COPING WITH COVID19

AND THE UNIVERSAL

HEALTHCARE ACT
Regional PHA Conference
I wish it need not have happened in my
time," said Frodo.
"So do I," said Gandalf, "and so do all
who live to see such times. But that is
not for them to decide. All we have to
decide is what to do with the time that
is given us.
Weaknesses in the Healthcare
System
• Healthcare has never been a top priority for
the national government for a very long time
• Healthcare requires a long-term view contrary to
the short-term goals of politicians
• Healthcare budget not enough to serve the needs
of the Filipino
Weaknesses in the Healthcare
System
• Government Sector
• No direct authority of DOH over the LGU healthcare system
• Primary healthcare and public health operationally under LGU
executing health policies from DOH
• National health programs implemented by LGU with funding
from DOH
• DOH sets standards for LGU hospitals but have no operational
authority over LGU hospitals
• Lack of a working tried and tested Integrated referral system
• Level 3 DOH hospitals under DOH authority
Weaknesses in the Healthcare
System
• LGU Primary healthcare centers underutilized:
• Lack of health centers
• 1 center: 20,000 population = 5,500 centers
• 2,200 centers currently – many Filipinos die without receiving medical
attention
• Lack of personnel
• Patients referred by PHC to gov’t hospitals for simple primary
healthcare problems
• Over utilization of gov’t hospitals for primary care problems
• Budget from LGUs frequently inadequate for healthcare needs
of community
Weaknesses in the Healthcare
System
• Private hospital sector
• Sub-standard private hospitals continue to operate
even if the viability of such hospitals may be
problematic if standards of care and safety are fully
implemented
• Hospitals concentrated in urbanized centers and large
towns
• Hospitals equipped with old refurbished equipment
that deliver substandard quality results
• Very poor referral system among private hospitals due
to competition
COVID19 and the healthcare
system
• Country unprepared for COVID19 (no country
was ready)
• No clear strategy to deal with COVID19
• Contact tracing
• Lack of resources (personnel, logistics and funds)
• Limited PCR capacity (public and private)
• Poor referral system in the healthcare system
• Limited facilities in both public and private sectors
Problems Facing Public
Hospitals during the Pandemic
• Tracing
• Very few trained personnel for tracing
• Most LGUs do not have the capability to trace exposed persons
• Test
• More PCR testing facilities but kits limited
• PCR tests 70% sensitive at best
• Treat
• Too many COVID19 patients depleting resources
• Limited quarantine facilities
• Limited critical care beds
• Limited equipment
• Limited personnel
 Problems Facing Private
Hospitals during the
• Tracing
Pandemic
• Data provided to DOH – no tracing in private sector
• Test
• Testing capacity present but Philhealth NBB reimbursement too low
for ROI
• Treat
• Shortage of ICU beds
• Limited isolation beds
• Only the bigger private hospitals have the capability to adequately
treat serious and critical COVID
• NBB restriction of Philhealth not adequate to cover hospital bill and
PF
 Problems Facing Private
Hospitals during the
Pandemic
• Lack of facilities to handle COVID19
• Classification of infirmary, level 1, 2 and 3 hospitals
• Hospital designs did not consider large scale
epidemics or pandemics
 Problems Facing Private
Hospitals during the
Pandemic
• Revenue loss due to:
• dramatic drop in OPD consultations
• low ancillary utilization and admissions due to
quarantine restrictions and patient fear of getting
COVID19
• Operating costs increase due to:
• PPEs
• Delay in the PCR results extending hospital stay
• Hazard pay for healthcare professionals
 Philhealth Coverage of the
COVID19 Pandemic
• COVID19 case rate classifications inadequate to
cover hospital bills and professional fees
• COVID19 has evolved beyond the initial
respiratory presentation so these other aspects
of COVID19 have to be incorporated into the
classification of the disease for more appropriate
classification and should be considered in the
cost of managing the disease
• IRM fiasco
What can government hospitals do?
• Level 1 hospitals
• Convert hospital into quarantine facility with compensation
from Philhealth
• Level 2 and 3 hospitals
• Coordinate with level 1 hospitals to transfer mild cases or
stable recovering cases for quarantine
• Conserve utilization of PPEs
• Discourage mass testing of hospital employees – follow PGH
experience of testing only symptomatic employees with PCR
• Strictly enforce the mask at all times, hand sanitation, face
shields or goggles
• Discourage LGUs from forcing issue with rapid antibody tests -
unreliable
What can private hospitals do?
• Process improvement for better hospital
performance
• Level 1 hospitals
• Focus on OPD and Non-COVID 19 Primary care
• Do a very good cost analysis of hospital
operations
• Check your break-even points
• Costs of services, room charges and ancillary charges
• Identify inefficient processes and improve efficiency to cut cost
• Network with level 2 and 3 hospitals for proper referral
systems
What can private hospitals do?
• Process improvement for better hospital
performance
• Level 2 and 3 hospitals – define your market position
based on:
• Existing strengths and weaknesses
• Do a very good cost analysis of hospital operations
• Capacity utilization
• Long-term market position
• What role do you want your hospital to play in the
healthcare system?
Universal Health Care
Act
 New Structure
• Primary healthcare centers (PHC) to handle OP
individual healthcare needs
• PHC provides healthcare for free – fixed funding for patient
population
• Keeps healthcare costs down
• Homecare visits by nurses or midwives
• PHC refers patients to hospital network for admission
• PHC doctor cannot admit patient as AP of patient
• Hospital AP manages patient’s acute illness and sends
back patient to PHC once patient’s acute illness
resolved
 Hospital Network
• Public, Public – Private or Private
• Relationships of different networks unclear
• Referral system moving up from level 1 to 2 and 3 as
level of disease complexity and severity increases
• Hospital network given global fund at the start of the
year
• Hospitals manage patients with lowest and most efficient cost
UHCA: Philhealth as a partner
of hospitals
• Philhealth will provide financing for hospitals under the UHCA
• Treat private hospitals as true partners in healthcare
• Payments will no longer distinguish between hospital fees
and doctors’ PF
• Ward rates will be NBB for both private and public hospitals
• Adequate funding for DRGs to ensure that NBB admissions do not
result in losses for private hospitals since private hospitals do not
have budget subsidies from government for capital expenditure
and operating expenses
• Co-Pay can be liberally set to improve hospital and physician
revenue for sustainable development of the private hospital sector.
 DOH and Hospital Operations
• DOH may better serve the public by focusing on quality health
outcomes in coordination with Philhealth
• Different standards if hospital equipped with automated equipment
or not
• To reduce cost, hospitals should be allowed to outsource services like
laboratory services to large internationally accredited laboratories to
reduce capital expenditures to meet DOH requirements just like in
Japan, Australia and other Western countries
• Limit the purchase of high end equipment based on the geographic
need of patients and level of the hospital for better ROI of equipment
• Manual to aid hospital administration when building or expanding
facilities and services
DOH and the UHCA
• Awaiting a clear definition of the operational
relationships various stakeholders in the UHCA
• Hospitals concentrated in urban centers creating
a maldistribution of services
• Provide government incentives for new and existing
hospitals in underserved areas
• Limit opening new hospitals in urban areas by:
• Setting higher requirements like new services or more
complete facilities before they are allowed to break
ground
National Government
• Provide better guidance and oversight over Philhealth
and DOH in the implementation of the UHCA (Philhealth
fiasco)
• National government should take the lead with UHCA
but when programs and projects are better
implemented by the LGUs, then following the principle
of subsidiarity, the national government should let the
LGUs execute
• National government provide LGUs funding through
DILG for district hospitals and PHC in municipalities with
limited resources
• Skill development for adequate staffing of PHCs and
 Summary
• Philippine Healthcare system is weak, fragmented and unable to
serve the healthcare needs of the population
• COVID19 exposed these weaknesses
• Many private hospitals are suffering terrible losses due to the fear
of patients, the costs of PPEs and the low case rates for COVID19
• To better manage COVID patients, improve referral process
• To survive, private hospitals need to assess their operations by
doing a thorough cost analysis of operations to reduce cost and
improve profit
• Hospitals also need to do a long term assessment of the role they
want to do in the future
 Summary
• Philhealth can help hospitals by
• Realistic case rates that would cover the true
cost of confinement in efficient cost effective
private hospitals
• Co-pay can be liberally set to allow for doctors
to earn a decent income and for hospitals to
turn a profit for sustainable growth
 Summary
• DOH
• Reduce the over-regulation of the details of
hospital operations and focus on the quality
output of patient care
• Create a detailed manual for building code for
hospitals available for sale at the DOH
• Incentives for hospitals, new and old, in
underserved areas
• Come up with the definitions of hospitals and
the networks soon so private hospitals can
 National Government
• Oversight over Philhealth and DOH in the
implementation of the UHCA
• Adequate funding for infrastructure and skill
development