Question

Describe the type of healthcare system and services typically available to Filipinos here in the US. You may want to contrast the health care available in the US versus what is practiced in the native country or in the Philippines. Do Filipinos have access to acceptable and affordable health care or are there obstacles? Explain.

Answer 1

The Philippines is an archipelago in the South-East Asia Region, with a population of 104.9 million. Filipinos tend to live longer now than in previous decades, with life expectancy at birth increasing from 62.2 years in 1980 to 69.1 years in 2016. This is attributed mainly to improvements in living conditions, better access to health services, and improved management and treatment
of infectious diseases like pneumonia and tuberculosis (TB). However, Filipinos now bear a triple burden of disease.
First, there is the increasing health impact of globalization and escalating climate change.
Second, changes in lifestyle and the increasing prevalence of risk factors related to diet, tobacco smoke and high systolic blood pressure contribute to a rising incidence of diseases of the cardiovascular system, malignant neoplasms, diabetes and road traffic accidents, which are cases of noncommunicable diseases (NCDs) in the country.
Third, despite advances in the management and treatment of infectious diseases, many Filipinos continue to suffer from diseases for which effective interventions are available. These include human immunodeficiency virus (HIV) infection, TB and vaccine-preventable diseases (VPDs) such as measles and diphtheria.

• Healthcare for expats in The Philippines is affordable and good quality in and around Manila.

• The Philippine government allocated $3.2 billion to the health sector for 2020, which was a 12% increase from the budget for 2019.

• The Philippine Department of Health (DOH) is building and upgrading medical infrastructure nationwide and is addressing the need for additional health personnel, particularly in hard to reach areas.

Health is a basic human right guaranteed by the Philippine Constitution of 1987. This is provided in the Philippines through a dual health delivery system composed of the public sector and the private sector. The public sector is largely financed through a tax-based budgeting system, where health services are delivered by government facilities under the national and local governments. The Department of Health (DOH) supervises the government corporate hospitals, specialty and regional hospitals, while the Department of National Defense runs the military hospitals. At the local level, the provincial governments manage and operate district and provincial hospitals, while municipal governments provide primary care, including preventive and promotive health services and other public health programmes through the rural health units, health centres and barangay health stations. Highly urbanized and independent cities provide both hospital services and primary care services. The private sector, consisting of for-profit and non-profit health-care providers, is largely market oriented, where health care is generally paid for through user fees at the point of service. The introduction of social health insurance administered by the Philippine Health Insurance Corporation since 1995 aimed to provide financial risk protection for the Filipino people. The rapid expansion of its membership in the past 5 years is considered a positive development as the Government pursues universal health coverage.

In terms of physical infrastructure, the Philippine health sector has 1224 hospitals, 2587 city/rural health centres and 20 216 village health stations. Sixty-four per cent of hospitals are Level 1 non- departmental hospitals, and 10% are Level 3 medical centres and teaching hospitals,. The private sector’s share of total hospital beds increased from 46% to 53%. The geographical distribution of these resources varies within the country. Almost two thirds of hospital beds are in the island of Luzon, which includes the National Capital Region. Operating indicators vary between public and private hospitals. The average bed occupancy rate of public medical centres is significantly higher than for private hospitals. On average, patients stay about two days longer in public than in private medical centres.

In terms of human resources for health, the top four cadres of institution- based health workers are nurses, doctors, midwives and medical technologists. The public sector engages a higher proportion of nurses, midwives and medical technologists. There are also marked differences in the number of institution-employed health workers available to serve area populations. The density of nurses per 10 000 population is highest in the NCR and lowest in the ARMM. The first point of contact for government-provided health services is the health centre and its satellite village health station, which typically employs an average of one doctor, two nurses and five midwives.

The leading cause of death in the Philippines is heart disease. This is followed by vascular diseases and malignant neoplasms. There is a notable shift in the leading cause of death from communicable diseases as the leading killer to noncommunicable diseases. Infectious diseases, particularly diarrhoea, continued to decline as a contributor to healthy lives lost due to premature deaths.
While the country continues to combat pneumonia and TB as the leading causes of death among Filipinos, it is facing an increasing number
of diseases of the heart, diseases of the vascular system, malignant neoplasms and diabetes. Among external causes, road traffic accidents are also becoming a major cause of death.

Getting sick is one of the most unfortunate things that could ever happen to a person aside from dying. Not only that it involves full time rest but most importantly it requires money, money for medical expenses is the real problem. As it turns out, this is why Philippines  is called Sick man of Asia. Majority of the Philippians are below poverty line and this alarming situation proves that a third world country need savings because if they can't feed then how would they supposed to buy medicines when sick. This is sad reality, some poor people wait for their deaths due to being poor and weak in social hierarchy.

# Health care delivery system in Philippines - 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.

# Filipino state health care system - The public healthcare system is delivered through public health and primary healthcare centres linked to local town health centres. Around 40% of the hospitals in the Philippines are public. Doctors at public hospitals in the Philippines are well-trained, but there are still a number that say the technology and equipment used at public hospitals isn’t as good as private ones. So one have to make sure to ask around from local contacts to get their opinion before choosing the hospital that’s right.

# Filipino private health care system - The private health sector caters to 30% of the population and is based on North American medical models. If private is the route chosen, one will be glad to find out that it’s not only widely available in major cities, but actually a majority of hospitals in the Philippines are privately run. Medical services in private hospitals are frequently touted to be held to a higher standard, but that also means it comes at a higher price. Expats may find private health insurance plans are more affordable than those from their home country. The high-quality, low-cost private healthcare system has put the Philippines on the map not only for medical tourism, but even permanent relocation. But even if one will just be visiting there for a short while, one will need to know that providers expect cash upfront before you can be treated.

# In case of an emergency in Philippines - In case of an emergency in the Philippines, Emergency ICU (Intensive Care Unit) care is usually comparable to what one would find at other high quality international providers. If complex trauma or a major medical emergency strikes, it could require evacuation to a better-equipped hospital in the Philippines. And it is a bit pricey. The cost for an ambulance or emergency air evacuation could be up to ₱50,000.

In 2000 the Philippines had about 95,000 physicians, or about 1 per 800 people. In 2001 there were about 1,700 hospitals, of which about 40 percent were government-run and 60 percent private, with a total of about 85,000 beds, or about one bed per 900 people. The leading causes of morbidity as of 2002 were diarrhea, bronchitis, pneumonia, influenza, hypertension, tuberculosis, heart disease, malaria, chickenpox, and measles. Cardiovascular diseases account for more than 25 percent of all deaths. According to official estimates, 1,965 cases of human immunodeficiency virus (HIV) were reported in 2003, of which 636 had developed acquired immune deficiency syndrome (AIDS). Other estimates state that there may have been as many as 9,400 people living with HIV/AIDS in 2001.

# Health reform initiatives in the Philippines -

Health reforms in the Philippines build upon the lessons and experiences from the past major health reform initiatives undertaken in the last 30 years. The adoption of primary health care (PHC) approach in 1979 promoted participatory management of the local health care system. The goal was to achieve health for all Filipinos by the year 2000. It emphasized the delivery of eight essential elements of health care, including the prevention and control of prevalent health problems; the promotion of adequate food supply and proper nutrition, basic sanitation and adequate supply of water, maternal and child care, immunization, prevention and control of endemic diseases, appropriate treatment and control of common diseases, and provision of essential drugs. To implement PHC, EO 851 was issued in 1983 integrating public health and hospital services (World Health Organization, 2011).
The People Power Revolution strengthened the call for legitimate local representation. In early 1990s, the Local Government Code (LGC) transferred the responsibility of health service provision to the local government units. The intention of LGC was to establish a more responsive and accountable local government structure. However, this has resulted to fragmentation of administrative control of health services between the rural health units and hospitals and between the different levels of political structure (World Health Organization, 2011). Prior to that, the Generics Act was adopted in 1988 to ensure adequate supply, distribution and use of generics thereby improving access to affordable drugs and medicines.
During that time, more than half of the population had no coverage, especially the poor, the self-employed and informal sector workers (World Health Organization, 2011). This led to the enactment of the National Health Insurance Act of 1995 or RA 9875 which aims to provide all citizens a mechanism for financial protection with priority given to the poor. It created the National Health Insurance Program “which shall provide health insurance coverage and ensure affordable, acceptable, available and accessible health services for all citizens of the Philippines.”
In 1999, the health sector reform agenda was launched as a major policy framework and strategy to improve the way health care is delivered, regulated and financed.
It was designed to implement the reform package in the convergence sites. The five reform areas are - 1. public health, 2. hospital, 3. local health systems,  4. health regulations and 5. health financing (Department of Health, 2004). It was during this time that the DOH underwent a major organizational reform to pursue its new role as a result of the devolution. At the local level, the municipalities were joined together to form inter- local health zones (ILHZs) to optimize sharing of resources and maximize joint benefits from local health initiatives.
The operational framework of health sector reforms was adopted in 2005 and was called Formula One for Health (F1). The objective was to undertake critical reforms with speed, precision and effective coordination directed at improving the efficiency, effectiveness and equity of the Philippine health system in a manner that is felt by the Filipinos especially the poor. The F1 organized health reform initiatives into four implementation components, namely: financing, regulation, service delivery and governance. This time also marked the enactment of two pieces of legislation: the Universally Accessible Cheaper and Quality Medicines Act of 2008 and the Food and Drug Administration Act of 2009.
However, despite the important progress made, successive reforms have not succeeded in adequately addressing the persistent problem of inequity.

The Philippines healthcare and pharmaceutical market is expected to experience robust growth. Additionally, healthcare expenditure in the Philippines is expected to continue to grow steadily through to 2029, rising from $17.2 billion to $60.7 billion.

The demand for healthcare in Southeast Asia as a whole is rapidly increasing because of growing population. According to the Asian Review, every year, the Philippines loses approximately 13,000 healthcare workers who go abroad to work. This has aggravated the domestic shortage of 290,000, according to the Philippine Overseas and Employment Administration. In 2020, the Philippines prohibited doctors, nurses, and other medical professionals from leaving to work overseas because the nation was grappling with the coronavirus.