Health financing and budgeting practices for health in the Philippines

Abstract

The Philippines has placed a strong emphasis on achieving Universal Health Coverage. In recent years, earmarked funds from new alcohol and tobacco taxes have substantially increased government funds available for health. This additional funding offers great potential to improve access and health outcomes, as long as the money is well spent. An important pre-requisite for effective spending is a strong budgetary process for health. In terms of budget formulation and planning, the Philippines government has -at the national level -introduced a comprehensive package of public financial management reforms that apply across all sectors. These have helped to measure results better and link the budget formulation process to the Medium-Term Philippine Development Plan. However, the responsibility for health care budgets in the Philippines is largely devolved to local governments and at the local government unit level there is only a weak link between the local health budget, and strategic plans and targets. Further, the complex relationship between national and local government makes aligning planning and budget formulation difficult. The Philippines government also faces important challenges in budget execution, with under-execution a common problem. Finally, several performance monitoring and evaluation mechanisms exist at the national and local levels. While commendable, to maximise their impact these should better feed into the budget decision-making process.

How has sustainable development goals declaration influenced health financing reforms for universal health coverage at the country level? A scoping review of literature

“…The twelve (12) articles included for analyses related the global sustainable development agenda or SDG declaration to health financing reforms, either as part of the background statements, findings, discussion or conclusion sections and made reference to a particular country. Two articles each were from China [ 34 , 47 ], and Philippines [ 43 , 44 ], and one each from Indonesia [ 33 ], India [ 46 ], Bangladesh [ 38 ], Zambia [ 39 ], Iran [ 40 ], Republic of Korea [ 41 ], Lao People’s Democratic Republic (LPDR) [ 42 ] and Nepal [ 45 ].…”

“…Three (3) of the articles can be described as mixed method studies, however they had limited or no statistical analysis rather simple trends or graphs of health financing quantitative indicators such as the level of out-of-pocket expenditure, health expenditure as proportion of total government expenditure and level of household impoverishment due to health spending [ 38 , 43 , 44 ]. Two studies were quantitative [ 40 , 42 ], four were qualitative studies [ 33 , 34 , 41 , 45 ], while three were commentaries [ 39 , 46 , 47 ].…”

“…Of the three mixed studies, one was a health system review using non-conventional approach to the conduct of research studies [ 44 ]. All studies and commentaries reviewed were based on data collected through documentary review except the one study by Capuno et al [ 43 ], that also involved key informant interviews.…”

“…From the reviewed articles, the SDG declaration has informed, caused or intensified national level discussions of health financing for UHC [ 33 , 34 , 43 – 45 , 47 ] and in some instances accelerated the pace with which governments considered the issue of UHC and its financing [ 41 , 42 , 46 ]. Agustina and colleagues [ 33 ], report that national level discussions in Indonesia on UHC scheme concluded that the scheme to be established should be adaptable, accommodative to the diverse needs and affordable as mandated by SDG declaration.…”

“… Revenue Collection – Exploring ways of implementing sustainable health care financing – Mandatory pre-payment contribution being established Pooling of funds – Commitment to allocating sufficient government funding for health – Establishment of NHIF fund as a pooling agency Purchasing – Exploring reforming payment mechanism from inactive to active purchasing Ahmadnezhad et al [ 40 ], 2019, Iran, Study Design: Quantitative, document review – Health transformation plan recalibrated to form part of government commitment on SDG agenda Purchasing – Ministry of Health and Medical Education (MOHME) reduced co-payment Policy on benefit entitlements – Basic health insurance coverage extended from 83.2% of population to 93.2% – Aim to decrease prevalence of catastrophic expenditure to less than 1% by end of 2021 Lee et al [ 41 ], 2019, Republic of Korea, Study design: Qualitative, documentary review – In 2017, government announced NHI reform ‘Moon Jae-in care’ to increase coverage rate to 70% by 2022 and its considered a government’s commitment to health-related SDG – Reinforcing the benefits and financial coverage of national health insurance (NHI) is a core aspect of the reform – The advent of SDGs and inclusion of the President’s name in the health financing reform indicates how seriously the government has taken health financing reforms for UHC Policy on benefit entitlements – The population already covered, reform focuses on increasing the scope/depth of coverage and reducing cost-sharing – Reducing out-of-pocket (OOP) from the cost sharing component to minimize the catastrophic and impoverishing expenditure Nagpal et al [ 42 ], 2019, LPDR, Study design: Quantitative, review of surveys data – Approved national health insurance (NHI) Law in 2017 – To achieve the health targets in the SDG and meet new and emerging challenges, the Government of LPDR accelerated its efforts towards universal health coverage, e.g. the nationwide scale-up of free at point of care MCH services – The NHI was quickly rolled out in 15 provinces by the end of 2017, and covered the entire country except Vientiane capital by the end of 2018 Pooling of funds – In 2016/17, free MCH program was consolidated with 3 other social protection schemes into a single national health insurance scheme (reducing number of risk pools), Purchasing – User fee payment by pregnant women and children under 5 replaced by case-based payment under the MCH initiative Capuno et al [ 43 ], 2018, Philippines, Study design: Mixed method, depth interviews and documentary review – Duterte government’s aims to attain the health-related SDG targets through extending health insurance coverage to all, thus ensuring each Filipino “financial freedom when accessing servi...…”