Health Care

Management
In the Philippines

HEALTH CARE MANAGEMENT IN THE PHILIPPINES

Health

care

management

describes

the

leadership

and

general

management of hospitals, hospital networks, and/or health care systems. In

international use, the term refers to management at all levels. The rendering of
health care services to the people is called health care delivery system. Thus,
health care delivery system is the network of health facilities and personnel
which carries out the task of rendering health care to the people. In the
Philippines health care management is complex set of organizations interacting
to provide an array of health services.
In the Philippines the components of the health care delivery system as
mandate of the Department of Health (DOH) is to be responsible for the
following: formulation and development of national health policies, guidelines,
standards and manual of operations for health services and programs;
issuance of rules and regulations, licenses and accreditations; promulgation of
national health standards, goals, priorities and indicators; development of
special health programs and projects and advocacy for legislation on health
policies and programs. The primary function of the Department of Health is the
promotion, protection, preservation or restoration of the health of the people
through the provision and delivery of health services and through the
regulation and encouragement of providers of health goods and services (E.O.
No. 119, Sec. 3).

The DOH vision is "Health as a right. Health for All Filipinos by the year
2000 and Health in the Hands of the People by the year 2020." While its
mission is "DOH, in partnership with the people to ensure equity, quality and
access to health care by: making services available; arousing community
awareness; mobilizing resources; and promoting the means to better health.
In the Philippine healthcare setting health care facilities are level as Level
I, Level II, and Level III. Level I (Primary Level of Health Care Facility) are the
rural health units, their sub-centers, chest clinics, malaria eradication units,
and schistosomiasis control units are directly operated by the DOH;
puericulture centers operated by League of Puericulture Centers; tuberculosis
clinics and hospitals of the Philippine Tuberculosis Society; private clinics,
clinics operated by the Philippine Medical Association; clinics operated by large
industrial firms for their employees; community hospitals and health centers
operated by the Philippine Medicare Care Commission and other health
facilities operated by voluntary religious and civic groups.

The Level II (Secondary Level of Health Care Facilities) is the smaller,

non-departmentalized hospitals including emergency and regional hospitals.
The services offered to patients with symptomatic stages of disease, which
require moderately specialized knowledge and technical resources for adequate
treatment. While the Level III (Tertiary Level of Health Care Facilities) are the
highly technological and sophisticated services offered by medical centers and
large hospitals. These are the specialized national hospitals. The services
rendered at this level are for clients afflicted with diseases which seriously
threaten their health and which require highly technical and specialized
knowledge, facilities and personnel to treat effectively.

Health care workers are also classified. There are three levels of health
workers in the Philippine. These are: the village or grassroots health workers;
the intermediate level of health workers; and the first line hospital personnel.
The village or grassroots health workers are the first contacts of the community
and initial links of health care. They provide simple curative and preventive
health care measures promoting healthy environment and participate in
activities geared towards the improvement of the socio-economic level of the
community like food production program. These are the barangay health
worker, volunteers or traditional birth attendants or hilot.
The intermediate level of health workers represents the first source of
professional health care. They attend to health problems beyond the
competence of village workers and provide support to front-line health workers
in terms of supervision, training, supplies, and services. These are the medical
practitioners, nurses and midwives. While the first line hospital personnel
provide backup health services for cases that require hospitalization and
establish close contact with intermediate level health workers or village health
workers. These are the physicians with specialty, nurses, dentist, pharmacists,
and other health professionals.

Health Care Mangement in hospital

According to the most recent World Bank report, the Philippines has
been among the dynamically emerging markets in the region with its sound
economic fundamentals and highly skilled workforce. Growth in the Philippines
is on average about 5% since 2002, significantly higher than the rate achieved
in the previous two decades. The Gross Domestic Product (GDP) country
remained steady at a 7.2% growth rate in 2013, even with all the calamities.
The WB report says growth momentum of the Philippines was maintained at
6% in the first half of 2014, which is one of the fastest in East Asia, surpassed
only by China (7.4%) and Malaysia (6.3%). Additionally, stable remittances have
also provided a strong basis for currency stability and a healthy buildup of
international reserves. The country currently enjoys a savings rate that exceeds
investment, while its human resources continue to be in high demand around
the world.

The percentage of the Philippines population is 34.53% for less than 15

year olds and 6. 21% for over 60 years old. Life expectancy at birth is 69 years
for both sexes with males at 65 years and female at 72 years, according to
World Health Organization. Economic growth here has created fiscal space for
health; however significant additional financing is now available to support
health reform and universal health coverage.

The Philippines health sector is a public-private mixed system, with the

private sector dominating the market. There is need for robust quality driven
health systems in the Philippines addressing management of chronic diseases
and better primary and referral centers as it is not only a fast growing economy,
but is also blessed with an English speaking population and a healthcare force
experienced in working in the most advanced healthcare systems in the world.

Promoting healthcare related industries could be further enhanced by

foreign investment; bringing foreign investment business experts, international
healthcare consultants, and international accreditation agencies. Activities of
all these will eventually contribute to higher GDP growth.

With fast economics, highly trained medical professionals, internationally

recognized and accredited medical centers, the Philippines could easily be a
hub of medical tourism. Medical tourism will promote other potential
industries such as the hotel industry, tourism, pharmaceutical and other
private and public sectors.

This is also an opportunity for Philippine hospitals and the medical

community to take advantage of the falling reimbursement system and
expensive healthcare in the USA and the European countries. It would be a
wise decision to promote the Philippines medical industry in the USA and
other western countries. Demand for quality medical services will be ever

growing in these countries and patients will be seeking more affordable medical
care abroad.

Such services should not be limited to cosmetic surgery or expensive

services for short gain, but long-term sustainable services that will benefit not
only international patients also the aging Phillipine population.

In order to address acute and chronic disease management issues, and

attract investment, the Philippine hospital leadership should immediately
consider the following initiatives at its upcoming meeting from November 1921, 2014 in Manila.

1. Hemodialysis Quality of care on hemodialysis centers are in disarray

in the Philippines. Therefore, an improvement of hemodialysis centers should
be facilitated by adaptation of Disease Prevention Programs with internationally
accepted Key Performance and Infection Control Indicators. There is an
immediate need of reassessment of all hemodialysis centers in the country
especially after the bad healthcare related outcome already reported at National
Kidney Center.

2. Patient-Centered Medical Homes (PCMH) In order to obtain a

successful outcome in cost utilization, population health, prevention, access to
care and patient satisfaction, establishment of PCMH must be considered by
the hospital leadership. PCMH is a patient-centered program based on a

comprehensive, team-based, coordinated, accessible initiatives focused on

quality and safety. It is also well practiced in the USA. It is a model for
achieving primary care excellence so that care is received in the right place, at
the right time, and in the manner that best suits a patients needs.

3.

Occupational

Medicine

Services

For

corporate

clients

and

international investors there is an immediate need to upgrade occupational

health services, especially in the urban areas. Need for such services will
constantly increase as more investments and new projects will be built in the
Asia Pacific region by international firms.

4. Leadership Development & Quality Institute: There is also a need for

the establishment of the Quality Institute similar to the US Hospital
Association Quality Institute. This program provides ongoing education to the
hospital leadership on quality, patient safety and hospital management.

5. Long term Acute Care Hospital (LTACH): There is also a need for
introducing the concept of LTAC hospitals in the healthcare market in the Asia
Pacific. Long-term acute care hospitals (LTACHs) are facilities that specialize in
the treatment of patients with serious medical conditions that require
continuing care but no longer require intensive care or extensive diagnostic
procedures. LTACHs often are housed within the walls of an acute care hospital
but function independently. LTACHs are able to provide more cost-effective care
than if these same patients were kept in acute-care facilities. The types of
procedures typically seen in LTACHs include prolonged ventilator use or

weaning, ongoing dialysis for chronic renal failure, intensive respiratory care,
multiple IV medications or transfusions, complex wound care/care for burns
etc. This is a successful business module for providing management to
prolonged chronic disease. Also, LTACHs could be utilized as the reference
center from other hospitals in the region.

I hope the above proposals for healthcare quality will be considered by

the

Asian

Hospital

Foundation/Philippines

Hospital

Association

at

its

forthcoming meetings and that it will have full political and international
support in the implementation of these initiatives.