OUR LADY OF FATIMA UNIVERSITY

COLLEGE OF PHARMACY
Valenzuela. Quezon City. Antipolo. Pampanga. Cabanatuan. Laguna

HEALTH CARE
DELIVERY SYSTEM
WEEK 1&2
PSAP 311

Name of Lecturer
Instructor- College of Pharmacy
COURSE FACILITATOR
TOPIC OBJECTIVES
At the end of this unit, the students are expected to:
• 1. Demonstrate understanding about the History of Health
Care Delivery System
• 2. Demonstrate understanding of Health Care System in the
Philippines
CHECKLIST:
1. Read course and unit objectives
2. Read study guide prior to class attendance
3. Read required learning resources; refer to unit terminologies for jargons
4. Proactively participate in discussions
5. Participate in weekly discussion board (Canvas)
6. Answer and submit course unit tasks
REQUIRED READINGS
• WHO, The Philippines Health System Review, Volume 8 No.
2, 2018, India
https://apps.who.int/iris/bitstream/handle/10665/274579/978
9290226734-eng.pdf?sequence=1&isAllowed=y
HEALTH CARE
• isthe maintenance or improvement of health
via the prevention, diagnosis, treatment,
recovery, or cure of disease, illness, injury,
and other physical and mental impairments in
people.
• Healthcare is delivered by health professionals
and allied health fields. Physicians and
physician associates are a part of these health
professionals. (WHO)
HEALTHCARE SERVICE
DELIVERY SYSTEMS
• are organizations established to meet the health needs of
targeted populations.
• According to the World Health Organization (WHO), a well-
functioning health care system requires a financing
mechanism, a well-trained and adequately paid workforce,
reliable information on which to base decisions and policies,
and well maintained health facilities to deliver quality
medicines and technologies
• PEOPLE-CENTRED CARE
• is care that is focused and organized
around the health needs and
expectations of people and communities,
rather than on diseases.
•

• PATIENT-CENTRED
• is commonly understood as focusing on
the individual seeking care (the patient).
INTEGRATED HEALTH
SERVICES
• encompasses the management and
delivery of quality and safe health
services so that people receive a
continuum of health promotion, disease
prevention, diagnosis, treatment,
disease-management, rehabilitation and
palliative care services, through the
different levels and sites of care within
the health system, and according to their
needs throughout the life course.
QUALITY OF LIFE

• A state of complete physical, mental, and social well-

being not merely the absence of disease (WHO)
• WHO defines Quality of Life as an individual's
perception of their position in life in the context of the
culture and value systems in which they live and in
relation to their goals, expectations, standards and
concerns. It is a broad ranging concept affected in a
complex way by the person's physical health,
psychological state, personal beliefs, social
relationships and their relationship to salient features
of their environment.
 HISTORY HEALTHCARE
SERVICE DELIVERY SYSTEM`
1900s to The medical profession was represented by
1930s general or family practitioners who operated
in solitary practices. A small percentage of
physicians were women. Total expenditures
for medical care were less than 4% of the
gross domestic product.

1904 The American Medical Association created the

Council on Medical Education to establish
standards for medical education.
HISTORY HEALTHCARE
SERVICE DELIVERY SYSTEM`
1928 Formal medical education was attributed to
Abraham Flexner, who wrote an evaluation
of medical schools in the United States and
Canada indicating many schools were
substandard.

1930 The healthcare industry was dominated by

male physicians and hospitals. Relationships
between patient and physicians were sacred.
Payments for physician care were personal.
HISTORY HEALTHCARE
SERVICE DELIVERY SYSTEM`
1940 to When group health insurance was offered,
1960s the relationship between patient and
physician changed because of third-party
payers (insurance).
- 1950s, federal grants supported medical
school operations and teaching hospital.
-1960s, the Regional Medical Programs
provided research grants and emphasized
service innovation and provider networking.
HISTORY HEALTHCARE
SERVICE DELIVERY SYSTEM`

2000 There are 125 medical schools that still follow

the Flexner curriculum. All require the MCAT
for admission. Approximately 30% of
physicians are women, many operate in
multispecialty groups, and nearly two thirds
are specialty physicians.
Milestone of the Hospital
System
1820s Alms houses or poorhouses, the precursor of
hospitals, were developed to serve the poor
primarily. Pest houses, operated by local
governments, were used to quarantine people
who had contagious diseases such as cholera.
-The first hospitals were built around urban areas
in New York City, Philadelphia, and Boston and
were used often as a refuge for the poor.
-Dispensaries or pharmacies were established to
provide free care to those who could not afford
to pay and to dispense drugs to ambulatory
patients.
Milestone of the Hospital
System
1850s A hospital system was finally developed but
their conditions were deplorable because there
were unskilled providers. Hospitals were owned
primarily by the physicians who practiced in
them.
1890s Patients went to hospitals because they had no
choice. There became more cohesiveness among
providers because they had to rely on each other
for referrals and access to hospitals, which gave
them more professional power.
Milestone of the Hospital
System
1920s The development of medical technological
advances increased quality of medical training
and specialization and the economic
development of the United States. The
establishment of hospitals became the symbol
of the institutionalization of health care. In
1929, President Coolidge signs the Narcotic
Control Act, which provides funding for
hospital construction for drug addicts.
1930s to Once physician-owned hospitals were now
1940s owned by church groups, larger facilities, and
government at all levels.
Milestone of the Hospital
System
1970 to The first Patient Bill of Rights was introduced
1080 to protect healthcare consumer representation
in hospital care. In 1974, National Health
Planning and Resources Development Act
required states to have CON laws to qualify for
federal funding
1980 to According to the AHA, 87% of hospitals were
1990 offering ambulatory surgery. In 1985, the
EMTALA was enacted, which required hospitals
to provide screening and stabilizing treatment
regardless of the ability to pay by the consumer.
Milestone of the Hospital
System

1990 As a result of the Balanced Budget Act cuts of

to 2000 1997, the federal government authorized an
outpatient Medicare reimbursement system.
 BRIEF HISTORY OF HEALTHCARE
SERVICE DELIVERY SYSTEM in
the PHILIPPINES
Pre-Spanish Prior to the arrival of the Spaniards, life and by
Era: Pre 1565 extension health care, was centered around the
animate and inanimate world.
- Traditional Filipino medicinal herbs were used
for a wide variety of ailments.
Spanish Era: As the Spanish were exposed to the unfamiliar
1565 – 1898 environment of the Philippines, they were
stricken with foreign disease. To combat this,
they created hospitals specially for their health.
Some of the first health institutions in the
country were handled by Spanish friars.
 BRIEF HISTORY OF HEALTHCARE
SERVICE DELIVERY SYSTEM in
the PHILIPPINES
Spanish Era: Hospital Real- Built in Cebu in 1565, Hospital Real
1565 – 1898 was the first hospital in the Philippines. The
hospital aimed to nurse the Spanish army and
navy, those inflicted with disease, and military
casualties.
Hospital de Naturales- Fray Juan Clemente, a 54-
year-old botanist and lay brother, was
instrumental in conception of the Hospital de
Naturales. He often made medicine for the many
people who begged outside the convent, until
eventually the number of patients grew too large
for accommodations.
 BRIEF HISTORY OF HEALTHCARE
SERVICE DELIVERY SYSTEM in
the PHILIPPINES
Spanish Era: Hospital de San Lazaro- Although previously the
1565 – 1898 Hospital de Naturales, the hospital was renamed
after Japanese emperor Iemitsu sent 150 lepers.
Although viewed as a hostile act to the church for
its growing influence in Japan, the lepers were
taken care of by the hospital, the clergy, and the
community.
 BRIEF HISTORY OF HEALTHCARE
SERVICE DELIVERY SYSTEM in
the PHILIPPINES
American Under General Wesley Merritt, a Board of
Era: 1898 – Health for supervising public health was
1918 established on September 29, 1898.

July 1, 1901- The Board of Health for the

Philippine Islands was established.
The Board soon became the Insular Board of
Health as provincial and municipal boards were
created.
 BRIEF HISTORY OF HEALTHCARE
SERVICE DELIVERY SYSTEM in
the PHILIPPINES
Filipinization Under the Jones Law and the governance of
of Health: Governor-General Francis Harrison, the Filipinos
1918 – 1941- were slowly allowed to practice self-
governance. The Department of Public
Instruction, one of the four executive
departments of the government, was in charge
of the Philippine Health Service
The Department of Public Instruction was
managed by Dr. Victor Heiser, during whose
term the Philippine General Hospital was put
up.
 BRIEF HISTORY OF HEALTHCARE
SERVICE DELIVERY SYSTEM in
the PHILIPPINES
Filipinization Filipinization of Health Services started when
of Health: Dr. Vicente de Jesus, the first Filipino Assistant
1918 – 1941- Director of the Department of Public
Instruction, became Director in 1919.

On May 31, 1939, the Department of Health and

Public Welfare was established through
Commonwealth Act 430
PHILIPPINE HEALTHCARE
SYSTEM TODAY
• Philippines is an archipelago in
the South-East Asia Region, with a
population of 104.9 million as of 2017.
• The Philippines is currently one
of Asia’s fastest growing economies
with a gross domestic product growth
of 6.7% at the end of 2017.
PHILIPPINE HEALTHCARE
SYSTEM TODAY
• 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).
FACTORS THAT AFFECTS
HEALTHCARE SYSTEM
1. GLOBALIZATION AND CLIMATE
CHANGE
- Increasing health impact with
the Philippines ranking third in the
world in terms of exposure to disaster
risks due to strong typhoons
occurring with high regularity
FACTORS THAT AFFECTS
HEALTHCARE SYSTEM
2. CHANGES IN LIFESTYLE and the
INCREASING PREVALENCE OF RISK
FACTORS
- 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
non-communicable diseases (NCDs) in the
country.
FACTORS THAT AFFECTS
HEALTHCARE SYSTEM
3. POVERTY AND IGNORANCE
- despite advances in the
management and treatment of
infectious diseases, many Filipinos
continue to suffer from diseases for
which effective interventions are
available.
HEALTH SERVICE DELIVERY
• Health is a basic human right guaranteed by the
Philippine Constitution of 1987.

• Thisis provided in the Philippines through a

dual health delivery system composed of the
public sector and the private sector.
Public sector
- largely financed through a tax-based budgeting system,
where health services are delivered by government facilities
under the national and local governments.
- • Department of Health (DOH) supervises the
government corporate hospitals, specialty and regional
hospitals.
- • Department of National Defense runs the military
hospitals.
- • Provincial governments- manage and operate district
and provincial hospitals,
- • 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.
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.
Social Health Insurance
- administered by the Philippine Health Insurance
Corporation (PhilHealth) 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.
Health Financing
Total health expenditure (THE) has consistently
increased since 2005 and compares well with neighbours
like Indonesia. Much of THE is for personal care.

The Three Major Flows of Public Health Financing

1. The DOH funds regional and apex hospitals

2. Local government units (LGUs) fund primary- and
secondary-level care.
3. PhilHealth reimburses government as well as
private health facilities. It reportedly covers 92% of the
population, 40% of which is the poor population and
subsidized by the Government for premium payments.
Health governance and
regulation
• DOH- provides national policy
direction and strategic plans,
regulatory services, standards and
guidelines for health, and highly
specialized and specific tertiary-level
hospital services.
Health governance and
regulation
• LGU- are responsible for managing and
implementing local health programmes and
services. A local health board chaired by the
local chief executive (governor or mayor)
serves as an advisory body to the local chief
executives and the local legislative council
members (sanggunian) on the local health
system
Health governance and
regulation
• Insurance Commission (IC) - under the
Department of Finance regulates and
supervises the operations of private
insurance companies, including health
insurance and pre-need companies as well
as mutual benefit associations.
Health system performance
• The national objectives for health (NOH) have
well-specified targets, but progress of local
governments towards these targets remains
highly uneven due to devolved health financing
and service delivery.
Health system performance
• Patientsatisfaction and user experience of
health services may show improvements, but
balance billing,
Health system performance
• Thelimited number of health facilities relative
to the growing population, overprovision of
physicians, under provision of care and poor
physician adherence to clinical practice
guidelines contribute to a low quality of care.
REFERENCES:
WHO, The Philippines Health System Review, Volume 8 No. 2
(2018)
Overview of the US Healthcare Delivery System, Chapter 1
(2006)
A Legacy of Public Health (2nd ed.)