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  • The Covid-19 Pandemic and Health Policy Change in the Philippines
  • Azad Singh Bali (bio) and Björn Dressel (bio)

Over the past decade, healthcare systems in the Asia-Pacific region have made significant strides in their efforts to achieve universal health coverage. There are, however, many ongoing challenges in these systems that relate to access, financial protection, and strengthening public health. These challenges were brought into sharp relief by the SARS-CoV-2, or Covid-19, pandemic that caught most governments unaware and inadequately prepared. Governments across the world have had to introduce changes to their health systems to shore up weaknesses as they respond to the pandemic. Measures have included, for example, increasing funding, introducing a spectrum of regulatory measures to manage the demand for services, and playing a central role in coordination, among others. This essay describes the extent and nature of changes in the Philippines' healthcare system that have been introduced in response to the pandemic. It looks at the extent to which these changes are relatively new or a continuation of past trends and existing universal coverage reforms.

Change in Healthcare Systems: Moving Past the Status Quo

Healthcare systems, defined as key actors and institutions involved in the production and delivery of healthcare services, are resistant to change. Most actors and institutions in the healthcare system have incentives to maintain the status quo, making significant departures rare and often challenging, as the sector is characterized by entrenched interests, dominant ideas, and powerful veto players. These factors create a system of incentives that promote policy stasis and impede change. However, large events (such as pandemics, among others), often described as focusing events, can [End Page 45] galvanize the attention of societal actors and are known to temporarily lower barriers that impede and constrain policy change. Further, the more proximate a sector is to the epicenter of a crisis, the greater the propensity for change. Given the inherent policy stability that characterizes healthcare systems, to what extent has the pandemic resulted in significant policy change?

It is important to clarify what is meant by policy change. Change can be thought of in terms of Howlett and Cashore's taxonomy that distinguishes between policy goals and the means to achieve them. Further, the taxonomy distinguishes between change at a macro level (e.g., new ideas or actors or institutions), meso level (e.g., new programs), and micro level (e.g., calibrations to existing settings of current programs), as illustrated in Table 1.1 Using this approach, a significant change is defined as one that occurs at the macro or meso level—that is, change in policy goals or ideas or new programs or agencies established in response to the pandemic. By contrast, micro-level changes in terms of regular policy calibrations are frequent and routine, and as such, do not generally amount to significant differences.


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Table 1.

Conceptualizing Policy Change in Healthcare Systems

As healthcare systems are complex, we focus on five key aspects of them.2 First, governance is an overarching function that comprises [End Page 46] providing direction and coordinating disparate public and private activities in the sector. The vast stakeholders and resources that go into the sector require a robust framework to provide stewardship to key actors and coordinate their efforts. Second, provision refers to the delivery of a range of healthcare services through public or private providers and organizing them in a manner that leads them to serve the public rather than their own interests. Third, financing involves establishing and managing risk pools to ensure that healthcare remains affordable to households. Fourth, healthcare systems require a viable system for paying providers that avoids both undersupply and oversupply of services. Fifth, such systems require a robust regulatory framework to ensure that patients are protected and that healthcare markets function effectively.

The Philippines' Healthcare System

The Philippines relies on a combination of public and private providers to deliver healthcare services. About 60% of hospitals are privately owned and operated, and a majority of the remaining public hospitals are administered by local government units (LGUs) that operate at the level of provinces, cities, and villages. Total health expenditure in the...

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