A health care delivery system is the organized network of people, facilities, financing, and governance that provides health services to a population. Its goals include better health, responsiveness, fair financing, equity, quality, access, and efficiency.
| Goal / criterion | Meaning |
|---|
| Efficiency | Maximum results from the resources used (output relative to input) |
| Effectiveness | Degree to which intended health goals are achieved |
| Equity | Fair distribution of services and burdens according to need, not ability to pay |
| Accessibility | Services are available, reachable, affordable, and acceptable |
| Quality | Services are safe, effective, and meet standards |
| Comprehensiveness and continuity | Promotion, prevention, treatment, rehabilitation, and palliative care provided without gaps across the life course |
WHO health system building blocks: service delivery; health workforce; health information; medical products, vaccines, and technologies; financing; leadership and governance.
Types of health systems (by financing and provision)
| Type | Financing | Example | Key feature |
|---|
| National health service | General taxes; state provides most services | United Kingdom NHS | Strong on equity and universal coverage |
| Social health insurance | Mandatory contributions from workers, employers, and government subsidy | Germany | Coverage tied to membership; government subsidizes those who cannot pay |
| Private / market-based | Private insurance and out-of-pocket payment | United States (largely) | Choice and competition, but gaps in access and equity |
| Mixed | Combination of the above | Most countries, including the Philippines | Public and private providers; taxes, social health insurance, and out-of-pocket spending |
Main actors in the Philippine system
- Department of Health (DOH) — national steward: policy, standards, regulation and licensing of facilities, national programs, and technical assistance; retains some specialty and regional hospitals
- Local government units (LGUs) — deliver most public health services under devolution
- PhilHealth — administers the National Health Insurance Program, the social health insurance that pays providers for covered services
- Private sector — hospitals, clinics, and practitioners, a large share of hospital care
- Communities and volunteers — barangay health workers and local organizations
Devolution under the Local Government Code of 1991 (RA 7160, Section 17)
| LGU level | Health responsibilities |
|---|
| Barangay | Maintains the barangay health center / station |
| Municipality | Primary health care, maternal and child care, communicable and non-communicable disease control (through the rural health unit) |
| Province | Hospitals and other tertiary health services (provincial and district hospitals) |
| City | All municipal and provincial services |
Each province, city, and municipality has a local health board chaired by the governor or mayor with the local health officer as vice-chair; it advises the local council on health budgets and matters.
Problem after devolution: fragmentation — municipal primary care and provincial hospitals were run separately with weak referral links. The UHC Act aims to re-integrate them.
Universal Health Care Act (RA 11223, approved 20 February 2019)
- Population coverage: every Filipino citizen is automatically included in the National Health Insurance Program
- Membership: two types — direct contributors (those with capacity to pay: employed, self-earning, professionals, migrant workers, lifetime members) and indirect contributors (all others, with premiums subsidized by the national government)
- Entitlement: immediate eligibility; the PhilHealth ID is not required to avail of services; no co-payment for services in basic or ward accommodation
- Primary care provider: every Filipino should have a primary care provider who acts as navigator, coordinator, and initial and continuing point of contact; except in emergency or serious cases and when proximity is a concern, access to higher levels of care is coordinated by the primary care provider
- Population-based services (health promotion, disease surveillance, vector control — delivered to groups) are contracted by the DOH through province-wide and city-wide health systems
- Individual-based services (care traceable to one person) are contracted by PhilHealth through health care provider networks — groups of primary to tertiary providers, public or private, with the primary care provider as navigator
- Province-wide and city-wide health systems integrate municipal and city health systems under Provincial and City Health Boards; minimum components are a primary care provider network with patient records accessible throughout the system, timely epidemiologic surveillance, and proactive health promotion
- Special Health Fund pools resources for population-based and individual-based services, operating costs, capital investment, and health worker remuneration and incentives
- Health information system: electronic health records and e-prescription logs through interoperable systems, consistent with the Data Privacy Act
Levels of care and referral
| Level | Where | Services |
|---|
| Primary | Barangay health stations, rural health units and city health centers, primary care clinics | First contact: health promotion, prevention, basic curative care, maternal and child care, program services |
| Secondary | General hospitals with basic specialist services (e.g., district and provincial hospitals) | Common conditions needing hospital care or specialist consultation |
| Tertiary | Hospitals with advanced and subspecialty services, residency training, and intensive care (regional and medical centers, specialty hospitals) | Complex, specialized, high-technology care |
Facility capability is formally set by the DOH hospital classification (Levels 1–3).
Referral system
- Referral moves a client to the level with the needed capability; back-referral returns the client with a care plan for follow-up at the lower level
- A complete referral includes the client's identity, findings, care given, reason for referral, and a contact person
- Emergencies go directly to the nearest capable facility and are stabilized first
- The PHN ensures continuity: links discharged clients to community services and follows up
Primary health care principles in the system (Topic 4): first-contact, accessible, continuous, comprehensive, and coordinated care.
Health policy process — commonly taught stages:
- Problem recognition and agenda setting
- Policy formulation (developing alternatives, using local and international experience and expert advice)
- Policy adoption (choosing and formally approving an alternative)
- Implementation
- Evaluation — may lead to revision, reformulation, or termination; the process is cyclical
Criteria for choosing policy alternatives include effectiveness, efficiency, equity, political acceptability, administrative feasibility, and cost.
- Serve as part of the primary care team: first contact, health promotion, prevention, and program services
- Help register families with a primary care provider and explain PhilHealth entitlements accurately
- Coordinate referrals and back-referrals; track clients so none are lost between levels
- Take part in surveillance and health promotion that province-wide and city-wide systems require
- Keep accurate electronic and paper records that can follow the client through the network
- Advocate in local health boards and with local officials for adequate health budgets and services for underserved areas
- RA 7160 devolved basic health services and created local health boards; RA 11223 keeps devolution but integrates LGU services into province-wide and city-wide systems.
- RA 11223 guarantees automatic inclusion and immediate eligibility, and RA 10932 (2017, strengthening the Anti-Hospital Deposit Law, BP 702) makes it unlawful to demand a deposit or advance payment before giving basic emergency care in emergency or serious cases; nurses must not turn away or delay emergency care over payment or PhilHealth documents.
- Patient information shared across networks must follow the Data Privacy Act (RA 10173) and the UHC Act's own requirement to uphold privacy.
- Equity is the central ethical value of UHC: priority for the poor, geographically isolated, and underserved.
- Nurses must work within their licensed scope (RA 9173) even when acting as navigators or in understaffed primary care settings.
Case 1 — Non-emergency specialist request. A client with controlled hypertension asks the RHU nurse for a direct appointment at a tertiary hospital for a routine check.
- Correct action: manage through the primary care provider, who coordinates referral if specialized care is needed.
- Why: under UHC, access to higher levels is coordinated by the primary care provider except in emergencies, serious cases, or when proximity is a concern.
Case 2 — No PhilHealth ID. A mother arrives with a child in respiratory distress but has no PhilHealth ID.
- Correct action: provide emergency care immediately; clarify coverage afterward.
- Why: every Filipino is automatically included, and the PhilHealth ID is not required to avail of services.
Case 3 — Returning from the hospital. A post-stroke client is discharged from a provincial hospital with a back-referral slip.
- Correct action: the PHN schedules a home visit, reviews the care plan and medicines, and links the family to rehabilitation resources.
- Why: continuity of care across levels is a core function of the network.
- Thinking PhilHealth provides most services directly — PhilHealth pays; LGUs, DOH facilities, and private providers deliver.
- Believing the UHC Act ended devolution — LGUs still deliver services, but integrated province-wide or city-wide.
- Confusing population-based services (DOH contracts province/city systems) with individual-based services (PhilHealth contracts provider networks).
- Assuming UHC means everything is free — co-payments may apply beyond basic or ward accommodation.
- Placing the barangay health station at the secondary level; it is primary care.
- Forgetting back-referral as part of the referral system.
- The Philippines has a mixed system: public and private providers; tax, social health insurance, and out-of-pocket financing.
- RA 7160 (1991): barangay → health station; municipality → primary care (RHU); province → hospitals; city → both.
- Local health boards: chaired by governor or mayor; health officer is vice-chair.
- RA 11223 (UHC Act, 2019): every Filipino automatically included in PhilHealth's program.
- Two membership types: direct and indirect contributors.
- No PhilHealth ID required; no co-payment in basic or ward accommodation.
- Primary care provider = navigator, coordinator, first and continuing contact; coordinates access to higher levels except emergencies.
- Population-based services → DOH contracts province/city-wide systems; individual-based → PhilHealth contracts provider networks.
- Province/city-wide system minimum components: primary care provider network with shared records, surveillance, health promotion.
- Special Health Fund pools local health resources.
- Levels of care: primary (BHS, RHU), secondary (general hospitals), tertiary (specialized centers); referral plus back-referral.