1. HEALTH FINANCING
AND BUDGETING
PRACTICES
IN THE PHILIPPINES
Asian SBO, Bangkok December 13-14, 2017

2. An international perspective
11.4
9.4
9.0
9.0
7.1
7.1
5.8
5.7
5.6
5.1
4.9
4.7
4.7
4.7
4.5
4.3
4.2
4.1
3.5
2.8
2.8
2.6
2.6
2.3
1.9
0
2
4
6
8
10
12
Public¹ Private%

3. Trends in health spending

4. Policy Goals

5. Health delivery system - responsibilities
• Regional secondary/tertiary hospitals
• Mental hospitals
• Research Centres
• Vertical programmes (TB, AIDs Malaria etc.)
National (DoH)
• Provincial, city and district hospitals
Provinces (81) and
independent cities
• City health clinics
• City hospitals
Municipalities
(1489)
• Local health stationsBarrangay
(42,000)

6. Financial flows in the health sector
TaxesBorrowings
National Government
PhilHealth Provinces DOH
Specialtypublic
hospitals
HMOs/PrivateHealth
Insurance
HouseholdandPrivateCompanies
Insurancepayments
Retained public
hospitals
Provincial,
District Hospitals
Local govt taxes,fees
& other revenues
Hospital
revenues
Privatehospitals,clinics,MDs
Household out-of-pocket payments
Foreign assistance/
grants
Rural
Health
Units
Municipalities Cities
City
hospital
City
Health
Center
Barangays
Baran-
gay
Health
Stations

7. Major reforms related to health
financing

8. Key achievements
• Funding for UHC - Sin Tax earmarks
• Expanded insurance benefits package and
population coverage (PhilHealth)
• CCT program helps poor to access free
health insurance (household targeting
system)
• Improvements in PFM at national level

9. Increases in DOH Allocations
0
20
40
60
80
100
120
140
2010 2011 2012 2013 2014 2015 2016
DOH Budget Allocations, 2010-16
(in billion pesos)
National Health Insurance Program Health Facility Enhancement Program Others

10. The national health insurance
programme
10
20
30
40
50
60
70
80
90
100
10
20
30
40
50
60
70
80
90
100
2010 2011 2012 2013 2014 2015 2016
%ofpopulation
No.ofmembers&dependents
PhilHealth Beneficiaries, 2010-2016
SP/IP Other Membership Programs % of pop

11. CCT program linked to health
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
200720082009 2010 2011 2012 2013 2014 2015
Millionpesos
Numberofhoseuholds
Household coverage and annual budget of the
Pantawid Pamilya Pilipino Program, 2007-
2010
Household Coverage Annual Budget (million pesos)

12. Key budget issues - 1
• Under-execution.

13. Key budget issues - 2
Inconsistency between LGU spending plans and DoH policy
objectives
Complex planning and procurement for vertical programs
leading to stock outs
Poor quality of local investment planning leading to under-
investment in capital
Weak response to program impact evaluation
Weak oversight and accountability (Health Boards)

14. Little change in local government
spending on health
0
5
10
15
20
25
Share of health in total local government
expenditures, by local government level,
2001-2014
Province (%) City (%) Muni (%)

15. Selected recommendations - 1
Fully implement LGU PFM Reform Roadmap to
match progress made at national level.
Streamline local planning processes (including
investment plans for health, poverty reduction plans)
to improve consistency and avoid duplication.
Improve programming and monitoring of the
intergovernmental fiscal transfer system.

16. Recommendations 2
LGUs to reinvigorate local health boards,
through civil society participation.
PhilHealth to shift performance focus from
enrolment to benefit utilization and develop the
necessary monitoring indicators and information
system.
Conduct independent audits or value-for-money
evaluations of selected government programmes
and projects, and increase the visibility of local
financial indicators.