1. The Healthcare Workforce Crisis
1 Professional regulation Commission
2 WHO website
3 Assuming 63M users in public sector
4 HHRDB DOH
5 Expected number in public sector – actual number in public sector
6 Assuming 33M users in private sector
7 Assuming non-government healthcare workers are all in private practice
8 Expected number in private sector – actual number in private sector ; negative
value means numbers are more than minimum
8 Deficit in public sector + deficit in private sector

3. 7 MD’s/10,000 Range 0.2 – 10 “registered”
Ideally, 30 MD’s/10,000 population  met in some areas, but in most, only 0.1 to 10 per 10,000; stats based on registered MD’s
70,418 doctors as of Mar 2013 (7/1000) vs ~30/1000 in developed countries
Now this is a spurious ratio because we all know that MD’s are concentrated in urban areas around the country!
This means, the 52% who live in rural areas – they have even poorer access to care (a geographic workforce crisis)
Segue: But, the people with access? They have problems of their own!
7 MD’s/10,000
Range 0.2 – 10
“registered” 3

4. THE PHILIPPINE WORKFORCE CRISIS
60% of Filipinos die without medical attendance

5. PHYSICIAN SUPPLY AND DEMAND
MITIGATING FACTORS
NURSES/MIDWIVES
COMMUNITY HEALTHCARE WORKERS
AGGRAVATING FACTORS
MALDISTRIBUTION
GROWING POPULATION
AGING POPULATION
SPECIALIST/GENERALIST
UNIVERSAL HEALTHCARE
1 63,0000 IN PRC BUT NOT ALL PRACTICING, not all here, and not all alive!
2 LESS CME, ADMIN WORK, TEACHING, RESEARCH
3 IN USA, 3000 CONSULTATIOPNS A YEAR for every 1000 POPulation
3 INCLUDES SURGERIES, PROCEDURES, ADVISE, PREVENTIVE MEASURES, PRIMARY CARE VISITS!!
CONSEQUENCES
LOW ACCESS RATES
* 60% DIE WITHOUT HEALTH CARE
* HIGHER HOSPITALIZATION RATES
* HIGHER MORTALITY RATES
LOW QUALITY HEALTHCARE
DELIVERED AT A HIGH COST

6. `
Primary care: A very special group of people, ironically called non-specialists.
Can we afford pushing primary care? The question is, can we afford NOT pushing primary care?
The government needs us, and the people need us. They just don’t know it yet.

8. National Average 7/10,000
= 15 min/consult
GIDA Average 3/100,000
= 30 sec/consult

9. Physicians/10,000 population
WHO ( )
Facts:
1. Philippines has no reliable data! Talo pa ng Laos, Cambodia etc
2. At 5/10,000, we are similar to Sri Lanka and Myanmar!
7.2/10,000  15 min/consult
3/100,000  30 sec/consult
Philippines (7.2)
PRC
Rural Areas (0.3)
DOH

10. Alternative Topic (Healthcare System Problems)

11. A Roadmap to Universal Primary Care
Prof. Antonio L. Dans, MD, MSc
Philippine Society of General Internal Medicine

12. How many of you work in government hospitals?
How many have worked worked > 6 years ago?
How many of you worked > 20 years ago?
Govt doesn’t know it, young doctors, even patients – unless they’ve been admitted before
My talk this morning is about how far we’ve gone, and how far we have to go

13. Outline Healthcare System Analysis
Healthcare System Reform (Primary Care)
A Transition to Primary Care
Im not here to praise or criticize
Im here to describe and present a plan

14. Good News and Bad News about the Philippine Health Situation
PhilHealth coverage has increased from 51% in 2010 to 88% in 2015 (PhilHealth) 1
But PhilHealth utilzation remains low, especially amongst the poorest (only 33%) 2
The health budget increased from PhP28.7B in 2010 to PhP205B in
But the number of Filipinos who die without seeing a HCW increased from 45% to 66% 4
1 Philhealth, 2 Faraon et al, 2013, 3 Department of Health, 4 Philippine Health Statistics
utilization = (# who successfully avail of Philhealth) / (# who eligible to make claims)
(the denominator is sick people who are bona fide members)
Coverage = the # who are enrolled / total population

15. Healthcare System Analysis
DOUBLE BURDEN OF DISEASE
This is the 1st half of slide #2
Double burden = as infectious diseases go down, population ages, and chronic diseases increase
This strains healthcare delivery, with the poor sector suffering the most, aggravating existing inequities
INEQUITY IN ACCESS TO CARE
INEQUITY IN HEALTH OUTCOMES

16. INEQUITIES IN HEALTHCARE
FROM WOMB TO TOMB
Slide #3 – EXAMPLES OF INEQUITIES FROM WOMB TO TOMB.

17. Healthcare System Analysis
DOUBLE BURDEN OF DISEASE
#2 exporter of doctors 1
#1 exporter of nurses 2
In public sector:
5 HCW’s per 10,000 pop.
Ideal = 25
1 doctor per 20,000 pop.
Ideal = 20
MD deficit=60,000
In private sector: excess of doctors (30,000) and nurses. 3
1 Matsuno et al,
2 World Health Organization,
3 Dans et al 2015
WORKFORCE SHORTAGE
2ND hald of slide #2
3 problems explain our difficulties in handling the double burden
- short 60,000 MD’s in public sector and 100,000 midwives
- can be covered partly by excess in private sector and excess of nurses
To address these problems, we propose conversion to a primary care system (PCB4)
We believe this package to become affordable and truly universal, coverage should be expanded to ALL filipinos
INEQUITY IN ACCESS TO CARE
INEQUITY IN HEALTH OUTCOMES

18. Healthcare System Analysis
DOUBLE BURDEN OF DISEASE
- 46 healthcare programs 2
- Donor-driven
- Overlapping coverage
- Common resources
2 DOH website
WORKFORCE SHORTAGE
POLICY FRAGMENTATION
2ND hald of slide #2
3 problems explain our difficulties in handling the double burden
- short 60,000 MD’s in public sector and 100,000 midwives
- can be covered partly by excess in private sector and excess of nurses
To address these problems, we propose conversion to a primary care system (PCB4)
We believe this package to become affordable and truly universal, coverage should be expanded to ALL filipinos
INEQUITY IN ACCESS TO CARE
INEQUITY IN HEALTH OUTCOMES

19. Healthcare System Analysis
DOUBLE BURDEN OF DISEASE
WORKFORCE SHORTAGE
- Decentralized system
- 42,000 barangays
- LGU independence
- Politicization of workforce
POLICY FRAGMENTATION
ADMIN. FRAGMENTATION
2ND hald of slide #2
3 problems explain our difficulties in handling the double burden
- short 60,000 MD’s in public sector and 100,000 midwives
- can be covered partly by excess in private sector and excess of nurses
To address these problems, we propose conversion to a primary care system (PCB4)
We believe this package to become affordable and truly universal, coverage should be expanded to ALL filipinos
INEQUITY IN ACCESS TO CARE
INEQUITY IN HEALTH OUTCOMES

21. PROVINCIAL AND DISTRICT HOSPITALS
DOH
81 PROVINCES
PROVINCIAL AND DISTRICT HOSPITALS
1491 MUNICIP.
BARANGAY
HEALTH
CENTERS
144 CITIES
BARANGAY
HEALTH
CENTERS
42,000
PRIVATE FACILITIES

22. Healthcare System Analysis
DOUBLE BURDEN OF DISEASE
WORKFORCE SHORTAGE
POLICY FRAGMENTATION
ADMIN. FRAGMENTATION
INEQUITY IN ACCESS TO CARE
INEQUITY IN HEALTH OUTCOMES
Healthcare
System
Reform!
Every president since 1975
Every secretary of health
Now we have the opportunity