV. Remaining Issues and Areas for Improvement
Issue Initial Work Done

Staggered In the overall review of the PNHA methodology
inclusion of the undertaken between 2010 and 2012, PCSO was
PCSO health identified as one of the targeted agencies for
expenditures, bilateral/focused discussions considering its
due to data possible contribution in the National
constraints Governments health expenditure.
faced by the
NSCB Technical Close coordination has been done by the NSCB
Staff Technical Staff towards obtaining the most
comprehensive relevant data possible (e.g.,
thru agency visits, bilateral meetings,
presentation/discussion in the IACHNS, etc.)

Continuation

Staggered The NSCB Technical Staff has renewed efforts
inclusion of the and transmitted to PCSO an official letter
PCSO health requesting for a bilateral meeting to discuss the
expenditures, following:
due to data Overview of the PNHA and the PCSO
constraints contribution to total health expenditure
faced by the Other PCSO health-related programs that
NSCB Technical should be covered in the PNHA
Staff Appropriate methodology to estimate the
administration cost of all health-related
programs of PCSO


Need to update the A bilateral meeting has been conducted
estimation between NSCB-TS and NSO; and the latter
parameters for the has agreed to consider the conduct of
following sectors: rider surveys to the APIS and the ASPBI to
Private households be able to update the PNHA estimation
Private schools parameters. However, the following
Other private should be considered:
establishments - Resources available (financial and
manpower)
- Ample time considering NSOs timeline
on the planning as well as conduct of
the survey
A separate meeting with WHO and DOH

was also conducted and both agreed to
support the PNHA research needs.

Greater data support The NSCB Technical Staff has closely
from the SEC towards coordinated with the SEC regarding this
strengthening/impro matter, since the overall review of the
ving the quality of PNHA estimation methodology in 2010-
the PNHA estimates 2012.
for HMOs
Processed relevant data from the SEC
can only be obtained, with a fee.
There is a need to revive the proposed

MOA with SEC on the annual provision of
financial statements needed as data
inputs for PNHA as well as for the
National Accounts of the Philippines.


No health NGOs may also be covered in the
expenditure proposed rider survey to the ASPBI.
estimates for NGOs However, the following should be
considered:
- Resources available (financial and
manpower)
- Ample time considering NSOs timeline
on the planning as well as conduct of
the survey
For consideration of the NSO.

V. Next Steps / Way Forward

Short-term
Data gathering and compilation of the 2011 PNHA
Participation of two NSCB-TS in the Training on the

System on Health Accounts (SHA) to be held in
Bangkok on March 11-15, 2013
Proposed re-entry/institutionalization program

based on the discussions during the Training on
SHA and the availability of data/resources in the
Philippine Statistical System. (Hence, it is expected
that there will be a phased adoption of the SHA.)

Short-term
Official release of the 2005-2011 PNHA estimates

(tables and press release) on April 8, 2013
Official release and dissemination of the 2011

PNHA publication by the end of April 2013

Medium-term
In the Philippine Statistical Development Program, 2011-2017, the

following are the statistical programs related to the PNHA:
Improvement of administrative reporting systems on National

Health Insurance Program and employees compensation,
claims and benefit paid
Improvement and compilation of the PNHA through conduct of
special surveys to update estimation parameters and generation
of more disaggregated information on out-of-pocket health
expenditures
Generation and improvement of local-level health, nutrition, and
other related statistics e.g., compilation of local health accounts
Enhancement of the statistical framework on health and nutrition
e.g., review of the statistical framework of the benefit package
of the social insurance program specifically on support value

Announcement
Call for Papers for the 12th NCS
Now inviting for papers for the 12th National Convention on
Statistics (NCS) to be held on 1-2 October 2013 in Metro Manila.
The NCS aims to cover a wide range of topics that are relevant
and critical in an informationoriented economy.
Include topics on:
Health and Nutrition Statistics including Reproductive Health
Biometrics
Statistical Methods in Genetics and Bioinformatics
Statistics in Clinical and Biopharmaceutical Research
Important Dates to remember:
Submission of abstract 30 March 2013
Notification of authors of accepted papers 30 April 2013
Submission of final manuscripts 15 August 2013
For info: call the NCS Secretariat (tel): 890-9678 or 890-96404
Email: ncs@nscb.gov.ph and rdv.sabenano@nscb.gov.ph
NCS website: (http://www.nscb.gov.ph/ncs)
visit: www. nscb.gov.ph
Like us on Facebook: NSCB Philippines
Follow us on Twitter: @NSCBPhilippines
Thank you very much.

Estimation Methodology
National Government
1. For each agency with health-related activities, actual expenditure
by activity is estimated by multiplying the obligations incurred per
activity by the utilization rate of the agency.
2. The utilization rate is computed by department by dividing the total
actual expenditure from COA by the total obligations incurred from
DBM. The utilization rate is assumed the same for all agencies under
each department.
3. The general administration cost of providing health services is
derived by multiplying the total amount spent for administrative
services by the ratio of health-related expenditure to the total
expenditure of the agency net of general administration expense.
4. The capital expenditures of each agency is estimated as the sum of
the net increases in the amounts of capital assets (property, plant,
and equipment) between the reference and previous years.

Foreign-assisted projects, loans and government
counterpart funding
1. The data obtained from DBM, DOH, and NEDA are used to
identify health-related foreign-assisted projects funded
through loans and to classify these projects by PNHA use of
fund.
2. Data provided by DBM include the actual annual loan
availment and counterpart funding by implementing agency.
For the DOH and NEDA reports, the annual expenditure per
project is calculated by dividing total project cost by the
project duration
3. For projects that have more than one implementing agency
or multisectoral concerns, only the share of the health-related
agencies is calculated by assuming equal sharing in the total
annual spending among implementing agencies.
4. The governments counterpart funding for foreign-assisted
projects, whether funded through loans or grants, are
included under this sector.
Local Government
The average shares of the detailed LGU expenditures to the total
expenditure are computed for the past three years and applied on the
total expenditure for the reference year to get the breakdown of
expenditures by use of funds and by expenditure item.
Social insurance: NHIP

The hospitalization benefit payments from the NHIP are directly obtained
from PhilHealth reports. All other expenditures of PhilHealth are
included in the PNHA as general administrative and operating costs
Social insurance: Employees Compesation

1. The EC health benefit payments covering medical and rehabilitation
services are directly obtained from reports provided by GSIS and
ECC.
2. The administrative and operating expenses of GSIS and SSS for
providing EC medical and rehabilitation services are computed by
multiplying the total general administration cost of EC with the share
of EC health benefit payments to total EC benefit payments.
Private household out-of-pocket
1. The basic procedure in estimating private household out-of-pocket
health expenditure is by applying the proportion of medical
expenditures derived from the FIES to the PCE level from the national
accounts.
2. Appropriate adjustments are made on the FIES ratios and the PCE
figures to ensure comparability in the composition of the two
indicators.
3. Double moving average is also applied on the FIES figures to
minimize the sudden increases and decreases in the data on the
share of health expenditure to the total household expenditure, but
still retain the longer-term trends indicated by the survey.

Private insurance: Life and non life insurance
1. Expenditures of private insurance companies for health and
accident benefit payments are sourced directly from the IC annual
report.
2. General administration and operating costs of health and accident
insurance activities are estimated by multiplying the proportion of
health and accident premiums (to total premium income of a
company) with the total general and other operating expenditures of
the same company.
Other private insurance: GSIS optional health
1. The annual health benefit payments from two GSIS optional health
insurance plans the Hospitalization Insurance Plan (HIP) and the
Family Hospitalization Plus Plan (FHPP) - are directly obtained from
the reports provided by the agency.
2. The corresponding general administration costs for these two plans
are determined proportionately based on the shares of their benefit
payments to the total benefit payments of the programs under which
they are classified, i.e., under the Optional Life Insurance Program
and the Pre-Need Program of the GSIS, respectively.
Health maintenance organizations
1. The annual health benefit payments and general administration and
operating costs of each HMO are computed directly from its
financial statement.
2. For each reference year, the previous years total health expenditure
of all HMOs is multiplied by the overall growth rate of at least the top
95 percent of HMOs in terms of health expenditure using matched
data.
Employer-based plans
1. For each year, the total expenditure of private establishments for the
in-house provision of health care goods, services, and facilities for
their personnel is calculated by applying the average health
expenditure per establishment by employment size and industry
group on the distribution of establishments for the year.
2. The health care expenditure estimates are summed up across all
employment sizes and industry groups and the computed total is
adjusted for inflation using the consumer price index (CPI) for
medical services.
Private Schools
1. For each year, the total expenditure of private schools for providing
medical and dental care to students is estimated by applying the
average health expenditure by enrolment size and by level of
education on the corresponding distribution of schools for the year.
2. The resulting health care expenditure estimates are summed up
across all enrolment sizes and the computed total is adjusted for
inflation using the CPI for medical services.

Rest of the world (FAPS, grants)
1. The data obtained from DBM, DOH, and NEDA are used to identify
health-related foreign-assisted projects funded through grants and to
classify these projects by PNHA use of fund.
2. Data provided by DBM include the actual annual grant availment by
implementing agency. For the DOH and NEDA reports, the annual
expenditure per project is calculated by dividing the total project
cost by the project duration.
3. For projects that have more than one implementing agency or
multisectoral concerns, only the share of the health-related agencies
is calculated by assuming equal sharing in the total annual spending
among implementing agencies.
4. The governments counterpart funding for foreign-assisted projects
funded through grants is not included under the rest of the world
sector.

Philippine National Health Accounts: Estimates For 2007-2010

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Philippine National Health Accounts:

Estimates for 2007-2010

Country Workshop on Health Accounts

0 NATIONAL STATISTICAL COORDINATION BOARD

1. Background on the PNHA

2. Efforts of the NSCB towards improvement of the

3. PNHA estimates for 2007-2010

4. Remaining issues and areas for improvement

1 NATIONAL STATISTICAL COORDINATION BOARD

What is the PNHA?

Health accounts mainly answers

Importance of health accounts

2 NATIONAL STATISTICAL COORDINATION BOARD

Actual policy uses of the PNHA

Analysis of public-private sector roles in health care

3 NATIONAL STATISTICAL COORDINATION BOARD

Concepts and definitions

Health care expenditure

Health care goods

4 NATIONAL STATISTICAL COORDINATION BOARD

Health care services

5 NATIONAL STATISTICAL COORDINATION BOARD

BASIC PNHA DESIGN/MATRIX

6 NATIONAL STATISTICAL COORDINATION BOARD

Personal health care Public health care Others

Government Hospitals Expenditure of General

Sources of funds persons or institutions that directly pay the

8 NATIONAL STATISTICAL COORDINATION BOARD

9 NATIONAL STATISTICAL COORDINATION BOARD

To address the issues and concerns confronting the PNHA

10 NATIONAL STATISTICAL COORDINATION BOARD

Activities undertaken from 2010-2012:

Identification of alternative data sources and estimation

Conduct of bilateral meetings with the data source

Series of deliberations and meetings within the NSCB for

11 NATIONAL STATISTICAL COORDINATION BOARD

Activities undertaken from 2010-2012 (cont.):

Release of the 2005-2007 PNHA updates (as

12 NATIONAL STATISTICAL COORDINATION BOARD

Activities undertaken from 2010-2012 (cont.):

Presentation to the NSCB Executive Board (November

Activities undertaken from 2010-2012 (cont.):

14 NATIONAL STATISTICAL COORDINATION BOARD

15 NATIONAL STATISTICAL COORDINATION BOARD

Total Health Expenditure

Total Health Expenditure

With the total health expenditure growing faster than

Per Capita Health Expenditure (in

Population (million) 87.9 89.4 91.0 92.6 1.8

19 NATIONAL STATISTICAL COORDINATION BOARD

23 NATIONAL STATISTICAL COORDINATION BOARD

Issue Initial Work Done

24 NATIONAL STATISTICAL COORDINATION BOARD

Issue Initial Work Done

25 NATIONAL STATISTICAL COORDINATION BOARD

Issue Initial Work Done

A separate meeting with WHO and DOH

Issue Initial Work Done

There is a need to revive the proposed

27 NATIONAL STATISTICAL COORDINATION BOARD

Issue Initial Work Done

For consideration of the NSO.

28 NATIONAL STATISTICAL COORDINATION BOARD