Health Care Expenditure Patterns in the Philippines: Analysis of National Health Accounts, 1991-1997

The analysis of the NHA matrices from 1991 to 1997 reveals four main trends. One, total health expenditures have been increasing in both real and per capita terms. But health and financial indicators suggest that the money have not always been spent wisely. Two, the share of family out-of-pocket spending has declined since 1994 in favor of government expenditures, but it remains the single largest source. This means that the financial burden on individual families remain heavy leaving access to care highly inequitable. Three, the share of expenditures for public health services has increased after 1993, but the bias for personal health services remains high. Public health programs, however, have not been able to effectively absorb increased spending. Despite heavy spending bias for hospitals, quality services remain largely inaccessible especially to the poor. Four, national government spending on health have increased mainly from national budget sources. However, increased spending by the Department of health have mostly been applied to the few hospital facilities it continues to operate. On the other hand, local health spending has increased beyond what was needed to maintain devolved health functions, and spending is focused on public health services, but local efforts remain uncoordinated. A package of interrelated reforms covering the areas public hospitals, priority public health programs, and the national health insurance system is proposed to address issues raised by the main findings.