Extracted from Papers of the Universal Health Care Study Group

Equity in health fair, just, and equal access to health care by all individuals, families and communities. Constitutional guarantee: Article II Section 15 – “The State shall protect and promote the right to health of the people and instil health consciousness among them.”

Overall health status – Lower than Thailand, Malaysia, Japan and Korea The 70 years average life expectancy at birth is more than 15 years shorter than those of developed countries. The infant mortality rate of about 35 per thousand live births translates into 80,000 Filipino babies dying of preventable causes each year Maternal mortality ratio that has remained well above 150 per 100,000 live births – meaning more than 3,000 Filipinas dying unnecessarily every year.

Status of Health Equity in the Philippines Indicator High Income / urban areas Low Income / Rural areas Life Expectancy at Birth >80<60 Infant Mortality Rate <10>90 Maternal Mortality Ratio <15>150

Childhood Death Rates by Mothers’ Level of Educational Attainment

Childhood Deaths By Wealth Index, 2003 NDHS Neonatal Mortality Postneonatal Mortality Child Mortality poorest richest

Comparison of Maternal Health Indicators by Wealth Index (Source: 2008 NDHS and 2006 FPS) Wealth Index Quintile Percentage of delivery by Skilled Health Professionals C- Section Rate Total Fertility Rate Unmet Need for Family planning Contraceptive Prevalence Rate (modern) Currently married women age 15-49) % of women who begun childbearing Richest (22) 3 Poorest * The 2008 NDHS data on antenatal care (4 visits) is 83% for urban and 73% for rural residents. Average is 78%.

Inadequate, inefficient, and inequitable Health Care Financing Total Health Expenditure (2005) PHP 200 billion % of GNP< 3 % % of GNP per WHO> 5 %

NHA2004: Sources of Funds Government (local & national) 30.3% Social Health Insurance 9.5% Private Shared Risk 12.5% Out of Pocket 47.7%

Only those with money (i.e., the rich) can fully pay for out of pocket payments and often they have generous health insurance The near-poor and the lower middle classes can become impoverished to meet out of pocket payments for health care. The very poor don’t even have pockets

Recommendation: Aim for Universal Health Care Increase in level and coordination of government spending by national government (including DOH and PHIL Health as well as other sources such as PAGCOR, PCSO) and local government to reduce out of pocket spending to <30% Restructure HRH production of government institutions to target government and other service oriented organizations to emphasize service over self- interest Strengthen regulation of private sector to include, where appropriate, cost containment measures