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At a glance: The Philippine health

care system
BY THE MANILA TIMES
APRIL 26, 2018

 HOME
 /
 SPECIAL FEATURES
 /
 AT A GLANCE: THE PHILIPPINE HEALTH CARE SYSTEM

THE health care system in the Philippines has undergone dramatic

changes in the last 20 years as the government has instituted various
reforms and policies to provide easy access to health benefits for every
Filipino.
The Department of Health (DoH) lists 1,071 licensed private hospitals,
and 721 public hospitals. The Department takes care of 70 of the
public hospitals while local government units and other state-run
agencies manage the rest.

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Most hospitals provide efficient and affordable health services.
Facilities, however, pale in comparison with those in high-end health
institutions abroad. On a positive note, private hospitals in the country
have better technical facilities than the public hospitals. Private
hospitals thus assure patients of higher quality service than public
hospitals can provide.

Human resources management, however, leaves much to be desired.

Health care providers and health educators are concentrated in urban
areas, like Metro Manila. Thus there is a dearth of health care
manpower in the rural areas.

Emergency services
In the Philippines, a few institutions measure up to the high
international standards for emergency services.

Some facilities, however, are not capable of handling complex trauma

and major medical emergencies.

The intensive care unit in some tertiary public facilities and in a

number of private hospitals meet international standards. Blood
products in the country are also generally regarded as safe.

Medicines
Most pharmacies in the Philippines provide medicines approved by
the Bureau of Food and Drugs.
Professional pharmacists who studied in top medical schools in the
country run most of the standard pharmacies and they follow strict
guidelines in drug prescription. While pharmacists in some countries
provide drugsto patients even without a doctor’s prescription,
pharmacists in the Philippines have to follow strict directives on the
sale of drugs.

Universal health care coverage

Today, the government continues to make progress towards
developing a universal health care system to ensure that every Filipino
will have easy access to every type of medical procedure. The health
insurance scheme is funded through subsidies and contributions from
employers and employees.

In September 2017, Congress passed into law the Universal Health

Coverage (UHC) program, which aims to provide comprehensive
health care and insurance for all Filipinos.

The UHC is expected to give citizens all health services they need—
disease prevention, treatment, and rehabilitation.

The law mandates that the Philippine Health Insurance System

(PhilHealth) will be reorganized as the Philippine Health Security
Corporation (PHSC). The PHSC will then serve as the “national
purchaser of health services.”

The government’s National Health Insurance Program (NHIP)

outlines the government’s Millennium Development Goals (MDGs) to
attain the Universal Health Coverage.

The program aims to let Filipinos know their entitlements and

responsibilities so that they may availthemselves of effective health
services. They may reimburse their health care expenses through
PhilHealth.

The health care program redirects PhilHealth operations to widen

coverage of the insurance system. The DoH also pushes for the use of
information technology to speed up processing of PhilHealth
payments.

The Department of Health also has developed the Health Facility

Enhancement Program (HFEP) to provide funds for improving
facilities for trauma and other emergencies. HFEP aims to upgrade 20
percent of DoH-retained hospitals, 46 percent of provincial hospitals,
46 percent of district hospitals, and 51 percent of rural health units.

Medical tourism
Another important DoHproject is the Philippine Medical Tourism
Program, which aims to make the country a global leader in
“providing quality health care for all through universal health care.”

The program will further improve the Philippines’ healthcare

manpower capabilities and facilities in both public and private sector
to make the Philippines the country of choice for health care.

With the program, the local health care industry can generate
substantial income to boost the Philippine econo
Philippines government expands health care
coverage
PhilippinesHealth
Overview
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Given the remarkable strides in improving health outcomes since the 1970s, Filipinos
are generally living longer and healthier lives. But despite these advances, the country
lags behind many of its neighbours on key health indicators, such as the maternal
mortality rate and incidence of tuberculosis, and its health expenditure is considerably
less than other countries in South-east Asia. At the same time, lifestyle diseases are
emerging as a new health challenge, requiring different responses. These are the issues
that the Philippines faces as it moves forward with its commitment to achieve universal
health coverage, ensuring that all Filipinos have access to quality, affordable health
care.

Health System
The Philippines has a mixed public-private health care system, with private services modelled
along the lines of the US’ system. The private segment caters to about 30% of the population, but
is far larger than the public system in terms of financial resources and staff. According to the
most recent data from the National Health Facility Registry (NHFR) at the Department of Health
(DoH), the Philippines has 1581 hospitals, including 591 public. About 24% of them do not have
licences. Hospitals are tiered according to the facilities they provide, with Level 1 being little
more than an infirmary and Level 4 covering facilities with the most advanced equipment and
expertise.

There are also 1428 fully licensed birthing stations – 630 public and 798 private – and 480
infirmaries – 207 public and 273 private – two of which do not have a licence, according to the
NHFR. The government also operates 20,123 Barangay Health Stations and 2588 rural health
units. These are mostly run by local and provincial authorities under a devolved management
scheme introduced in 1991, with the DoH providing technical assistance and being responsible
for the operation of only a few tertiary facilities.

Indicators
Since the 1970s successive governments have lifted life expectancy at birth to 72 for women and
65 for men, according to World Bank figures, through structural reforms and increased spending,
as well as by improving access to clean water, sanitation and vaccination programmes. Spending
on health has also risen over the past decade, although not as quickly as it has in the rest of the
Asia-Pacific region.

The DoH’s budget was P122.63bn ($2.6bn) in 2016, compared with P86.97bn ($1.8bn) the
previous year. Spending in 2010 totalled only P24.65bn ($521.5m). The passage of Republic Act
10351, also known as the Sin Tax Reform Law, in 2012 increased duties on tobacco and alcohol
and helped boost the amount of money available for health expenditures.

According to DoH figures, by 2015, 83% of children were fully immunised, with 73% coverage
achieved for the measles vaccine. This has helped reduce the infant mortality rate from 28 per
1000 live births in 2008 to 21 in 2015, and the under-five mortality rate from 34 per 1000 live
births to 27 over the same time period. The under-five mortality rate now matches the targets that
were set under the UN’s Millennium Development Goals (MDGs), and while the infant mortality
rate is still higher than the MDG, the trend is downwards. The attendance of skilled midwives
and other birth attendants, as well as improved antenatal coverage and more deliveries at
hospitals and clinics, has also helped reduce maternal mortality to 114 per 100,000 live births in
2015, compared with 129 in 2010. Again, while this is higher than is ideal and not yet in line
with the MDG, the mortality rate is improving.

Moving Forward
Health authorities in the Philippines are now focusing on the UN’s Sustainable Development
Goal (SDG) 3: good health and well-being. The aim is to achieve universal health coverage and
ensure that the poorest Filipinos have access to affordable and effective health care. In her
presentation at the Health Summit in Pasay City in September 2016, Paulyn Jean B Rosell-Ubial,
secretary of health, noted that the country struggled with “persistent inequities” in health
outcomes. A Filipino child born to one of the country’s poorest families is three times less likely
to reach his or her fifth birthday. Moreover, with around a quarter of the population living below
the poverty line, according to World Bank figures, childhood malnutrition and related
development issues remain a problem. After 25 years of improvement, the prevalence of
nutritional stunting actually increased to 33% in 2015, compared with 30% in 2013, according to
a report by the Save the Children Fund. The international NGO added that childhood
malnutrition costs the country nearly $7bn, or 3% of GDP, per year in terms of education
spending and lost productivity.

Spending
Total health expenditure rose to P585.3bn ($12.4bn) in 2014, up 10% from P530.3bn ($11.2bn)
the year before, with private out-of-pocket sources accounting for more than half of total health
spending. Under the 2010-20 Health Care Financing Strategy, the government set itself a target
of increasing health expenditure to 4.5% of GDP, national government spending to 10% of
health spending and national government spending on public health to P10bn ($211.6m). While
it had surpassed all these targets by 2014, it has still to reach five others: lifting the health budget
as a percentage of total government spending to 6%; reducing out-of-pocket health spending as a
percentage of total health expenditure to 45%; increasing local government spending as a
percentage of health spending to 11%; ensuring local government spending on health reaches
P29bn ($613.5m); and raising the contribution of the National Health Insurance Programme (
PhilHealth) to 19% of total health expenditure.

In a bid to achieve its goals, such as financial protection from the high cost of health care, better
outcomes and a responsive system, the new administration of President Rodrigo Duterte has
devised the ACHIEVE framework under the Philippine Health Agenda 2016-22, which aims to
leverage additional funds from the Philippine Amusement and Gaming Corporation. “This is
really something positive. Before, the government could not even reimburse the expense of a
hospital. [Now] hospitals will be ready to deal with sick Filipinos,” Climaco Caliwara, executive
director of the Philippine Hospital Association, told local daily the Manila

By 2030, in line with the UN’s SDGs, the Philippines aims to reduce maternal mortality to less
than 70 per 100,000 live births, and the under-five mortality rate to as low as 25 per 1000 live
births. Other targets include an end to the AIDS epidemic, tuberculosis, malaria and neglected
tropical diseases, as well as reducing incidences of premature mortality due to non-
communicable diseases (NCDs) by one-third.

Role Of Private Care

The scale of demand for health care services in a country like the Philippines, given the
government’s limited finances, means private health care companies have long played a major
role in the health sector. Private operators are mostly local companies, as foreign investment is
restricted to 40% – which is the lowest rate in the region after Malaysia. They are market
oriented, mainly for profit and concentrated around the more affluent areas of central Luzon and
Metro Manila. Salvador P Castro Jr, chairman and president of medical project services firm SP
Castro, told OBG, “The health care industry has faced high growth and significant investment as
demand for health services grows in tandem with an expanding middle class. Metro Manila, in
particular, has seen a surge in investment in new facilities or expansion of existing ones,
primarily driven by the private sector.”

Local Units
Under the Local Government Code of 1991, responsibility for public health care was devolved to
local government units (LGUs) across the country. The decision divided health care providers
along municipal, provincial and regional lines, leaving LGUs responsible not only for health care
in their regions, but also for the management of provincial- and district-level clinics and
hospitals within their area. LGUs now operate most public-funded facilities. But the devolution
also led to the breakdown of the country’s integrated referral system, putting further strain on the
service.

The World Health Organisation (WHO), in a 2011 review and report of the country’s health care
system, reported that, “The involvement of three different levels of government in the three
different levels of health care has created fragmentation in the overall management of the
system. Local and provincial authorities retain considerable autonomy in their interpretation of
central policy directions, and provision of the health services is often subject to local political
influence. As a result, the quality of health care varies considerably across the country.”

The Philippines had 1.8 hospitals per 100,000 people according to the WHO’s “World Health
Statistics 2015” report. According to the most recent available figures, in 2012, for a population
of around 100m people, the country had 98,155 hospital beds, with 49,372 in public hospitals
and 48,783 in private facilities. The Philippines’ hospital bed density rate is the fourth-lowest in
ASEAN, after Myanmar, Laos and Cambodia, “reflecting the potential for growth,” according to
a Frost & Sullivan study prepared for UK Trade & Investment, now the UK Department for
International Trade.

Public Sector
Government hospitals have been criticised for long waiting times, overcrowding, poor hygiene
and a lack of respect for confidentiality. This generally negative perception has encouraged those
with higher incomes to seek private treatment. Moreover, the standard of health care is uneven,
with both public and private hospitals situated in developed and urban areas. Some 34% of all
hospital beds are situated in the National Capital Region, although it is home to only around 12%
of the country’s population, according to the Philippine Institute of Development Studies.

Every year some 600,000 patients pass through Philippine General Hospital, which has 1500
beds. Its emergency room deals with 2000-3000 patients every day, according to Dr Jose Joven
Cruz, assistant director at the Philippine General Hospital. The hospital has asked for funding to
add an additional 500 people to its staff of 4000 and is looking to build additional floors. “We
are at the apex of the system,” Cruz told OBG. “We are always full. All the specialities are
represented in this hospital, and we get patients from all over the country.”

New Partners
In order to address problems in the public sector, previous governments have implemented
public-private partnership (PPP) programmes to allow private firms to finance, design, build,
operate and maintain a hospital for a maximum of 25 years, after which it must be handed over
to the DoH. PPPs can also take the form of technology transfer, training and funding such as La
Union Medical Centre, which was set up as a joint venture with private investors to secure a
haemodialysis machine and other equipment, as well as staff, under which the investors keep a
share of the revenues. The investors pay the necessary staff, rental and other costs, and share
15% of the revenues with La Union Medical Centre. The authorities have also worked with
foreign aid agencies to improve health care facilities, with three hospitals in Iloilo province
reopening in October 2016 after a three-year renovation programme funded by the Korea
International Cooperation Agency. The hospitals now have more beds and better equipment,
ensuring local people have access to better treatment.

Ayala Corporation, through its Ayala Healthcare Holdings unit (AC Health), which it set up in
2015 to lead its expansion in the industry, is among the most active in the industry. It has a joint
venture with Mercado Group to operate three private hospitals and six clinics, and, through its
Globe Telecom unit, runs a medical hotline service in a joint venture with Mexico’s Salud
Interactiva. Under the QualiMed brand, Ayala also plans to build a chain of 10 hospitals and 10
clinics over the five years to 2020. It has also been acquiring stakes in medical retailers. In
February 2017 Paolo Borromeo, the chief executive of AC Health, told the Nikkei Asian Review
that the company sensed the Philippines health care sector was “ripe for disruption”. Meanwhile,
in an effort to target the more affluent, Metro Pacific Investments has taken over 13 tertiary
hospitals with nearly 3000 beds. The country’s largest private hospital group is now considering
an initial public offering to fund further expansion in the health sector.

Social Insurance
The considerable cost of health care for ordinary Filipinos has long been a concern to the
country’s governments. The National Health Insurance Act of 1995 established PhilHealth,
which is managed by the Philippine Health Insurance Corporation (PHIC). The aim was to
reduce out-of-pocket expenditure and address inequities in health care financing by pooling the
funds contributed by healthy members to subsidise those who could not afford care, but over the
years, it became clear that the country’s poor benefit from the system at around the same level as
richer citizens amid concerns about the quality of care and the risk of co-payment. In 2012 the
WHO described the Philippines health care financing system as “fragmented with insufficient
government investment, inappropriate incentives from providers, weak social protection and high
inequity.”

Successive governments have attempted to revise the programme to broaden coverage. In 2013
the Philippines introduced the Universal Health Care Act to ensure that all Filipinos, especially
the poor, receive health insurance coverage from PHIC. The Duterte administration has renewed
the government’s commitment to achieving universal coverage, from about 92% currently, by
prioritising the poor and marginalised. It is low-income Filipinos who work in the informal
sector who tend to fall through the gaps, because those who are employed are guaranteed health
services, while the very poorest are sponsored by the government.

Care For All

To address this problem, the plan is to consolidate categories within the covered population to
just two: formal and non-formal work. This is in addition to simplifying the rules and committing
to “no balance billing” for poorer patients in basic hospital accommodation. The latter was first
introduced in 2011 but not properly enforced. Previously, those who had used up their premium
were asked to pay the excess, which they often could not afford. There will also be a fixed co-
payment for non-basic accommodation. PhilHealth will also be the main gateway for free or
affordable care, with all Philippine nationals being members – the employed will pay their
premiums through payroll and the rest through a tax subsidy. The national health scheme is also
expected to become the main revenue source for all health care facilities, with benefits expanded
to cover a wide variety of services and health care providers grouped into networks to ensure
services are more efficient.

The hybrid health system, and the limitations of PhilHealth – which offers a defined set of
services at predetermined rates and does not cover items such as dental check-ups – has helped
fuel the development of health maintenance organisations (HMOs), with about 28 HMOs now
registered across the country. Now regulated by the Insurance Commission, after regulatory
control was transferred from the DoH in 2015, the country’s HMOs provide access to a wide
range of health care services to their members, depending on the fees paid and the package
bought. HMO plans for corporate accounts are always integrated with PhilHealth benefits
because employers pay 50% of their employees’ PhilHealth premiums. There are few individual
and family plans, which tend to be more expensive.

New Packages
In line with government initiatives to insure all Filipinos have health coverage, HMOs are also
rolling out micro-health plans that are targeted at the working poor – people who make a living
as fishermen, drivers, farmers and labourers. “It is just the cost of a bottle of beer – about P36
($0.76) a day – and the benefits are good,” Carlos Da Silva, executive director of industry body
Association of Health Maintenance Organizations of the Philippines, told OBG. “These products
should be able to bridge health care gaps across the labour force.” Under HMO policies,
accredited doctors are not allowed to charge private rates when a patient has exceeded their
maximum limit per illness or injury for the year, but only at the HMO agreed contractual rate.

Keeping Costs Down

The cost of medicines has traditionally been one of the largest out-of-pocket costs for Filipinos
in the health care system, but the Generics Act of 1988, which required the production of drugs
identified by their generic names and that providers to write out prescriptions using only generic
terminology, has helped rein in costs and contributed to the development of a local drug
manufacturing industry.

The country’s pharma segment is the third largest in ASEAN, after Indonesia and Thailand. The
market is expected to be worth $4.1bn by 2020, up from $3.4bn in 2015, according to research
and consulting firm GlobalData. IMS Consulting Group, meanwhile, forecasts growth of 5%
both in 2017 and in 2018.

Furthermore, the Universally Accessible and Affordable Quality Medicines Act of 2008
introduced price caps on medicine prices and led to the adoption of measures that promote access
to affordable and good quality drugs to protect public health. The following year the Food and
Drug Administration (FDA) Act ensured access to patented and non-patented medicines, as well
as registered drugs, medical devices and diagnostics. The focus on affordability has also fuelled
the expansion of pharmacy chains specialising in generics, increasing the choice of drugs
available to patients. Burgeoning demand has also prompted more established pharmacies to
stock the drugs. About 85% of medicines in the Philippines, including nutritionals, are sold over
the counter rather than through doctors and hospitals, according to DoH figures. Botika ng
Barangays, government-licensed pharmacies that are privately owned and operated, have also
appeared in villages across the Philippines, selling drugs at lower prices and providing rural
communities with access to quality medicines. In 2014 there were more than 7700 Botika ng
Barangays, compared to 2000 in 2010.

The market’s potential is such that local conglomerates have begun to buy stakes in local generic
pharmacies. In May 2016 Robinsons Retail Holdings of the Gokongwei Group bought 51% of
The Generics Pharmacy, a network of 1800 largely franchised chemist shops. In February 2017
the Ayala Corporation, which bought 50% of Generika in 2015 with the intention of opening
1000 stores by 2020, took a minority stake in Wellbridge Health, which operates an online
pharmacy. Local drugs manufacturers have also benefitted from the growth in demand for
generics. United Laboratories has about 48% of the market.

Clinical Trials
The Philippines is also an emerging destination for global clinical trials. According to the US
Food and Drug Administration, the number of clinical trials in the Philippines increased by 31%
in 2009, the eighth-highest annual growth rate in the world in that year. In 2015 there were 461
clinical trials under way, most of them part of global programmes and subject to strict
international conditions, according to a joint report by IMS Consulting Group and the
Pharmaceutical and Health Association of the Philippines (PHAP).

According to the most recent figures from the Philippine Council for Health Research and
Development, there were 113 registered research studies in 2013, 74 of which were clinical
trials, three times the number of registered studies the previous year. Contract research
organisations (CROs) and research-based pharmaceutical companies funded 65 of the 113
studies, and the budget for these could reach more than P1bn ($21.2m), according to the PHAP
report. Research-based pharmaceutical companies conducting local trials are also working with
CROs in the Philippines in a move that the Philippines FDA expects to lead to further
improvements in the quality of clinical research. The University of the Philippines’ National
Institutes of Health has also teamed up with publicly listed Philab Industries to work on research
relating to improving diagnostics, with a focus on diseases that affect the country. Under the
partnership, announced in August 2016, the plan is to construct an 18-storey, P1.6bn ($33.8m)
building to house 10 health institutes.

This focus on research is likely to have a number of benefits for Filipinos. One area of study that
has garnered much attention and investment is stem cells. “There are now more than 80 approved
applications for cord blood stem cells, primarily for some forms of leukaemia and other blood
disorders,” Michael Arnonobal, CEO of Cordlife Philippines, told OBG. “Numerous clinical
trials are also ongoing worldwide investigating the use of stem cells in the treatment of various
diseases, from cerebral palsy and diabetes, to other neurological and degenerative disorders. This
is an indication of the strong trend towards cellular therapy.”

Infectious Diseases
Straddling the tropics, the Philippines has long struggled with the presence of certain infectious
diseases. Vaccination programmes and improved sanitation have helped reduce the incidence of
some communicable diseases, particularly those affecting young children and the elderly. A free
pneumococcal vaccination for those aged 60-65 was introduced in May 2016, providing
protection against diseases such as pneumonia, meningitis, and middle-ear and sinus infections.
The PHAP also reported that research-based pharmaceutical companies have introduced more
than 55 vaccines in the country, focusing particularly on diseases that affect women, children and
the elderly, such as pneumonia, measles and rubella, and firms in the segment have also released
76 new molecules or combinations for the treatment of NCDs, including cardiovascular diseases,
cancer, chronic respiratory infections and diabetes.

While it has managed to control some diseases, others are emerging as major public health
concerns. Along with Afghanistan, the Philippines has the fastest-growing HIV rate in Asia.
“Right now, the Philippines runs the risk of letting the infection get out of control,” Steven
Kraus, director of the Joint UN Programme on HIV/AIDS (UNAIDS) told The New York
Times in February 2017. Although the actual number of people living with HIV remains low at
39,600, UNAIDS estimates the rate of new infections increased by more than 50% between 2010
and 2015. Some 841 cases of the disease were reported in June 2016 by the DoH – the highest
monthly figure since 1984. Efforts by the DoH and Department of Education to raise awareness
about HIV and tackle the virus’ spread have been hampered by conservative politicians and
religious groups, which remains hugely influential in the country. A plan to distribute condoms
and expand sex education in public schools was scrapped in January 2017, and legally anyone
under the age of 18 is required to demonstrate a parent’s consent to buy condoms or get tested
for HIV.

In his state of the nation address in July 2016, President Duterte indicated he would implement
the Reproductive Health Law, despite opposition from the religious groups. The law was passed
in 2012 in the face of objections from religious leaders and took effect after the Supreme Court
ruled it constitutional two years later. Under the law, the government would be able to lead a
public information campaign on sexuality and ensure the distribution of contraceptives.

Dengue & Zika

The Philippines also has to contend with mosquito-borne diseases such as dengue. From 2013 to
2015 the country ranked first in dengue incidences in the Western Pacific, according to the
WHO. The Philippines also participated in the clinical trial for the world’s first dengue vaccine,
Dengvaxia, developed by Sanofi Pasteur and said to be 90% effective against the most severe
strains of the disease. A mass vaccination programme worth P3.5bn ($74m) was launched across
schools in April 2016, the first in the region, and aims to vaccinate 1m children aged nine and
above.

The zika virus, another mosquito-borne disease, has also become endemic. The Philippines
reported 12 cases in 2016. Zika causes what seems like a case of the flu, but is thought to result
in birth defects such as microcephaly. The government has committed to eradicating rare tropical
diseases such as zika by 2030, and in March 2017 it announced plans to start a nationwide
registry of rare diseases to better help those afflicted seek medical treatment. In early 2017 the
DoH announced that in 2016, 10 of the country’s 28 provinces had reached the goal of
eliminating schistosomiasis as a public health problem, and 35 out of 45 endemic provinces had
eliminated lymphatic filariasis, 41 areas were declared rabies-free, and 17 out of 79 provinces
surveyed had managed to reduce the prevalence of soil transmitted helminthiasis to less than
20%.

NCD
The leading causes of death in the Philippines for both men and women are now lifestyle
diseases such as heart disease, which was the top killer in 2012, accounting for 15.4% of deaths,
followed by strokes (11.1%) and diabetes (5.9%), according to WHO data. The crude death rate
for each has been increasing since 2000, and the result has been a decline in healthy life
expectancy – nine years less than overall life expectancy for both men and women in 2012 –
with heart disease and diabetes being the most likely to cause poor health and premature
mortality. Filipinos aged 30-70 have a 28% probability of dying from an NCD, according to the
WHO. The increase in NCDs also has consequences for an economy that lost an estimated $10bn
of GDP due these illnesses in 2010, a figure that is set to triple by 2030, according to the PHAP.

With the burden of NCDs expected to increase threefold by 2030, the DoH recently established a
specialised NCD unit and, given the costs involved, is focusing not only on treatment, but also
prevention. The DoH is encouraging people to live healthier lives, including the poorest and
most remote communities, as well as emphasising the need to catch potential problems early by
seeing a doctor more often (see analysis).

The TseKap coverage package, introduced in early 2015, provides Filipinos with a basic health
check-up and laboratory tests. The scheme is designed to reduce health care outlays, principally
for poor households. Teodoro Ferrer, president of Generika, told OBG, “Health is not only about
the cure, but more important and with longer lasting benefits are wellness and prevention.
However, for preventive health care initiatives to succeed, they need to be done on a mass level,
with the involvement of LGUs and NGOs.”

Outlook
The Philippines continues to face several challenges in its bid to achieve universal health care
and reform a system that is not working for those who need it most. The country’s population is
 not ageing as fast as elsewhere in South-east Asia – by 2020 about 6% of its population will be
aged 65 or over, compared with 4.2% in 2010 – which should ensure some relief from the health
needs associated with an ageing population, but policymakers will need to work together if they
are to reach their goals and not be afraid to take on political and religious interests to protect the
nation’s health.

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The Report
Philippines 2017

This article is from the Health chapter of The Report: The Philippines 2017. Explore other
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Healthcare in the Philippines

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Introduction
Overall, the healthcare system in the Philippines is of a high standard. Filipino medical staff are
expertly trained, but the facilities may not be as impressive as those found in high-end US or
European hospitals. The quality of the Philippines’ state-subsidised public healthcare, although
good, varies widely between rural and urban areas. Private healthcare in the Philippines provides
much more consistent care and facilities tend to be better equipped than public ones. English is
also spoken throughout the Philippines, meaning that there should be few language barriers
preventing expats from accessing healthcare.
Public healthcare
Doctors and nursing staff in public hospitals are highly proficient, however public healthcare in
the Philippines faces some limitations. Despite having achieved universal healthcare, the
Philippines still struggles with unequal access to medical care. As such, the standard of public
healthcare in the Philippines generally varies from excellent in urban centres to poor in rural
areas. Public healthcare also faces strain both from treating the large number of Filipinos who
rely on public healthcare and from the trend of Filipino medical staff migrating to Western
countries. This has resulted in understaffing in some hospitals and patients may experience
delays in treatment.

Public healthcare in the Philippines is administered by Philhealth, a government owned

corporation. Philhealth subsidises a variety of treatments including inpatient care and non-
emergency surgeries, although it does not cover all medical treatments and costs.

Enrolling with Philhealth is mandatory for expats who are employed in the Philippines.
Philhealth contributions are derived from employers, employee salaries and the state. Expats can
voluntarily enrol with Philhealth if they have residency status.
Private healthcare
Private healthcare services are well-established and growing in the Philippines. Although doctors
in private hospitals are as good as doctors practising in the public sector, private facilities are
much better equipped and treatment is typically faster. Private services are considered to be
expensive by locals, but are relatively cheap by most expat standards. The relative affordability
of private healthcare can be seen in the increasing popularity of the Philippines as a medical
tourism destination.
Pharmacies and medicine
There are numerous pharmacies in the Philippines and many 24-hour pharmacies can be found in
major cities and attached to most hospitals. Pharmacies are staffed by accredited pharmacists
who maintain the state’s strict guidelines on the sale of prescription drugs.

Although most medicine is available in the Philippines, some prescription medicine may not be
available in the country, so expats should ensure that they either bring the necessary medication
with them, or that alternatives can be prescribed in the Philippines.
Health hazards
Expats should speak to their doctor at least six weeks before travelling to the Philippines to
ensure that their vaccinations are up to date. Although contraction rates are low, mosquito-borne
diseases such as Japanese encephalitis, malaria, dengue fever and the chikungunya virus are
health hazards in the Philippines. These are best avoided by adopting preventative measures,
such as sleeping under a mosquito net and wearing mosquito repellent.
Emergency services
911 is the general national emergency number in the Philippines.

The quality of ambulance services differs significantly and this problem is compounded by the
lack of strict policies governing how emergency services operate. This may result in slow
response times and poor pre-hospital treatment. The public emergency system also directs most
serious emergencies to designated public facilities which may delay emergency care.
Private ambulances generally have highly proficient staff and better equipment while also
promising faster response times. Private ambulance services are often secured through monthly
subscriptions, or their services are included as part of a medical insurance package. Many private
hospitals also have their own ambulance services.

Healthcare in the Philippines is variable, ranging in quality from excellent to dire.

Hospitals in the major cities are generally of a high standard, while many in rural areas
lack infrastructure and investment.

Healthcare is provided through both private and public hospitals in the Philippines.
Although healthcare is generally expensive for the average Filipino, expats may find it
more affordable than in their home country.

Local medical staff are well trained, especially in big cities. Many have studied and
practised medicine overseas, and speak English. The Philippines is one of the biggest
exporters of medical staff in the world, with many nurses and doctors leaving the
country to work abroad. While the remittances sent home from these workers are an
important contributor to the Philippines economy, healthcare provision in the Philippines
has been undermined by the departure of so many medical professionals.

All citizens are entitled to free healthcare under the Philippine Health Insurance
Corporation (PhilHealth). The scheme is government-controlled and funded by local and
national government subsidies, as well as by contributions from employers and
employees.

Public healthcare in the Philippines

Doctors at public hospitals in the Philippines are well-trained, although equipment and
facilities may not be up to the standard of private institutions.

Access to public healthcare in the Philippines remains a contentious issue, particularly

in rural areas. Although all Filipino nationals are entitled to healthcare through
PhilHealth, not all medical procedures are covered by the scheme and medical
expenses are often paid for by the individual patient.
Private healthcare in the Philippines
Private healthcare is widely available in major cities. Most hospitals in the Philippines
are privately run. For those who can afford it, treatment in private hospitals is excellent.
Although expensive by local standards, services at these institutions are relatively
cheap for many expats when compared to what they would pay back home. The
Philippines is even becoming a popular destination for medical tourism due to the low
cost and high standard of services offered at private facilities, most of which expect
cash payment upfront before commencing treatment.

Medicines and pharmacies in the Philippines

Pharmacies are widely available in the Philippines. Signs for pharmacies are in English
and easily recognisable. Most are staffed by well-trained pharmacists. Local
supermarkets sometimes stock basic medications that do not require a prescription.
However, drug control is strict in the Philippines and strict guidelines pertain to
prescription drugs. Many pharmacies in major cities are open 24/7, and most hospitals
also have 24/7 pharmacies.

Health hazards in the Philippines

Mosquito-borne diseases such as malaria and dengue fever are endemic in many parts
of the country, particularly during the rainy season between June and November.
Expats should ensure that they take adequate precautions to avoid being bitten by
mosquitoes.

Health insurance in the Philippines

Most companies provide health insurance to their Filipino employees, through
contributions to PhilHealth and private health insurance providers. PhilHealth provides
access to medical care for contributing members at any accredited hospital in the
Philippines. Foreigners are not covered under PhilHealth and should ensure that they
have private health insurance.

Most expats opt for an international health insurance plan, which should be arranged
before arriving in the country.

Many expats travel to Singapore or Hong Kong for specialised medical treatment.
Expats wishing to leave the Philippines for medical purposes should ensure that they
have adequate cover for medical evacuation to these destinations.
Emergency services in the Philippines
Emergency services are available in all major cities, but are limited in more remote
areas. In case of emergency, dial 112 or 117.