HEALTH FINANCING AND BUDGETING PRACTICES IN THE PHILIPPINES

Asian SBO, Bangkok December 13-14, 2017

An international perspective

11.4

9.4

9.0

9.0

7.1

7.1

5.8

5.7

5.6

5.1

4.9

4.7

4.7

4.7

4.5

4.3

4.2

4.1

3.5

2.8

2.8

2.6

2.6

2.3

1.9

0

2

4

6

8

10

12

Public¹ Private%

Trends in health spending

Policy Goals

Health delivery system - responsibilities

• Regional secondary/tertiary hospitals • Mental hospitals • Research Centres • Vertical programmes (TB, AIDs Malaria etc.)

National (DoH)

• Provincial, city and district hospitals Provinces (81) and independent cities

• City health clinics • City hospitals

Municipalities (1489)

• Local health stations

Barrangay (42,000)

Financial flows in the health sector

TaxesBorrowings

National Government

PhilHealth Provinces DOH

Specialty public hospitals

HMOs/Private Health Insurance

Household and Private Companies Insurance payments

Retained public hospitals

Provincial, District Hospitals

Local govt taxes, fees & other revenues

Hospital revenues

Private hospitals, clinics, MDs

Household out-of-pocket payments

Foreign assistance/grants

Rural Health

Units

Municipalities Cities

City hospital

City Health Center

Barangays

Baran-gay

Health

Stations

Major reforms related to health

financing

Key achievements

• Funding for UHC - Sin Tax earmarks

• Expanded insurance benefits package and population coverage (PhilHealth)

• CCT program helps poor to access free health insurance (household targeting system)

• Improvements in PFM at national level

Increases in DOH Allocations

0

20

40

60

80

100

120

140

2010 2011 2012 2013 2014 2015 2016

DOH Budget Allocations, 2010-16 (in billion pesos)

National Health Insurance Program Health Facility Enhancement Program Others

The national health insurance

programme

10

20

30

40

50

60

70

80

90

100

10

20

30

40

50

60

70

80

90

100

2010 2011 2012 2013 2014 2015 2016

% o

f p

op

ula

tio

n

No

. o

f m

em

be

rs

& d

ep

en

de

nts

PhilHealth Beneficiaries, 2010-2016

SP/IP Other Membership Programs % of pop

CCT program linked to health

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

2007 20082009 2010 2011 2012 2013 2014 2015

Mil

lio

n p

es

os

Nu

mb

er

of

ho

se

uh

old

s

Household coverage and annual budget of the Pantawid Pamilya Pilipino Program, 2007-

2010

Household Coverage Annual Budget (million pesos)

Key budget issues - 1

• Under-execution.

Key budget issues - 2

Inconsistency between LGU spending plans and DoH policy objectives

Complex planning and procurement for vertical programs leading to stock outs

Poor quality of local investment planning leading to under-investment in capital

Weak response to program impact evaluation

Weak oversight and accountability (Health Boards)

Little change in local government

spending on health

0

5

10

15

20

25

Share of health in total local government expenditures, by local government level,

2001-2014

Province (%) City (%) Muni (%)

Selected recommendations - 1

Fully implement LGU PFM Reform Roadmap to match progress made at national level.

Streamline local planning processes (including investment plans for health, poverty reduction plans) to improve consistency and avoid duplication.

Improve programming and monitoring of the intergovernmental fiscal transfer system.

Recommendations 2

LGUs to reinvigorate local health boards, through civil society participation.

PhilHealth to shift performance focus from enrolment to benefit utilization and develop the necessary monitoring indicators and information system. Conduct independent audits or value-for-money evaluations of selected government programmes and projects, and increase the visibility of local financial indicators.