The European Journal of Health Economics

, Volume 9, Issue 4, pp 343–349 | Cite as

Lessons for health care reform from the less developed world: the case of the Philippines

  • Konrad Obermann
  • Matthew R. Jowett
  • Juanito D. Taleon
  • Melinda C. Mercado
Original paper

Abstract

International technical and financial cooperation for health-sector reform is usually a one-way street: concepts, tools and experiences are transferred from more to less developed countries. Seldom, if ever, are experiences from less developed countries used to inform discussions on reforms in the developed world. There is, however, a case to be made for considering experiences in less developed countries. We report from the Philippines, a country with high population growth, slow economic development, a still immature democracy and alleged large-scale corruption, which has embarked on a long-term path of health care and health financing reforms. Based on qualitative health-related action research between 2002 and 2005, we have identified three crucial factors for achieving progress on reforms in a challenging political environment: (1) strive for local solutions, (2) make use of available technology and (3) work on the margins towards pragmatic solutions whilst having your ethical goals in mind. Some reflection on these factors might stimulate and inform the debate on how health care reforms could be pursued in developed countries.

Keywords

Health care reform Philippines Decentralisation Technology Ethics 

JEL Classification

I 18 H 41 

Notes

Acknowledgments

The authors thank Dr. Maria Ofelia Alcantara, Dr. Eduardo Banzon and Dr. Claude Bodart for their stimulating discussions. The views expressed here, however, are entirely the authors and do not necessarily reflect the views of the institutions we work for. We also wish to thank two anonymous referees for very helpful comments.

Conflict of interest and funding

KO was a long-term advisor for GTZ Health in the Philippines between 2002 and 2004. MRJ works for GTZ Philippines as an advisor to PhilHealth and holds a visiting research position at the Department of Health Sciences, University of York, UK. JDT is responsible for the development of local health systems at the Department of Health. MCM is senior vice president, operations, for PhilHealth. There was no specific funding for writing this paper; no institution has had any influence in the preparation of this manuscript.

References

  1. 1.
    Busse, R., Schwartz, F.W.: The Philippines’ National Health Insurance Act: a German perspective. Int. J. Health Plann. Manage. 12, 131–148 (1997)CrossRefGoogle Scholar
  2. 2.
    Baerninghausen T., Sauerborn R.: One hundred and eighteen years of the German health insurance system: are there any lessons for middle- and low-income countries? Soc. Sci. Med. 54, 1559–1587 (2002)CrossRefGoogle Scholar
  3. 3.
    GTZ Deutsche Gesellschaft für Technische Zusammenarbeit. Introduction of social health insurance—systems of solidarity. Experiences from German development cooperation. http://www.gtz.de/de/dokumente/en-social-health-insurance.pdf (2006). Accessed 23 January 2006
  4. 4.
    Roberts M., Hsiao W., Berman P., Reich M.M.: Getting health reform right. A guide to improving performance and equity. Oxford University Press, New York (2004)Google Scholar
  5. 5.
    Towse A., Mills A., Tangcharoensathien V.: Learning from Thailand’s health reforms. Br. Med. J. 328, 103–105 (2004)CrossRefGoogle Scholar
  6. 6.
    Berwick D.: Lessons from developing countries on improving health care. Br. Med. J. 328, 1124–1129 (2004)CrossRefGoogle Scholar
  7. 7.
    Jones R.: Why do qualitative research?. Br. Med. J. 311, 2 (1995)Google Scholar
  8. 8.
    Giacomini M., Cook D.J.: A user’s guide to qualitative research in health care. J. Am. Med. Assoc. 284, 478–482 (2000)CrossRefGoogle Scholar
  9. 9.
    Pope C., van Royen P., Baker R.: Qualitative methods in research on healthcare quality. Qual. Saf. Health Care 11, 148–152 (2002)CrossRefGoogle Scholar
  10. 10.
    Pope C., Mays N.: Qualitative Research: Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. Br. Med. J. 311, 42–45 (1995)Google Scholar
  11. 11.
    Greenhalgh T., Taylor R.: How to read a paper: papers that go beyond numbers (qualitative research). Br. Med. J. 315, 740–743 (1997)Google Scholar
  12. 12.
    Meyer J.: Using qualitative methods in health related action research. Br. Med. J. 320, 178–181 (2000)CrossRefGoogle Scholar
  13. 13.
    Economist. Democracy as showbiz. The Economist 1 July 2004Google Scholar
  14. 14.
    Transparency International (Ed). Highlights from the transparency international global corruption report 2004. http://www.globalcorruptionreport.org/download/gcr2004/Highlights_from_the_GCR_2004_FINAL.pdf
  15. 15.
    Brilliantes, A.B.: Decentralised democratic governance under the local government code: a governmental perspective. Philipp. J. Public Admin. 42, 38–57 (1998)Google Scholar
  16. 16.
    World Bank. Philippines. Devolution and health services. Managing risks and opportunities. (Report No 12343-PH). Manila (1994)Google Scholar
  17. 17.
    World Bank. Philippines health policy note: on improving the poor’s access to affordable drugs. Manila (2002)Google Scholar
  18. 18.
    Department of Health. The health sector reform agenda (HSRA). Manila: DOH (1999)Google Scholar
  19. 19.
    Philippine National Statistical Coordination Bureau. Philippine National Health Accounts (http://www.nscb.gov.ph/stats/pnha/2003/default.asp (2006). Accessed 23 January 2006
  20. 20.
    World Bank. Country Data. http://devdata.worldbank.org/external/CPProfile.asp?PTYPE=CP&CCODE=PHL (2006). Accessed 23 January 2006
  21. 21.
    Horton R.: The coming decade for global action on child health. Lancet 367, 3–5 (2006)CrossRefGoogle Scholar
  22. 22.
    Philippine National Statistical Coordination Board. Vital, health and nutrition statistics (http://www.nscb.gov.ph/secstat/d_vital.asp (2006). Accessed 23 January 2006
  23. 23.
    Obermann K., Jowett M.R., Alcantara M.O., Banzon E.P., Bodart C.: Social health insurance in a developing country: the case of the Philippines. Soc. Sci. Med. 62, 3177–3185 (2006)CrossRefGoogle Scholar
  24. 24.
    Murray C.J. L., Lopez A.D.: Evidence-based health policy. Lessons from the global burden of disease study. Science 274, 740–743 (1996)CrossRefGoogle Scholar
  25. 25.
    Muir Gray J.A.: Evidence-based healthcare. In: Edinburgh et al. (eds) How to make Health Policy and Management Decisions 2nd edn. Churchill Livingstone, London (2001)Google Scholar
  26. 26.
    Magno, C. (2004). The Devolution of agricultural and health services. Social Watch—Philippines 2001. (http://www.socwatch.org.uy/es/informeImpreso/pdfs/articled2001_phi.pdf) (2004). Accessed 27 April 2004
  27. 27.
    Delegation of the European Commission to the Philippines: Health Sector Policy Support Programme (HSPSP). http://www.delphl.cec.eu.int/index.cfm?pagename=devtdetails&devtID=62 (2007). Accessed 20 August 2007
  28. 28.
    Philippine Health Insurance Cooperation: Information System Strategic Plan (ISSP) for 2005–2007. http://www.philhealth.gov.ph/mis/issp/ISSP%202005–2007.pdf (2007). Accessed 18 August 2007
  29. 29.
    Iglesias C.P., Drummond M.F., Rovira J. for the NEVALAT project group: Health-care decision-making processes in Latin America: problems and prospects for the use of economic evaluation. Int. J. Technol. Assess. Health Care 21,1–14 (2005)Google Scholar
  30. 30.
    Philippine Health Insurance Cooperation: PhilHealth Honors Key Stakeholders (news release) http://www.philhealth.gov.ph/newsroom/2006_news/022706a_news.htm (2007). Accessed 18 August 2007
  31. 31.
    Kleinke J.D.: Vaporware.com: The failed promise of the health care Internet. Why the Internet will be the next thing not to fix the U.S. health care system. Health Affairs 57, 58–60 (Nov./Dec. 2000)Google Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Konrad Obermann
    • 1
  • Matthew R. Jowett
    • 2
    • 3
  • Juanito D. Taleon
    • 4
  • Melinda C. Mercado
    • 5
  1. 1.University of Applied Sciences of the German Red CrossGöttingenGermany
  2. 2.GTZ Unified Health ProgrammePasig CityPhilippines
  3. 3.Department of Health SciencesUniversity of YorkYorkUK
  4. 4.Bureau of Local Health Development, Department of HealthMetro ManilaPhilippines
  5. 5.Philippine Health Insurance CorporationPasig CityPhilippines

Personalised recommendations