Unified System of Governance of the P/CWHS, Private Sector Engagement, and Primary Care Strengthening
The delineation of functions between the Local Government Units (LGUs) and National Government Agencies (NGAs), and decentralization of powers, authority and resources to Local Government Units in 1991, pursuant to Republic Act (RA) No. 7160 (Local Government Code of 1991) resulted in the fragmentation of the public health system. To address the lack of coordination across the different levels of care and continuity in services provided, and to meet the demands and needs of constituents, there is a need to reintegrate hospital and public health services for a holistic delivery of health care. In January 2000, Executive Order No. 205 was issued by the President which provided for the establishment of Inter-Local Health Zones (ILHZ) throughout the country. This was inspired by the concept of the District Health System that was introduced by the WHO. The ILHZs were created by clustering several adjacent municipalities and cities. Each ILHZ has a defined population within a defined geographical area and is composed of a core referral hospital and several primary levels facilities, such as Rural Health Units (RHUs) and Barangay Health Stations (BHS).
The Implementing Rules and Regulations (IRR) of RA No. 10354 (Responsible Parenthood and Reproductive Health Act of 2012) and RA No. 10351 (Sin Tax Law) in 2013 and 2014, respectively, provided for the establishment of Service Delivery Networks (SDNs) which aimed for an integrated, coordinated, and efficient provision of health care services. Consequently, as part of the Guarantees of the Philippine Health Agenda 2016-2022, Administrative Order No. 2017-0014 on Service Delivery Networks was issued in August 2017 by the Department of Health, through the Bureau of Local Health Systems Development (BLHSD). This AO served as a guide in the organization and operationalization of SDNs. In compliance with the abovementioned legislation and issuance, several provinces had already initiated the establishment of their respective SDNs, with assistance from the DOH-Centers for Health Development and some Development Partners. Most of these provinces made use of the existing ILHZs or programmatic SDNs as the starting point for the type of SDNs that will provide a comprehensive set of health care services.
With the passage of RA No. 11223 (Universal Health Care Act) in 2019, the provision of continuous, coordinated, and integrated care will be further facilitated through the organization and functionality of Health Care Provider Networks (HCPNs). The HCPN has three (3) frameworks/ types as reflected in the image below.
The programs, projects, and activities (PPAs) of the Service Delivery Section (Section 1) are anchored on the Universal Health Care (UHC) Act, particularly Section 17 on the creation of Primary Care Provider Networks (PCPNs) to support the delivery of population-based health services, Section 19 on the organization of P/CWHS, and Section 22 on complementation of public and private health care providers and public or private health sector investments. This Section shall focus on the development of policies, researches, and other technical documents, provision of technical assistance, and conduct of monitoring and evaluation related to the establishment of the public HCPN or P/CWHS, and strengthening of local health systems through private sector engagement and implementation of primary care strategies. Given the devolved set-up of the health care delivery system, the attainment of the Section’s program objectives is through the cumulative and coordinated efforts among DOH, PhilHealth, LGUs, development partners, and other stakeholders.
The Public Health Care Provider Network (HCPN) is a type of HCPN that is owned and managed by the public sector. It is created by linking a group or cluster of public primary care providers and facilities with secondary and/ or tertiary care providers within defined geographic or political boundaries. The Public HCPN has two (2) sub-types, the Province-Wide Health System (PWHS) and City-Wide Health System (CWHS).
- The Province-Wide Health System (PWHS) consists of the provincial, municipal, and component city health offices; provincial, district, and municipal hospitals; health centers; barangay health stations; and other LGU-managed health facilities and services.
- The City-Wide Health System (CWHS) includes the city health office, hospitals, health centers, barangay health stations, and other city-managed health facilities and services in highly urbanized cities (HUCs) and independent components cities (ICCs).
The organization of the P/CWHS shall be first implemented in LGUs that expressed their commitment, otherwise known as the Universal Health Care Integration Sites (UHC IS), to determine the impact of an integrated local health system in improving overall health outcomes and to have readily available models that the rest of the LGUs can use as a guide to organizing their P/CWHS when nationwide roll-out is implemented. The status of each UHC IS in progressively realizing the integration reform will be tracked using the Local Health Systems Maturity Levels (LHS ML). The LHS ML outlines the ten (10) key integration characteristics, one of which is the Unified System of Governance of the Local Health Systems.
Unified System of Governance
- The Provincial/City Health Board (P/CHB) is the steward of the integrated local health systems and responsible for setting the policy and strategic directions of the P/CWHS.
- The Management Support Unit (MSU) is the administrative secretariat of the health board and is responsible for assisting in its operations, in close coordination with the P/CHO.
- The Provincial/City Health Office (P/CHO) is the technical secretariat of the health board and is responsible for the technical integration and supervision of the P/CWHS.
- In provinces that opted to create Sub-Provincial Health Systems (SPHS), Technical Management Committee (TMC) is to be created to assist the P/CHO in supervising each SPHS. It is composed of technical staff from the member health facilities, DOH representatives, patient representatives, and others, and to be assisted by administrative staff designated by participating provincial, city, or municipality.
A Unified System of Governance is needed to facilitate efficiency and responsiveness of the health care delivery system, specifically to:
- Re-integrate hospital and public health services;
- Improve and rationalize the coverage and utilization of health services;
- Strengthen technical supervision and management of health activities;
- Set up a structure to anchor the integrated health information system, referral system, primary health care initiatives, among others;
- Improve responses to disaster and emergencies; and
- Identify areas of resource complementation, including human resources, facilities, and budget, among the municipal, component city, provincial, and regional health systems (e.g., sharing of personnel, transport/ambulance, common health trust fund).
Given that certain health or health-related services may not always be available in public-owned and managed health facilities, the UHC Act highlighted the importance of complementation of resources and efforts between the public and private sectors to ensure the availability of quality health care services to all Filipinos, particularly the underserved and unserved areas. Thus, the public health facilities or networks may contract out certain services to the private sector to complete their health services.
The UHC Act has given due emphasis on strengthening primary care, especially that the Primary Care Provider Networks (PCPNs) serves as the foundation of the HCPNs. The PCPNs are coordinated groups of public, private, or mixed primary care providers that act as the navigator, initial and continuing point of contact of clients to the health care delivery system. It is, therefore, important that all Filipinos will be registered to their own Primary Care Provider of choice, whether public or private. These PCPNs shall:
- Serve as the gateway to the HCPN and coordinate the delivery of a continuum of services;
- Guarantee the equitable access of the entire population to essential health and health-related services through the provision of these services in health centers and other care settings, such as homes, schools, and workplaces;
- Facilitate social participation and inter-sectoral action through the development of ties with individuals, their families, and their community/ies, and with other social sectors; and
- Ensure flow of information throughout the entire network, regardless of where care was delivered.
For these PCPNs to perform these expected functions, primary care strategies focus on ensuring the delivery of integrated and comprehensive primary care services, the presence of more strategic financing for primary care, and availability of safe, quality, and affordable primary care.
Related Policies/Issuances
- Administrative Order No. 2020-0019 dated 14 May 2020, “Guidelines on the Service Delivery Design of Health Care Provider Networks”
- Administrative Order No. 2020-0021 dated 22 May 2020, “Guidelines on Integration of the Local Health Systems into Province-wide and City-wide Health Systems”
- Administrative Order No. 2020-0037 dated 13 August 2020, “Guidelines on Implementation of the Local Health Systems Maturity Levels (LHS ML)”
- Department Memorandum No. 2020-0469 dated 30 October 2020, “Local Health Systems Maturity Levels (LHS ML) Monitoring Tool”
- Administrative Order No. 2020-0024 dated May 22, 2020, “Primary Care Policy Framework and Sectoral Strategies”
- Joint Administrative Order No. 2020-0001 dated December 28, 2020 “Guidelines on the Registration of Filipinos to a Primary Care Provider”
- Department Circular No. 2021-0071 dated February 22, 2021 “FY 2020 LHS ML National Baseline Assessment Report for UHC-IS”
FAQs
What are 3 different types of healthcare delivery systems? ›
- Exclusive Provider Organization (EPO) EPO's have a network of providers who have agreed to provide care for the members at a discounted rate. ...
- Health Maintenance Organization (HMO) ...
- Integrated delivery system (IDS) ...
- Preferred Provider Organization (PPO) ...
- Point-of-Service (POS) Plan.
Figure 1–1 illustrates that a health care delivery system incorporates four functional components—financing, insurance, delivery, and payment, or the quad-function model.
What is problem with healthcare delivery system? ›The perennial problem of controlling healthcare costs has taken on new urgency, and margins remain cumulatively negative for US hospitals as of June 2022. Staffing shortages, the end of COVID-19 relief funds, supply chain problems and rising inflation suggest that pandemic-era financial issues will linger for years.
What are the main objectives of a healthcare delivery system? ›Health care delivery forms the most visible function of the health system, both to patients and the general public. It concentrates on patient flows as well as the organization and delivery of all services dealing with the diagnosis and treatment of disease, or the promotion, maintenance and restoration of health.
What are the 5 A's in healthcare delivery? ›We conceptualise five dimensions of accessibility: 1) Approachability; 2) Acceptability; 3) Availability and accommodation; 4) Affordability; 5) Appropriateness.
What are the 7 common health care delivery models? ›Health care delivery models offer the very first layer of confusion for many consumers. Here, we'll discuss seven common models: HMO, PPO, POS, EPO, PFFS, SNP and ACO and examine the differences between each one.
What are the different types of health delivery system? ›What are 3 different types of healthcare delivery systems? Primary care, secondary care, tertiary care, and quaternary care are the four levels of care. What are the four levels of the healthcare system? Primary care, secondary care, tertiary care, and quaternary care are the four levels of care.
What is a healthcare delivery system give examples? ›Definition. Improved provision and distribution of health services to a patient population. Delivery systems typically include healthcare providers, insurers, and government regulators. Health care delivery is measured in terms of cost, method of payment, regulation, and quality of care.
What does service delivery mean in healthcare? ›The World Health Organization defines integrated service delivery as the “the management and delivery of health services so that clients receive a continuum of preventive and curative services, according to their needs over time and across different levels of the health system”.
How can we improve healthcare delivery system? ›- Collect Data and Analyze Patient Outcomes. If you can't measure it, then you can't manage it. ...
- Set Goals and Commit to Ongoing Evaluation. ...
- Improve Access to Care. ...
- Focus on Patient Engagement. ...
- Connect and Collaborate With Other Organizations.
What causes poor health service delivery? ›
The sudden influx of people into cities forces health facilities to function beyond their intended capacity. This leads to inadequate staffing and overcrowding, which in turn cause a drop in the quality of healthcare delivery in urban hospitals (Kamndaya et al.
Why is information important in the delivery of healthcare? ›Health information is essential for good healthcare – their quality depend on accurate and prompt documentation of care provided and regular analysis of contest. Good quality healthcare data play a vital role in planning, development and maintenance of optimal healthcare.
What are the 3 C's in healthcare? ›Paramount among these are the "3Cs": consistency, continuity, and coordination of patient care.
What are the 3 P's in healthcare? ›The 3 P's model encompasses an evidence‐based approach to preparation, protection and prevention, for safety of patients and healthcare staff.
What are the 7 C's in healthcare? ›- Communication. • A supportive care register is compiled to record, plan and monitor patient care. ...
- Co-ordination. • ...
- Control of Symptoms. • ...
- Continuity. • ...
- Continued Learning. • ...
- Carer Support. • ...
- Care in the Dying Phase. • ...
- The Seven Cs of the GSF.
Traditionally, four dominant methods are mentioned in the literature on the organization of nursing care delivery: functional nursing, individual, team nursing, and primary nursing [4].
What are the 6 major categories of health care services? ›The range includes inpatient, outpatient, community-based, voluntary, insti- tutional, governmental, hospice, and comprehensive health maintenance agencies.
What are the 5 types of health care? ›Types of Health Insurance Plans: HMO, PPO, HSA, Fee for Service, POS.
What are the 8 types of healthcare services? ›They cover emergency, preventative, rehabilitative, long-term, hospital, diagnostic, primary, palliative, and home care.
What is the purpose of service delivery system? ›Service delivery is important because it helps provide people with amenities they want or need by linking them to an organization with the resources to provide those services. Companies can tailor service delivery to meet the specific needs of their customers through function or price.
What is service delivery process? ›
A service delivery process is a process enabling the delivery of a service. It requires a coupling between a provider and consumer and sometimes necessitates means. The service is returned as long as the coupling exists. When it stops, the service ends and each stakeholder find back its freedom.
What are the 3 biggest health problems? ›cardiovascular conditions (such as coronary heart disease and stroke) cancers (such as lung and colorectal cancer) mental disorders (such as depression)
What are the biggest problems in healthcare right now? ›- Cybersecurity Threats.
- Telehealth Implementation.
- Invoicing and Payments.
- Price Transparency Mandate.
- IT Healthcare Investments.
- Patient Experience.
- Effective Payment Models.
- Healthcare Staffing Shortages.
- Physical Activity and Nutrition.
- Overweight and Obesity.
- Tobacco.
- Substance Abuse.
- HIV/AIDS.
- Mental Health.
- Injury and Violence.
- Environmental Quality.
- Clinical competence of the hospital staff. ...
- Physical ambience of the hospital. ...
- Amenities provided by the hospital. ...
- Expertise of the physicians. ...
- Behaviour of the staff. ...
- In-patient experience. ...
- Patient satisfaction.
- The tiering of health care. ...
- Growing numbers of elderly people. ...
- The uninsured. ...
- New technologies. ...
- New and reemerging infectious diseases. ...
- The threat of terrorism. ...
- Rediscovery of lifestyle-related health issues.
Key barriers included: lack of appropriate human resources and expertise for service delivery; lack of culturally appropriate screening tools and interventions; and difficulties integrating services with the existing mental health system.
What are the 4 barriers to accessing health services? ›- Insufficient insurance coverage. A lack of insurance often contributes to a lack of healthcare. ...
- Healthcare staffing shortages. ...
- Stigma and bias among the medical community. ...
- Transportation and work-related barriers. ...
- Patient language barriers.
An increase in prescription prices has led to the slow growth of prescription spending. The rise in pharmacy prescription prices is one of the major healthcare challenges for both healthcare enterprise and patients.
Who is the most important person in the healthcare delivery system? ›“It's important for doctors and other medical providers to listen to the most important member of the healthcare team, the patient. After all, there is no bigger stakeholder. Involving the patient in the decision making process is essential, to both better the patient outcome and improve patient experience.”
What are the sources of information on health service delivery? ›
The main sources of health statistics are surveys, administrative and medical records, claims data, vital records, surveillance, disease registries, and peer-reviewed literature. We'll take a look into these sources, and the pros and cons of using each to create health statistics.
What is the biggest impact of health information system to the health care service? ›Benefits of Health Information Technology
The potential to improve patient safety exists through the use of medication alerts, clinical flags and reminders, better tracking and reporting of consultations and diagnostic testing, clinical decision support, and the availability of complete patient data.
Healthcare delivery systems are structured social systems purposely designed for the delivery of healthcare services by specialized workforces. This collection of people provides varied services to defined communities, populations, or markets. The scope of healthcare delivery systems is very broad.
What are the different types of care delivery? ›Traditionally, four dominant methods are mentioned in the literature on the organization of nursing care delivery: functional nursing, individual, team nursing, and primary nursing [4].
What type of healthcare delivery system does the US have? ›Coverage Overview
The US healthcare system does not provide universal coverage and can be defined as a mixed system, where publicly financed government Medicare and Medicaid (discussed here) health coverage coexists with privately financed (private health insurance plans) market coverage.
These steps in such a care delivery process, are: 1) Recognition/Assessment, 2) Cause Identification/Diagnosis, 3) Management/Treatment, and 4) Monitoring (Figure 1).
What is healthcare delivery system summary? ›Health Care Delivery Systems are the organizations that provide services to medical professionals like nurses, doctors, pharmacists, etc. their main aim is to provide health services at lower cost and in higher amount so that these can be made available to a large number of individuals.
Who controls the US health delivery system? ›The federal agency that oversees CMS, which administers programs for protecting the health of all Americans, including Medicare, the Marketplace, Medicaid, and the Children's Health Insurance Program (CHIP).
What is the main role of the government in the US health delivery system? ›Role of government: The federal government's responsibilities include: setting legislation and national strategies. administering and paying for the Medicare program. cofunding and setting basic requirements and regulations for the Medicaid program.