National Government

.:: DOH and Other National Government Agencies

• Data Sources

The following documents/data were used, namely: (a) COA’s 1991-1999 and 2002 Annual Financial Report of National Government which reports total actual expenditure per agency; (b) COA’s special tabulation of 2000-2001 actual expenditure per agency excluding FAPs for agencies covered in the PNHA; (c) DBM’s 1991-1994 General Appropriations Act (GAA) containing appropriation per program/project/activity (PPA) per agency; and (d) DBM’s 1995-2002 National Expenditure Program (NEP) files containing obligations incurred per PPA per agency.

• Coverage and Estimation

Expenditures included in the PNHA are those for national government agencies with health-related activities. For PNHA purposes, national government agencies were broadly classified into two, namely: (a) agencies whose mandates are all health-related (i.e., “health-related” agencies); and (b) agencies also providing non-health services (i.e., “partial budget” agencies).

The entire budget/expenditures of “health-related” agencies are included in the PNHA. These are as follows: DOH-OSEC, DDB, PHC, LCP, NKTI, PCMC, PVAO-VMMC, FNRI, NMIC, AFP-Medical Center, NNC, POPCOM, PCHRD, NCWDP.

“Partial-budget” agencies, on the other hand, are those agencies in which only a portion of their expenditures are for health care. These are: AFP-GHQ, AFP-PN, AFP-PA, AFP-PAF, NBI, BFP, BCOR, DECS-OSEC, OP-Proper, UP System, DOLE-OSEC, PNP and NAPOLCOM.

Since COA does not report expenditures with the required PNHA breakdown (i.e. by agency and by program/project/activity or PPA), expenditures per PPA were estimated.

For the years 1992-1994, national government expenditures with the required PNHA breakdown (i.e. by agency and by program/project/activity or PPA) were estimated based on (a) appropriation per PPA by agency as reported in the 1992-1994 GAA of the DBM; and (b) agency actual expenditure-to-appropriations ratios or "utilization rates" computed from agency-level data reported in the 1992-1994 Annual Financial Report of National Government of COA. For the 1995 to 2002 series, the estimates were based on: (a) obligations incurred per PPA by agency as obtained from the NEP files of the DBM and (b) agency actual expenditure-to-obligations incurred ratios or “utilization rates” computed from agency level data reported in the 1995-1999 and 2002 Annual Financial Report of National Government of COA and the 2000-2001 special tabulation of actual expenditure (excluding FAPs) per agency also provided by COA.

The 2002 Annual Financial Report (AFR) of the National Government of the COA is the first report based on the New Government Accounting System (NGAS). The NGAS is a simplified set of accounting concepts, guidelines and procedures adopted by COA to ensure correct, complete and timely recording of government financial transactions and production of accurate and relevant financial reports. One implication of the new accounting system is the non-comparabilty of data on expenses by object, that is, by Personal Services (PS), Maintenance and Other Operating Expenses (MOOE) and Capital Outlay (CO). The new summary reports from COA now include expenses according to: PS, MOOE, Financial Expenses and Subsidy. Thus, expenses for CO are estimated using previous proportions of CO to total.

Expenditures of GOCCs like National Kidney and Transplant Institute, Philippine Heart Center, Philippine Children's Medical Center and Lung Center are funded by budgetary support coming from the national government as well as by revenues from agency operations and other sources of corporate funds.

In the case of the Bureau of Corrections, health expenditures are measured only in terms of the salaries of its medical officers and chiefs of hospitals. Other operating costs of its facilities could not be estimated from the current format of expenditure reporting.

Administration cost of health services in agencies also providing non-health services (i.e. "partial budget" agencies) are estimated by multiplying (a) total general administration and support services expenditures with (b) percentage share of health-related expenses to total expenses of the agency net of general administration expense.

• Classification by PNHA Use

Expenditures for mixed services/facilities (e.g., payment for hospital, medical and other professional health care by NAPOLCOM) which could not be disaggregated by component are classified according to the most expensive component or that which is expected to account for most of the total. In the example cited, the mixed-uses expenditures of NAPOLCOM are classified under government hospital care. This general rule on classification is applied repeatedly on various types of expenditure mixes as described in some of the succeeding items below.

Expenditures of DOH's Dental Services are classified under personal health care since most of its budget are for dental commodities provided to RHUs through the Community Health Care Agreement (CHCA).

RHU expenditures for dental services are included under public health care because no detail on RHU/BHS budget is available. Based on service statistics reports for RHUs and BHS, however, dental cases account for about 2.14 percent of all cases seen at RHUs and BHSs. For a rough estimate of dental cost, the percentage may be applied to total DOH budget for Field Health Services, for pre-devolution years, or to total LGU budget for Health Services, for post-devolution years.

Due to data limitations, expenditures for dental clinic services of the following agencies are lumped under either the government hospital health care or clinic care categories: AFP/General Headquarters, AFP-PAF, AFP-PA, AFP-PN, DECS-OSEC and OP-Proper.

Expenditures of the DOH for its Traditional Medicine Program and Herbal Processing Plants are classified under (personal) traditional health care.

All activities of government hospitals including those for general administration and support services are classified under government hospital care.

Terminal Leave Benefits, Personnel Economic Relief Allowance and other similar (non-salary or non-wage) personnel compensation/benefits, which were reported lump-sum under General Administration and Support from 1992-1993, were all assigned under the PNHA uses category Other-General Administration. This rule must particularly be taken into account when comparing levels of central government administration expenditures to expenditures for other PNHA uses. It should be noted that these benefits are paid not only to personnel performing administrative functions but also to those performing health care provision functions.

Starting 1994, with the reclassification of national government expenditure items, only Medicare, EC and PAGIBIG premium payments were retained lump-sum under General Administration. All other types of personnel benefits or non-salary compensation (90 percent of all benefits) were already reported as part of Personal Services for each program or activity of the agencies, i.e. transferred out of General Administration. With this new way of reporting, majority of personnel benefits have then been classified according to the program or activity to which they have been transferred, i.e. no longer General Administration. This change should be taken into account when comparing General Administration cost between the years 1993 and 1994.

.:: Foreign-Assisted Projects

• Data Sources

Data on health expenditures by foreign-assisted projects (FAPs) came from three basic sources (listed in the order of preference): (a) DBM's BESF; (b) DOH-Foreign Assistance Coordination Service reports and DOH Annual Reports; and (c) NEDA Project Management Staff reports. BESF is preferred because it is the source that provides actual fund utilization by projects. The other two sources, however, are also necessary because not all FAPs are reported in the BESF.

• Coverage and Estimation

All FAPs undertaken by the DOH (or those in which DOH is one of the implementors) are included in the PNHA. Similarly, all FAPs of other national government agencies whose mandates are entirely health-related (e.g., National Nutrition Council, Food and Nutrition Research Institute, Philippine Council for Health Research and Development, etc.) are also included.

Actual availment for the year are reported only for projects listed in the BESF and, when available, availment figures are used directly in the PNHA. For projects with multiple implementing agencies, only the availment of the DOH and the health-related agencies are included in the PNHA.

When actual availment data are not available, as in the case for FAPS reported only in DOH-FACS or NEDA-PMS documents, an alternative estimation method is used. Three pieces of information are required: (a) total project cost, (b) project duration and (c) number/types of implementing agencies. Annual availment is then estimated as follows: divide total project cost by the duration of the project and then calculate for the share of the health agencies out of the total estimated availment assuming that each implementing agency is assumed to take equal share out of total availment. If even one piece of information is missing, annual availment was not estimated.

• Classification by PNHA Use

Expenditures by FAPS for mixed services/facilities (e.g., Philippine Health Development Project's payments for hospital equipment, vector control, training of public health personnel, improvement of provincial health office planning and programming and more) which could not easily be disaggregated by component are classified according to the most expensive component or that which is expected to account for most of the total. In the case of the PHDP, most of the expenditures are for providing public health care.

.:: Local Government

• Data Sources

Health care expenditures of the Provincial, Municipal and City Governments are reported, along with all other local government expenditures, in the Commission on Audit's (COA) 1991-2001 Annual Financial Reports of Local Government.

• Coverage and Estimation

Health expenditures of LGUs are reported under two (COA-defined) expense categories: Health, Nutrition and Population Control (Population Control was reported together with health services in 1991. Starting 1992, the program was renamed Family Planning Service and assigned under Social Welfare Services) and Education Subsidiary Services (a subcategory under Education Services).

General administration cost for health services provision was estimated by applying (a) the proportion accounted for by health services out of total cost for all LGU services (i.e., total include health, education, labor and employment, housing, economic and others) to (b) total general administration cost of LGUs. Administration cost includes those for the following: Executive, Planning and Coordination, Accounting, Auditing, Treasury, Budgeting, Administrative and General Services.

The data for education subsidiary services (under item on Non-Hospital MD Facilities) is not available from the 2002 COA AFR. Current data were therefore estimated using regression of the proportion to total local government health expenditure.

• Classification by PNHA Use

LGU health expenditures were generally classified under four uses: Hospital Services under personal (hospital) care; Education Subsidiary Services under personal (non-hospital) care; Health Services, Chest Clinic, Population Control, Development Funds and Miscellaneous Health Services under public health care; and Administration Expenditures under "others".