MIDTERM Have better education therefore are more aware of the

THE HEALTH SECTOR good benefits of utilizing healthcare.

Healthcare goods and services are NOT ordinary They are more exposed to health risks.
commodities! They have better access to health facilities.
Healthcare goods and services are both: AGE AND GENDER
1. consumption of goods – people consume it because it Urban dwellers have better access to modern health
makes them feel good, and facilities, which increases their usage rates
2. investment goods – people consume health because Urban dwellers tend to have higher incomes
better health makes them more productive Have better education therefore are more aware of the
ORDINARY COMMODITIES good benefits of utilizing healthcare
Consumers evaluate whether to buy a product or not. They are more exposed to health risks
Consumers decide to buy. They have better access to health facilities
Consumer to pay. Adults and children report different disease profiles.
HEALTHCARE GOODS AND SERVICES Children report acute illnesses (nutritional and
Potential seek medical attention infectious problems) often while older adults report
MDs evaluate and decide w/c goods and services chronic and degenerative illnesses more often
patients need. Medical expenditures tend to be the same for both
Patients cosumes. sexes during the earlier years. Expenditure exceeded by
Patients pay. women because of obstetrical changes.
DETERMINANTS OF HEALTH-SEEKING BEHAVIOR THE SUPPLY OF HEALTH SERVICES
ECONOMIC FACTORS The supply of healthcare goods and services is different
INCOME from other commodities because it is composed of
Higher-income equals higher expenditure for health multiple inputs. When someone “buys health” he or she
and demands more modern and expensive healthcare. buys multiple goods and services.
PRICE OF THE HEALTH COMMODITY Manpower – required to produce health
Lower-priced goods or providers will have a higher Health infrastructure – facilities needed to carry out the
probability of being used. delivery of health
VALUE OF PATIENT’S TIME Drugs – over-the-counter (OTC) drugs, prescription
Time has a value. Sacrificing an earning activity for drugs, herbal drugs
another activity(like seeking health care) has a cost. Others – like training, research, etc.
And the value of time differs from person to person. MEASURING COSTS AND OUTCOMES
SOCIO-CULTURAL AND DEMOGRAPHIC FACTORS To assess whether these health resources are used
ROLE OF MOTHERS optimally we will have to find a way to measure the costs of
Mothers generally allocate financial and non–financial health interventions and the effects of these health
resources (like time) for the family. interventions. Ideally, the effects of health programs,
EDUCATION OF MOTHERS activities, or interventions, should outweigh their costs.
The higher the education of mothers, the lower UNDERSTANDING COSTS
healthcare expenditures observed (a shift in the type COSTS
of healthcare goods and services demanded). These are what society, governments, or individuals incur
It leads to a better recognition of the need for medical to run a program or to produce something that they desire,
care and an increase in the use of preventive methods, like better health. Costs are the monetary value of
which subsequently decreases medical care for acute producing a good or service, while prices are cost plus
illnesses. markup which is largely driven by market forces.
More open to modern medical concepts and have a DIFFERENT KINDS OF COST ACCORDING TO THE
greater tendency to demand more modern health BEHAVIOR OF COST
facilities and commodities. TOTAL COST
MOTHERS AGE - more open to modern medical concepts Is the measure of all the costs entailed in producing a
and have a greater tendency to demand more modern given level of output. E.g. in the vaccination program, total
health facilities and commodities costs will be comprised of all the vaccines given, all the
MARITAL STATUS syringes and other medical supplies, training and salaries of
Single people tend to use more medical care. personnel, equipment, transportation expenses, etc.
Have more disposable income and time to devote to MARGINAL COSTS
themselves and therefore to health–seeking behavior. Is the measure of the resources associated with a small
LOCALITY/ACCESS TO HEALTHCARE FACILITIES increase change in output. E.g. adding an extra vaccine,
Urban dwellers have better access to modern health extending vaccination to another village
facilities, which increases their usage rates ACCORDING TO THE BEHAVIOR OF COST (CONT….)
Urban dwellers tend to have higher incomes
AVERAGE COST finances or financial distress when he/she becomes
Is the measure of the total cost of production associated PRIVATE INSURANCE - these are bought by individuals for
with each unit of output. E.g. if the total cost of the themselves or their families or may also be bought by
vaccination program is P1,000,000.00 and the program is employers as medical benefits for their employers.
able to vaccinate 10,000 children, then the average cost seriously sick
would be P100/child immunized. Advantage:
OPPORTUNITY COST The individual pays a relatively small amount to be
Is the cost of sacrificing other outputs/outcomes in favor assured of relatively big hospitalization coverage within
of a chosen program a period of one year.
According to the relationship of costs to the product or Disadvantage:
service produces The individual who does not get seriously sick and
DIRECT COSTS requires hospitalization within the coverage period is
These are costs that can be directly attributed to a not able to avail of or utilize health services. This
specific output or product. E.g. making shoes requires assumes that insurance premiums paid will be forgone
leather, thread, buckle in favor of the insurance company.
INDIRECT COSTS In HMO the consumer pays a premium, which will give
Are costs incurred as a “sacrifice” for being in ill health, him a comprehensive health care program through a
or in performing a healthy-producing activity “package of benefits”.
INTANGIBLE COSTS Advantage:
Are costs attached to entities that we cannot touch and Low out-of-pocket costs – members are responsible for
feel? E.g., pain, and suffering when one is sick paying a percentage of the bill every time receive
According to the frequency of incurring costs medical care.
CAPITAL COST Focus on wellness and preventive care – HMO
These are costs for items with a life expectancy of more encourages members to seek medical treatment early
than a year e.g. construction of a building, purchase of before health problems become severe.
equipment, and basic manpower treatment. Typically no lifetime maximum payout –place no limit on
RECURRENT COSTS lifetime benefit, HMO will continue to cover treatment
Costs necessarily incurred each year or each month, e.g. as long as you are a member
salaries & and wages of personnel, medical supplies like Disadvantage:
drugs, and utilities like fuel, electricity & and water are Tight controls can make it more difficult to get
incurred on a monthly basis. specialized care – members must choose primary care
FACTORS AFFECTING HEALTH CARE COST before seeking care from another physician or
Growth in the aging population specialist.
Abundance of specialized providers Care from non-HMO providers is generally not covered
Surplus of hospital beds – except for emergencies occurring outside the HMO’s
Inequitable financing of services treatment area, HMO members are required to all
The passive role of consumers similar treatment from HMO physicians
Increase in the number of lawsuits EMPLOYER-BASED PLAN
FINANCING HEALTH Are health packages that companies administer for the
WHAT IS FINANCE? medical benefits of their employees.
Finding a way to pay for something PRIVATE SCHOOLS
WHAT IS HEALTH FINANCING? Are required to put up clinics and set budgets for the
Finding a way that will maintain and/or improve our healthcare needs of their students
health. E.g. Meralco has put up its own hospital for its employees
WHAT IS HEALTHCARE BENEFITS? HEALTH CARE BENEFITS vs. SOCIAL PROTECTION
Are provided in kind to maintain the wellness of a person. BENEFITS
WHAT IS SOCIAL PROTECTION BENEFIT? 1. Health care benefits are benefits in kind and their
Are provided in cash or in terms of financial assistance to provision is more complex than that of cash transfer by
people who are sick and require medical treatment. other branches of social protection.
DIFFERENT MODES OF PRIVATE HEALTH FINANCING 2. The need to provide cash benefits to people who were
OUT - OF - POCKET not previously earning a regular income can be questioned,
Is simply taking out your wallet and paying for the health but there are no such arguments in health care.
goods and services that you utilize. 3. Sick people require services independent of income
Advantage: and/or prior insurance or employment status
An individual spends money only when he/she gets 4. Health Care benefits are provided in kind to maintain the
sick wellness of a person while social protection benefits are
Disadvantage: provided in cash or in terms of financial assistance to
An individual may encounter problems in securing people who are sick and require medical treatment.
REQUIRED HEALTH INSURANCE IN THE PHILIPPINES AND AGES
ITS FINANCING SCHEMES Workers in the drug industry receive relatively higher
SSS – private employees wages in other industries.
B. Phil Health – private and government employees It is estimated that they receive 150% higher
GSIS – government employees compensation than other manufacturing industries.
DRUG INDUSTRY
The drug industry is a 46 billion industry on antibiotics
with a 22% share of the industry. The demand is quite WHO HEALTHCARE SYSTEM
big because most of the diseases are infectious and WHO 6 SYSTEM BUILDING BLOCKS
require antibiotic treatment What are the Health System Building Blocks?
Cough & cold preparations ranks 2nd with 18% share Definition: Health System
Vitamins & and minerals rank 3rd. The demand is quite A system is an arrangement of parts and their
high due to awareness of the community in urban areas interconnections that come together for a purpose. A
& and the government's thrust in rural healthcare. health system consists of all organizations, people and
Cardiovascular preparation with a 12% share has the actions whose primary intent is to promote, restore or
fastest growth in terms of market share due to maintain health. Like any other system, it is a set of
unhealthy diets & and lifestyles & and consumers. interconnected parts that have to function together to be
TB preparation. A high share of this category is effective.
attributed to poor living conditions of the majority of
the population & and malnourishment. A health system is composed of many parts. In particular:
Other drugs like asthma, dermatological & and Patients
nutritional preparations…. Contribute to the drug Families
industry’s growth Communities
Problem presently confronting the industry. Ministries of Health
high price of prescription drugs. Health providers
unemployment. Health financing bodies
high tariffs on pharmaceutical raw materials.
increasing the cost of labor.
marketing & and distribution prices. The Six Health System Building Blocks
DRUG HISTORY The World Health Organization recommends supporting and
1st pharmaceutical industry in the country was strengthening a health system based on the framework.
Laboratorio Hizon (now Hizon Laboratories) in 1900. When you strengthen a health system, you improve the six
In 1913, Manuel Zamora launched the commercial health system building blocks and manage their interactions
production of Tiki-tiki. in ways that achieve more equitable and sustained
1918, Phil-American Drug Co (Botica Boie) introduced improvements across health services and health outcomes.
home remedies from local medicinal plants. PEOPLE are often listed as the seventh building block.
By WWII, about 20 drug manufacturers were mostly “People” refers to individuals, households, and
owned by Filipinos and used manual techniques in communities as civil society, consumers, patients, payers,
manufacturing. and producers of health through knowledge, attitudes,
DRUG DISTRIBUTION behaviors, and practices.
After the manufacture & and packaging of the drug, it is
distributed to retail drugstores, hospital pharmacies, WHO 6 BUILDING BLOCKS OF THE HEALTH SYSTEM
etc. with the company’s distributing arm Leadership and Governance
Some drug companies avail the services of independent Service Delivery
distributors. Health Information
DRUG RETAIL Health Financing
Most Filipino consumers buy their medicines from retail Medicine and Technologies
drugstores where drugs are priced higher. Human Resources
Retail stores add about 7% -15% mark-up on prices of
drug products. LEADERSHIP AND
LABOR IN THE PHILIPPINE DRUG INDUSTRY GOVERNANCE
In pharmaceutical industries, there is a high ratio of non- Accountability is therefore an intrinsic aspect of
production employees compared to production line governance that concerns the management of relationships
workers. between various stakeholders in health, including
Production work mainly involves the compounding & individuals, households, communities, firms, governments,
and packaging of medicines. nongovernmental organizations, private firms, and other
More employees are needed therefore in the delivery, entities that have the responsibility to finance, monitor,
promotion & sales of pharmaceutical products. deliver and use health services.
Accountability involves, in particular: delegation or an HEALTH INFORMATION SYSTEM
understanding (either implicit or explicit) of how services 4 KEY FUNCTIONS
are supplied; data general
financing to ensure that adequate resources are compilation
available to deliver essential services analysis and synthesis
performance around the actual supply of services; communication and use.
receipt of relevant information to evaluate or monitor Health planners and decision-makers need different kinds
performance of information including:
enforcement, such as imposition of sanctions or the health determinants (socioeconomic, environmental,
provision of rewards for performance. behavioral, and genetic factors) and the contextual
Indicators for measuring health system governance environments within which the health system operates);
Rules-based indicators measure whether countries have inputs to the health system and related processes
appropriate policies, strategies, and codified approaches (policy and organization, health infrastructure, facilities
for health system governance. and equipment, costs, human and financial resources,
Outcome-based indicators measure whether rules and and health information systems);
procedures are being effectively implemented or enforced, the performance or outputs of the health system
based on the experience of relevant stakeholders. (availability, accessibility, quality, and use of health
Core indicators information and services, the responsiveness of the
1a: Existence of an up-to-date national health strategy system to user needs, and financial risk protection);
linked to national needs and priorities. health outcomes (mortality, morbidity, disease
outbreaks, health status, disability and wellbeing); and
1b: Existence and year of last update of a published national health inequities (determinants, coverage of the use of
medicines policy. services, and health outcomes, including key
stratifiers such as sex, socioeconomic status, ethnic
1c: Existence of policies on medicines procurement that group, and geographical location).
specify the most cost-effective medicines in the right A good health information system brings together all
quantities; open, competitive bidding of suppliers for relevant partners to ensure that users of health
quality products. information have access to reliable, authoritative,
usable, understandable, and comparative data.
1d: Tuberculosis—the existence of a national strategic plan Expectations from country health information systems
for tuberculosis that reflects the six principal components Individual-level data about the patient’s profile,
of the Stop-TB strategy as outlined in the Global Plan to healthcare needs, and treatment serve as the basis for
Stop TB 2006–2015. clinical decision-making.
Health facility-level data, both from aggregated facility-
1e: Malaria—the existence of a national malaria strategy or level records and from administrative sources, such
policy that includes drug efficacy monitoring, vector as drug procurement records, enable healthcare
control, and insecticide resistance monitoring managers to determine resource needs, guide
purchasing decisions for drugs, equipment, and
1f: HIV/AIDS—completion of the UNGASS National supplies, and develop community outreach.
Composite Policy Index questionnaire for HIV/AIDS. Population-level data are essential for public health
decision-making and generate information not only
1g: Maternal health—the existence of a comprehensive about those who use the services but also, crucially,
reproductive health policy consistent with the ICPD action about those who do not use them.
plan. Public health surveillance brings together information
from facilities and communities with a main focus on
1h: Child health—the existence of an updated defining problems and providing a timely basis for
comprehensive, multiyear plan for childhood immunization. action.
Methods for assessing country health information system
1i: Existence of key health sector documents that are performance
disseminated regularly (such as budget documents, annual Self-assessment approaches are the degree of country
performance reviews, and health indicators). ownership generated that enables the assessment to serve
as the basis for the development of a plan for improvement
1j: Existence of mechanisms, such as surveys, for obtaining Independent assessment is generally based on existing
opportune client input on appropriate, timely, and effective sources, such as databases of international agencies, so as
access to health services. to minimize the reporting burden on countries.
Core indicators
Indicators related to data generation using core sources
and methods (health surveys, civil registration, census,
facility reporting, and health system resource tracking). Health system resource tracking
Indicators related to country capacities for synthesis, At least one national health accounts exercise was
analysis, and validation of data. These measure key completed in the past five years.
dimensions of the institutional frameworks needed to National database with public and private sector health
ensure data quality, including independence, transparency, facilities and geocoding, available and updated within
and access. the past three years.
Summary of core indicators and scoring for Health National database with health workers by district and
Information Systems Performance Index (HISPIX) main cadres updated within the past two years.
Health surveys Annual data on the availability of tracer medicines and
The country has a 10-year costed survey plan that commodities in public and private health facilities.
covers all priority health topics and takes into account HEALTH SYSTEM FINANCING
other relevant data sources. Health financing refers to the “function of a health system
Two or more data points are available for child mortality concerned with the mobilization, accumulation, and
in the past five years. allocation of money to cover the health needs of the
Two or more population-based data points for maternal people, individually and collectively, in the health system…
mortality in the past 10 years, including one in the purpose of health financing is to make funding available,
the past five years. as well as to set the right financial incentives to providers,
Two or more data points for coverage of key health to ensure that all individuals have access to effective public
interventions in the past five years. health and personal health care”
One or more data points on smoking and adult Objectives:
nutritional status in the past five years. to raise sufficient funds
Birth and Death registration. to provide financial risk protection to the population
•Birth registration of at least 90% of all births efficiency in resource utilization
(intermediate goal 50%). Indicator: Percentage of births 3 Inter-Related Functions
registered. Revenue Collection
Death registration of at least 90% of all deaths Fund fooling
(intermediate goal 50%). Indicator: Percentage of deaths Purchasing/Provision of services
registered. Sources of information on health systems financing
ICD-10 is used in district hospitals and causes of death MINISTRY OF HEALTH
are reported to the national level. DEPARTMENT OF HEALTH
Censuses. Core indicators
Census completed within the past 10 years. Total expenditure on health
Population projections for districts and smaller General government expenditure on health as a proportion
administrative areas available for the next 10 years, in of general government expenditure (GGHE/GGE)
print and electronically, and well documented. The ratio of household out-of-pocket payments for health
Health facility reporting to total expenditure on health
Number of institutional HEALTH WORKFORCE
deliveries available, by district, and published within 12 The health workforce can be defined as “all people engaged
months of the preceding year. in actions whose primary intent is to enhance health”. These
•HIV prevalence for relevant human resources include clinical staff, such as physicians,
surveillance populations published within 12 months of nurses, pharmacists, and dentists, as well as management
the preceding year. and support staff, I.E. Those who do not deliver services
•Country website for health statistics, with the latest directly but are essential to the performance of health
report and data available to the systems, such as managers, ambulance drivers, and
general public. accountants
Reporting of notifiable diseases makes use of modern Core Indicators
communication technology and reporting of statistics Number of health workers per 10,000 population
from district to national levels is web-based Distribution of health workers – by occupation/
At least 90% of the districts submit timely, complete, specialization, region, place of work, and sex.
accurate reports to the national level. Indicator: Annual number of graduates of health professions
percentage of districts that submit timely, complete, educational institutions per 100 000 population – by
accurate reports to the national level. level and field of education
•Data quality assessments carried out and published MEDICAL PRODUCTS AND TECHNOLOGIES
within the past three years, using internationally agreed OBJECTIVES
quality criteria, such as Data Quality Assessment national policies, standards, guidelines, and regulations
Framework (DQAF). that support policy;
 information on prices, the status of international trade Number and distribution of inpatient beds per 10,000
agreements, and the capacity to set and negotiate population
prices; Number of outpatient department visits per 10,000
reliable manufacturing practices when they exist in- population per year
country and quality assessment of priority products; General service readiness
procurement, supply and storage, and distribution General service readiness score for health facilities
systems that minimize leakage and other waste; and Service-specific availability
support for rational use of medicines, commodities, and Proportion of health facilities offering specific services
equipment, through guidelines and strategies to assure Number and distribution of health facilities offering
adherence, reduce resistance, and maximize patient specific services per 10,000 population
safety and training. Service-specific readiness
Sources of information on access to essential medicines Service-specific readiness score for health facilities
Facility surveys Service quality
A general facility survey usually focuses on a wide range Assessing the quality of care can be difficult because it
of key health services and collects information on can cover both the complex processes of evaluating,
facility infrastructure, equipment and supplies, support diagnosing, and treating a patient as well as the
systems, management systems, and providers’ outcomes of that treatment for the patient.
adherence to standards.
Key informant surveys HEALTH CARE SYSTEMS IN ASIAN COUNTRIES
Surveys by experts with extensive knowledge about the HEALTHCARE DISRUPTION IN ASIA
medical situation in a country can be used to generate Aging population: By 2025, Asia will be home to 456
information about pharmaceutical policies and million seniors age 65 or older, representing 10 percent
practices related to regulation, selection of essential of its population. This is a 14 percent growth over 2021—
medicines, as well as procurement and use. a rapid demographic change that both increases
Core Indicators potential demand for health services and decreases the
The average availability of 14 selected essential available supply of manpower to deliver care.
medicines in public and private health facilities Supply constraints: The average number of doctors per
Median consumer price ratio of 14 selected essential 1,000 people in Asia is lower than the Organization for
medicines in public and private health facilities Economic Cooperation and Development average. In
Additional indicators for a full pharmaceutical profile addition, the World Health Organization has estimated a
Access to essential medicines/technologies as part of global shortfall of nine million nurses, with some of the
the fulfillment of the right to health, recognized in the worst affected countries located in Asia. While
constitution or national legislation investments in hospitals and physician health
Existence and year of last update of a published national infrastructure will continue to rise, traditional, labor-
medicines policy intensive care delivery models are unlikely to meet
Existence and year of last update of a published national Asia’s rising health needs.
list of essential medicines Rising consumer expectations: Consumers are spending
Legal provisions to allow/encourage generic substitution more on health and wellness and increasingly demand
in the private sector access to convenient, affordable care. According to
Public and private per capita expenditure on medicines McKinsey research, 43.5 percent of Chinese consumers
Percentage of the population covered by health are reportedly spending more on their health in the past
insurance 12 months and 23.1 percent are spending more on their
Percentage mark-up between manufacturers and nutrition.
consumer prices Growing financial burden: Today, governments in Asia,
HEALTH SERVICE DELIVERY on average, spend only 4.5 percent of GDP on
Key characteristics of good service delivery healthcare, compared with the OECD average of 12
1. Comprehensiveness percent. Yet governments are the dominant payer in
2. Accessibility Asia, accounting for 64 percent of all health
3. Coverage expenditures in 2018 (compared with private insurers,
4. Continuity which covered 7 percent). Finding ways to control the
5. Quality growth of healthcare expenditures remains an urgent
6. Person-centeredness public priority even while prioritizing quality and access
7. Coordination for patients.
8. Accountability and efficiency Technological innovation: Asia is home to half the
Core indicators world’s internet users, and already leads digital
General service availability innovation worldwide in multiple sectors. Indeed,
Number and distribution of health facilities per 10 000 venture capital and private equity investments in digital
population health in Asia have grown at 38 percent.
SINGAPORE emergency and elective procedures, such as plastic surgery
Known as a medical centre of excellence in Southeast The country spends 4.2% of the GDP on health care
Asia, Singaporeis home to a thriving health tourist (comparable with India and Papua New Guinea), with a
industry. relatively low doctor ratio with 1 practitioner to 1,000
The mandatory Medicare, and more comprehensive population. For foreign workers, a high level of care is
Medishield insurance scheme, are open to those classed available from good quality private and government
as ‘permanent residents’. hospitals, most with English-speaking doctors. Private
The quality of care is supported by ten high-standard medical insurance is mandatory (usually employer
public hospitals, thirteen private and numerous other arranged) and it’s important to note that you’ll be required
specialist clinics and treatment centres, in which English to provide a deposit before treatment, if you don’t have
is commonly spoken. adequate medical insurance cover.
This is financed by 2.75% of the GDP and staffed by HONG KONG
nearly 2 doctors per 1000 population. It’s no wonder A wealthy, well-established commercial centre, everything
in Hong Kong comes at a premium – including health care.
Singapore sits at number 6 of the World Health
Generally regarded as very expensive, there’s a high
Organization (WHO) World health report.
standard of health care provision across both the public
THAILAND
and private sectors.
Thailand’s health care system is delivered across private
The island manufactures medical equipment, so it’s no
international and public government-funded hospitals.
surprise medical facilities feature the latest technology
Private hospitals have excellent facilities, employing many
across 12 internationally accredited private hospitals
English-speaking doctors, and usually have an International
Hong Kong is recognised as part of China by the WHO and
Liaison
so separate statistics for the territory are not provided in
Department to help foreign nationals with medical
their reports.
insurance and financial matters. In public hospitals, which is better for things like general
The public system has limited nursing care, with the day-to- surgery and maternity care, there’s a two-tier system of
day well-being of patients being left to relatives. As a whole, charging: ‘eligible’ rates and ‘non-eligible’ rates.
the country is ranked at place 47 of the WHO league table INDONESIA
for the performance of its health care. Ranked in 92nd place by WHO and with only 1 doctor per
Thailand’s health tourism is worth about US$ 2 billion and 5000 population,
receives 40% of medical tourist arrivals in Asia. Indonesia spends just 2.9% of its GDP on health care — one
There are just 0.4 doctors per 1000 population with a of the lowest rates in the world. The government has
shortage of general practitioners (GPs, also known as family pledged investment and there is a fledgling universal health
doctors). The country spends 6.5% of its GDP on public scheme
health care (which is at the lower end of the world scale, The world’s largest single-payer healthcare system can be
comparable with countries like Cambodia and Indonesia). found in Indonesia in the form of the government run
VIETNAM Jaminan Kesehatan Nasional (JKN)
Ranked at 160th place of 191 member states by the The existing healthcare system has been facing significant
World Health Organization, the Vietnamese government deficits and there are infrastructure concerns that still
has stepped up investment in its health care system in need to be resolved before universal coverage can be
recent years and the country as a whole spends 7.1% of achieved
its GDP — more than many of its neighbours. There’s a BRUNEI DARUSSALAM
little over 1 doctor to 1,000 people — which is also a A small but wealthy sultanate, Brunei Darussalam offers a
good ratio for this corner of Southeast Asia. good standard of health care which is free to citizens and
In rural areas, standards are lower and you may be permanent residentS. Apart from emergency treatment,
required to pay for treatment up front (even emergency hospitals will ask for a deposit or proof of cover before
care). But in the main cities such as Han Noi and Ho Chi admitting a patient. The wider health care system is rated
Minh City, you can expect better facilities and English as 20th in the world and is supported by a network of
speaking staff. Expats who don’t speak English or health clinics and a mobile flying service for more remote
Vietnamese might want to consider language support areas
when accessingcare or treatment There are no teaching hospitals, and because doctors are
MALAYSIA from overseas, foreign nationals are more likely to find a
professionals who speak English and other languages
With a highly rated health care system across private and
There are 1.4 doctors per 1,000 population, a slightly
publicly funded hospitals, Malaysia’s provision is ranked in
higher ratio than neighbouring Malaysia.
49th place on the WHO league table. Like most countries in
PHILIPPINES
the area, the best level of care is available in the larger
The Philippine healthcare system is shared between the
cities and tourist areas. Recent increased investment in
public and private sectors. Public hospitals focus their
specialist doctors in areas such as cardiologyand
efforts on preventive and primary care while also taking the
ophthalmology, has led to the country becoming a medical
lead in educating the public on health issues.
centre for excellence— with outsiders coming in for routine,
 Private hospitals focus on specialized care for cardiovascular diseases, cancer, pulmonology, and orthopedics.
The Philippine Government signed Republic Act 11223 or the Universal Health Care (UHC) Law in 2019, allowing all Filipinos,
including Overseas Filipino Workers (OFWs), access to healthcare services under the Government’s health insurance
program (PhilHealth). The UHC aims to cover at least 50% of medical expenses to encourage Filipinos to visit specialty
doctors and undergo advanced medical procedures.
The Philippines is seen as an emerging medical tourism country and currently ranks 24th out of 46 countries on the 2020
Medical Tourism Index with competitive medical services prices and English-speaking medical professionals.
The Philippine healthcare market has opportunities for health IT and innovative medical devices.
SOUTH KOREA
South Korea is considered to have one of the most sophisticated healthcare systems in Asia, having managed to implement
a social health insurance system that provides coverage to approximately 97% of its population.
In South Korea, all residents, including qualified foreign residents, are covered under the National Health Insurance Service
(NHIS).
Overall, South Koreans are quite satisfied with their medical care with 55%reporting the quality of care they have access to
as being “very good /good”
Healthcare access however continues to be a problem as the majority of clinicians are located in urban areas, making it
difficult for rural residents, many of whom are elderly, to receive high-quality medical care.
CHINA
In China, ~95% of the population participates in one of three public health insurance programs: the UrbanEmployee Basic
Medical Insurance (UEBMI), the UrbanResident Basic Medical Insurance (URBMI), or the New RuralCooperative Medical
Care Scheme (NRCMS).
While the insured rate in China may seem high, many individuals are still very concerned about their ability to cover
healthcare costs as on average ~28% of care must be paid for out-of-pocket,
There are also disparities in access to care as rural doctors are often undertrained, causing patients to often travel to seek
care at public, urban hospitals.
Variations in insurance coverage based upon one’s residence leave rural residents at an advantage as the plans offered to
them by the government do not adequately cover the higher rates charged by urban healthcare providers.
Long wait times also often come as hospitals only represent 3.5% of medical institutions in China yet they handle 45% of all
outpatient visits.
JAPAN
Japan ranks seventh in the index as the country with one of the most efficient healthcare systems in the world.
Additionally, to ensure that everyone is covered, those employed are covered by the Employee’s Health Insurance while
those who are unemployed, self-employed, or retired fall under the National Health Insurance.
Their healthcare system is known for its preventive care rather than reactive care, as they offer many free health
screenings and check-ups to detect early signs of illnesses or diseases. This is the main reason why Japan has one of the
highest life expectancy rates in the world, reaching 90 years old.
TAIWAN
Taiwan is ninth in the world for most efficient healthcare. It is the final country on our list for having one of the best
healthcare systems in Asia due to its universal and mandatory health insurance for its constituents.
There is free coverage for preventive care like health screenings, available care for mental health and general health, and
access to basic necessities such as medication. The system operates on a single-payer system, where one public agent
controls healthcare in Taiwan.
Due to this nationalized system, administration costs are very low, and Taiwan only spends about 6% of its GDP on
healthcare.
 1960 - FAYE GLENN ABDELLA
Nursing Theories Developed the 21 Nursing Problems Theory.
1860 - FLORENCE NIGHTINGALE 'Nursing is based on an art and science that molds the
Founder of Modern Nursing and Pioneer of the attitudes, intellectual competencies, and technical skills
Environmental Theory. of the individual nurse into the desire and ability to help
Defined Nursing as "the act of utilizing the environment people, sick or well, cope with their health needs."
of the patient to assist him in his recovery." Changed the focus of nursing from disease-centered to
Stated that nursing "ought to signify the proper use of patient-centered and began to include families and the
fresh air, light, warmth, cleanliness, quiet, and the proper elderly in nursing care. The nursing model is intended to
selection and administration of diet - all at the least guide care in hospital institutions but can also be applied
expense of vital power to the patient." to community health nursing, as well.
Identified five (5) environmental factors: fresh air, pure
water, efficient drainage, cleanliness or sanitation, and 1962 _ IDA JEAN ORLANDO
light or direct sunlight. She developed the Nursing Process Theory.
"Patients have their own meanings and interpretations of
1952 - HILDEGARD PEPLAU situations, and therefore nurses must validate their
Pioneered the Theory of Interpersonal Relations inferences and analyses with patients before drawing
Peplau's theory defined Nursing as "An interpersonal conclusions."
process of therapeutic interactions between an Allows nurses to formulate an effective nursing care plan
individual who is sick or in need of health services and a that can also be easily adapted when and if any
nurse specially educated to recognize, respond to the complexity comes up with the patient.
need for help." According to her, people become patients requiring
Her work is influenced by Henry Stack Sullivan, Percival nursing care when they have needs for help that cannot
Symonds, Abraham Maslow, and Neal Elgar Miller. be met independently because of their physical
It helps nurses and healthcare providers develop more limitations, negative reactions to an environment, or
therapeutic interventions in the clinical setting. experience that prevents them from communicating
Peplau's Theory of Interpersonal Relationships their needs.
Factors influencing the orientation phase: The role of the nurse is to find out and meet the patient's
Nurse immediate needs for help.
Values
Culture race 1968 - DOROTHY JOHNSON
Beliefs The Behavioral System Model defines Nursing as "an
Past experiences external regulatory force that acts to preserve the
Expectations organization and integrate the patients' behaviors at an
Preconceived ideas optimum level under those conditions in which the
Nurse-Patient Relationship behavior constitutes a threat to the physical or social
Patient health or in which illness is found."
Values Advocates to foster efficient and effective behavioral
Culture race functioning in the patient to prevent illness and stresses
Beliefs the importance of research-based knowledge about the
Past experiences effect of nursing care on patients.
Expectations Describes the person as a behavioral system with seven
Phases of Nurse-Patient subsystems: the achievement, attachment-affiliative,
Relationship aggressive-protective, dependency, ingestive,
Orientation eliminative, and sexual subsystems.
Identification
Exploitation 1970 -MARTHA ROGERS
Resolution In Roger's Theory of Human Beings, she defined Nursing
as "an art and science that is humanistic and
1955 - VIRGINIA HENDERSON humanitarian.
Developed the Nursing Need Theory The Science of Unitary Human Beings contains two
Focuses on the importance of increasing the patient's dimensions: the science of nursing, which is the
independence to hasten their progress in the hospital. knowledge specific to the field of nursing that comes
Emphasizes the basic human needs and how nurses can from scientific research, and the art of nursing, which
assist in meeting those needs. involves using nursing creatively to help better the lives
"The nurse is expected to carry out a physician's of the patient.
therapeutic plan, but individualized care is the result of A patient can't be separated from his or her environment
the nurse's creativity in planning for care." when addressing health and treatment.
1971 - DOROTHEA OREM Agravante's CASGARA Transformative Leadership Model
In her Self-Care Theory, she defined Nursing as "The act THE THEORIST:
of assisting others in the provision and management of Sister Carolina S. Agravante, SPC., RN, PhD
self-care to maintain or improve human functioning at “Focus on the type of leadership in Nursing that can
the home level of effectiveness." challenge the values and change the world”.
Focuses on each individual's ability to perform self-care.
Composed of three interrelated theories: Divinagracia's COMPOSURE Model
(1) the theory of self-care, THE THEORIST:
(2) the self-care deficit theory, and Carmelita C. Divinagracia, RN, PAD
(3) the theory of nursing systems, “Nursing as a healthcare profession would prove its point
which is further classified into wholly compensatory, in being at par in quality performance with another
partially compensatory, and supportive-educative. healthcare professional”.

1971 - IMOGENE KING Retirement and Role Discontinuity Model

Conceptual System and Middle-Range Theory of Goal THE THEORIST:
Attainment Sister Letty G. Kuan, EdD, MAN, MSN
'Nursing is a process of action, reaction, and interaction “I have grown and sown and now I can reap the reward
by which nurse and client share information about their and blessing of a life lived in joy" and love, for I too have
perception in a nursing situation" and "a process of made others grow."
human interactions between nurse and client whereby
each perceives the other and the situation, and through
communication, they set goals, explore means, and agree
on means to achieve goals."
Focuses on this process to guide and direct nurses in the
nurse-patient relationship, going hand-in-hand with their
patients to meet good health goals. Explains that the
nurse and patient go hand-in-hand in communicating
information, setting goals together, and then taking
action to achieve those goals.

1972 - BETTY NEUMAN

In Neuman's System Model, she defined nursing as a
'unique profession in that is concerned with all of the
variables affecting an individual's response to stress."
The focus is on the client as a system (which may be an
individual, family, group, or community) and on the
client's responses to stressors.
The client system includes five variables (physiological,
psychological, sociocultural, developmental, and
spiritual), It is conceptualized as an inner core (basic
energy resources) surrounded by concentric circles that
include lines of resistance, a normal defense line, and a
flexible line of defense.