Mara K. Warwick
World Bank Country Director
Mara K. Warwick is the World Bank Country Director for Brunei, Malaysia, the Philippines and Thailand. Trained as an environmental engineer, Mara Warwick has expertise in flood management, urban development, urban environmental services and disaster risk management. Before she assumed the role of Country Director, Mara Warwick served as the Portfolio and Operations Manager for China, Mongolia and Korea. In this role, she supported programs and projects in climate change mitigation and adaptation, infrastructure development and social service reform in China and Mongolia. From 2010 to 2012, she was Sector Coordinator for Sustainable Development in Ankara, Turkey. In this role she coordinated the World Bank’s development policy and investment lending in the energy, environment, urban and rural development, transport and social development sectors in Turkey. From 2003 to 2009, Mara Warwick managed projects in both China and the Philippines related to water supply, wastewater, solid waste and flood management. Before joining the World Bank in 2003, she worked as an engineer in the private sector. An Australian national, Mara Warwick received her B.E. in Civil Engineering from the University of Adelaide, Australia and her M.S. and Ph. D. in Environmental Engineering from Stanford University in the US.
Session 1: The Philippine Perspective
Philippine Health Agenda with focus on FOURmula One Plus (F1 Plus) and Provider Payment Reforms
Mario C. Villaverde
Department of Health
Mario C. Villaverde graduated as a Doctor of Medicine (MD) from the University of Santo Tomas in Manila. Preparatory to a medical degree, he took Bachelor of Science (BS) at the Aquinas University graduating at the top of his class as Magna cum Laude. He completed his Master of Public Health (MPH) at the University of the Philippines-Manila where he ranked second place in his graduating class. In 2003 he was awarded a scholarship as a Lee Kuan Yew Fellow and graduated with a Master in Public Management (MPM) under a joint program of the National University of Singapore and the Harvard Kennedy School.
In 2017, Dr. Villaverde was appointed as Undersecretary of Health. Recently he was designated as Chief of Staff of the Secretary of Health. As such, he has been tasked to coordinate the strategic activities of the different units of Department of Health in pursuit of its sectoral and organizational thrusts. In addition, the position requires him to supervise some offices that directly report to the Office of the Secretary. Prior to his current assignment, he was assigned to head the Office for Health Regulation where he spearheaded the development and implementation of policies related to the regulation and licensing of health facilities, health products, quarantine services and international health surveillance.
In 2000, Dr. Villaverde was designated as Special Assistant to then Secretary Alberto Romualdez. He was tasked to develop and implement the Philippine Health Sector Reform Agenda and the Philippine National Objectives for Health, which provided the strategic framework for the major reform strategies, policy changes and public investments needed to improve the way health care is delivered, regulated and financed. He also supervised the implementation of the maternal, newborn and child health and nutrition policy and organized other programs and projects on environmental health, health promotion, and disease prevention and control.
Dr. Villaverde also teaches public policy and health governance at the Ateneo de Manila University-School of Government (ASoG) and the Development Academy of the Philippines (DAP). From 2011-2016, he served as the Associate Dean for Academic Affairs of the Ateneo School of Government, where he initiated the restructuring of the Master in Public Management (MPM) program and the development of the curriculum for health governance. He also spearheaded several executive education programs and researches on leadership, public management and health development.
In recognition of his various accomplishments in the public service, he was given the THOMAS Award in 2007 as most outstanding alumnus for government service by the University of Santo Tomas Medical Alumni Association. He was also conferred by the President of the Philippines with the GAWAD CES Award as an outstanding government career executive officer for 2010. The University of the Philippines College of Public Health recognized him as most outstanding alumnus during its 85th foundation anniversary in 2012.
Philippines Health Finance and Provider Payment History and Reforms
Ruben John A. Basa
PhilHealth
Mr. Ruben John A. Basa is a graduate of Political Science from Ateneo de Manila University with a Masters degree in Development Studies from De La Salle University.
He was involved in the Health Finance Development Project of DOH and USAID (1993-1995) as a Health Policy and Legislative Fellow. He also served in the Senate as the Technical Staff Head of the Committee on Health and Demography.
In PhilHealth, he held various executive positions, such as Corporate Planning (CorPlan), Information Technology Management Department (ITMD), Corporate Affairs Group (CAG), Area Vice-President, Senior Vice President in the Health Finance Policy Sector (HFPS) among others, since he started his career in the Corporation in 1997.
Currently, he is the Chief Operating Officer of the Philippine Health Insurance Corporation.
Analytical framework and international experiences with provider payment reforms (Session 2 Looking Beyond DRGs : Integrated care models and how strategic purchasing could play a role in promoting better care integration reforms)
Karima Saleh
World Bank
Karima Saleh is a Senior Economist (Health) at the World Bank. She has over 20 years of experience working in more than 20 countries, with work experience (including fieldwork) on health financing and service delivery policy and planning in low-, lower, and -middle-income countries. She holds a PhD in health economics from the Johns Hopkins University. She was part of the core team that developed the 1993 World Development Report, Investing in Health (Washington, DC: World Bank, 1993). Among her recent publications are The Health Sector in Ghana: A Comprehensive Assessment (Washington, DC: World Bank, 2013), Health Financing in Ghana (Washington, DC: World Bank, 2012), and Health Financing in the Republic of Gabon (Washington, DC: World Bank, 2014).
Session 2. Looking beyond DRGs
Toomas Palu
World Bank
Toomas Palu, MD, MPA, is the Global Practice Manager for Health, Nutrition and Population in the World Bank. He leads a team of thirty five health and development professionals in East Asia and Pacific Region with active health programs in more than 15 countries. In his prior engagements, he led World Bank health programs in several countries in Eastern Europe and Former Soviet Union, served as a Director in the Estonia Social Health Insurance Fund Management Board and as a Deputy Director of the Tallinn Emergency Care Hospital in Estonia. His key qualifications experience includes health policy and health sector reforms in middle-income transition economies and health systems strengthening in developing countries. Toomas has a Medical Doctor degree from the Tartu University in Estonia and a Master of Public Administration degree from the Harvard University in the US. He has also studied public policy and medical sociology in the Oxford University and health economics in the University of York in the UK.
How strategic purchasing could play a role in promoting better care integration reforms and what role payment methods play?
John (“Jack”) Langenbrunner
Bill and Melinda Gates Foundation
John (“Jack”) Langenbrunner is a Senior Officer with the Bill and Melinda Gates Foundation since September 2015. Jack is a Health Economist with both research and operations experience. Previous to his Gates work, he was a Lead Health Economist for the World Bank in China and East Asian countries including the Philippines, and coordinated a Health Financing and Health Insurance Thematic Group within the Bank. He led the Bank’s Global Expert Team for Health Financing and Health Systems in 2011-2013. He has extensive experience in countries in Europe, Middle East and Asia. Jack’s most recent books are “Health Financing and Universal Health Coverage in Indonesia: Policy Notes” (2015) and “Financing Health Care in East Asia and the Pacific: Best Practices and Remaining Challenges,” (2012) co-authored with Aparnaa Somanathan. The book contains extensive discussions on the Philippines. He also has co-authored 2 books on Resource Allocation and Strategic Purchasing, and has authored or co-authored a number of papers related to this initiative. He is co-author of a new book on DRGs and hospital payment models in Asia launched in early 2016. Previous to his work at the Bank, Jack was with the US Center for Medicare and Medicaid Services (CMS), a public health insurance program for over 80 million Americans, and with the US Office of Management and Budget. In the mid-1990s, he served on the Clinton Health Care Reform Task Force for the US White House.
Estonia case study: Experiences in measuring care integration and how this information feeds into payment system reforms
Triin Habicht
World Bank
Prior to that she was a Head of Department of Health Care at the Estonian Health Insurance Fund where she worked since 2006. Previously she worked as the Head of Health Policy Unit in the Public Health Department at the MoSA (2004-2006) and as a health economist at the Estonian Health Insurance Fund (2001-2003). Her work has been mainly focused on all aspects of health system financing including development of different payment and contracting schemes for health care providers but also assessment of new health technologies, enhancement of health care quality assurance system and transforming hospital and primary health care provider network. She has been teaching health economics and health financing policy at the University of Tartu. Triin Habicht has been working with the World Health Organization and the World Bank in the areas of health systems, health financing policy and hospital governance.
US Maryland case study: Moving to global budgets, paying for quality of care
Robert Murray
Global Health Payment LLC
Robert Murray is President of Global Health Payment LLC, a management consulting firm specializing in the design and implementation of reimbursement systems for health care providers. In addition to his consulting responsibilities, Mr. Murray is also a writer and health service researcher. Prior to his consulting experience Mr. Murray was appointed by the Governor of Maryland to serve as Executive Director of the Health Services Cost Review Commission (HSCRC) in 1994, Maryland’s all-payer hospital rate-setting agency. He served in that capacity for 17 years.
Under Mr. Murray’s leadership the HSCRC initiated a number of innovative payment programs: 1) the nation’s first severity adjusted DRG-based payment system, 2) a bundled outpatient hospital prospective payment system, 3) the implementation of bundled and Admission-Readmission episode-based for 31 other hospitals in the State; 4) global budgets for 10 rural hospitals, which served as the proto-type payment including demonstration for the State’s current state-wide hospital global budget demonstration with CMS; and 5) several all payer pay-for-performance incentive arrangements focusing on improving patient satisfaction and reducing the frequency of adverse events and hospital-acquired conditions.
Since leaving the HSCRC, Mr. Murray has worked as a consultant developing hospital global budget payment models for the State of Vermont and a prospective payment system for 26 small and rural hospitals for the Oregon Health Authority and the Oregon Association of Hospitals and Health Systems. In Maryland, Mr. Murray is assisting the CareFirst Maryland BlueCross BlueShield extends its successful Patient-Centric Medical Home (PCMH) Shared Savings Program and represents CareFirst on policy issues before the HSCRC. Internationally, he has assisted the Chinese and the French Ministries of Health in the design of DRG-based payment systems and has worked as a Short Term Consultant for the World Bank on payment reform initiatives in the Russian Federation, Brazil, India and the United Arab Emirates. Mr. Murray has a BA and MA in Economics and an MBA, from Stanford University in Palo Alto, California.
Controlling costs and quality by a regulated fee FFS system in Japan
Naoki Ikegami
School of Public Health
St Luke's International University
Tokyo, Japan
Naoki Ikegami is Professor at the School of Public Health, St Luke’s International University, and Professor Emeritus at Keio University, Tokyo. He was Chair of the Department of Health Policy and Management at the Keio School of Medicine, from which he received his MD and PhD. He also received a Master of Arts degree in health services studies with Distinction from Leeds University (United Kingdom). During 1990-1991, he was a visiting professor at the University of Pennsylvania’s Wharton School and Medical School, and has continued to be a Senior Fellow at Wharton. He is a founding member of interRAI (a non-profit international consortium of researchers and clinicians focused on care planning instruments), and served as a consultant to the WHO and the World Bank. He has been President of the Japan Society of Healthcare Administration and of the Japan Health Economics Association. He has sat on various national and state government committees, including the Chair of the Investigative Specialist Sub-committee on Case-mix Based Reimbursement for Chronic Inpatient Care and member of the Reforming Elder Healthcare Council and of the End-of-Life Health Care Council. His research areas are health policy, long-term care and pharmacoeconomics. His publications include “The Art of Balance in Health Policy - Maintaining Japan’s Low- Cost Egalitarian System” (Cambridge University Press, 1998) with John C. Campbell, “Japanese universal health coverage: evolution, achievement, and challenges” (lead author) (Lancet, 2011), “Universal Coverage for Inclusive and Sustainable Development: Lessons from Japan” (editor) (World Bank, 2014)
Session 2. Looking beyond DRGs
Francisco Z. Soria Jr., MD
PhilHealth
Dr. Francisco Soria, Jr. is a physician with more than a decade of experience in public service that spans the frontline local government unit health operations to central policy and program development work in public health and social health insurance in both the DOH and PhilHealth.
Since April 2017, Dr. Soria had been designated as OIC of the Health Finance Policy Sector of PhilHealth- the office tasked to develop benefit and provider payment policies as well as quality assurance program for health care providers. Prior to his current designation, he was Vice-President for quality assurance, at the same time overseeing the development of primary care and MDG-related benefits. As VP, he was responsible of PhilHealth’s provider engagement policy-- developing accreditation and provider performance standards, designing provider performance monitoring program and accreditation policy.
Dr. Soria graduated from the University of the Philippines College of Medicine and is an M.Sc. (Clinical Epidemiology) candidate in the same institution.
Ozren Pezo
World Bank
Ozren Pezo graduated Computer Science and Diploma in Management of University of Zagreb and hold Master in IT from Politecnico Milano Mr. Pezo worked as CIO in the Croatian Health Insurance Fund (CHIF) from 2014-2017. During that period, he was holding the following responsibilities and duties: Chairman of Governing Council of Croatian Institute of Telemedicine, Member of National Committee for IT Strate of Healthcare, National contributor at European Cloud in Health Advisory Council. Mr. Pezo was responsible for strategic planning, developme and operational excellence of IT in CHIF and Croatian national e-Health projects. (ePrescription, eReferral, eBooking, eSchedule Li eFindings, BI portal, Fraud detection tool, eCitizen health portal, EHR, etc.). Speaker, presenter and panelist at more than 15 national, region and international IT/Health conferences.
Currently he acts as international expert and consultant for World Bank in various healthcare reform projects in Philippines and Kosovo.
What is Diagnosis related grouping: what is the framework within which to consider this payment mechanism?
Dr. Ric Marshall
Health Sciences University of Sydney
Dr. Ric Marshall is an international consultant on healthcare pricing and performance management. He is a former clinician, healthcare service manager and system developer. He has held Professorial appointment with the Faculty of Health Sciences at the University of Sydney and the Institute of Global Health Innovation at Imperial College London. He specializes in Healthcare system performance analysis, funding reform and Management Information Development.
He established the Activity Based Funding (ABF) mechanisms for public hospitals for Australia’s Independent Hospital Pricing Authority. He also set up the role of Director of Pricing for the NHS in England, and held the role of Chief Expert on Case mix and Activity-Based Funding and Payment of China National Health Development Research Centre. Ric’s long history as an international expert adviser in Healthcare funding reform programs and health insurance system development has included healthcare performance improvement, associated health information systems design and case payment and integrated care classification implementations. In addition to his work in Australia, he has managed and advised on health insurance system development and funding reform projects in both the public and private sectors in over 30 countries internationally.
Croatia case study: Adopter of Australian DRG
Dr. Tihomir Strizrep
Effectus Business School
Croatia
Dr. Tihomir Strizrep, medical doctor (School of Medicine, University of Zagreb), has worked for 9 years in the health care administration of the Republic of Croatia holding a variety of positions, including the position of Director of the National Health Insurance Fund of the Republic of Croatia (2009-2012). Being a key specialist and decision-maker during the healthcare reform and harmonization of the health care system of the Republic of Croatia according to EU standards, Dr. Strizrep was responsible for implementation of reforms in all major structures of the Health Care System, including health care financing reform and implementation of DRG system; health services pricing policy; the national strategy for the development of human resources in Health Care, organization and restructuring of Primary Health Care and hospitals; development and implementation of a comprehensive IT system including full implementation of e-Prescription; implementation of transparency and anti-corruptive decision making procedures; external reference pricing of medicines (international price comparisons); internal reference pricing of medicines (ATC levels 3 and on); tender based procurement of medicines and vaccines; claw back, rebate and cross product agreements for expensive drugs; mandatory ethical promotion agreements for pharma companies; and others. Dr. Strizrep has co-written numerous papers in the field of Health Care Reform, published in national and international journals, including EuroHealth. Currently Dr. Strizrep is Adjunct Professor at the Effectus Business School and director of consulting company Audenta savjetovanje. He acts as consultant for the World Bank, World Health Organisation, USAID, and other in numerous European, Central Asia, and African countries on the topic of Health Care reforms (Azerbaijan, Belarus, Bosnia and Herzegovina, Kazakhstan, Kosovo, Kyrgyzstan, Latvia, Macedonia, Moldova, Montenegro, Serbia, South Africa, Ukraine). Dr. Strizrep leads the Health, Finance & Governance (HFG) Strategic Health Purchasing and related work in HFG countries in close collaboration with HFG country, regional and global teams.
Thailand case study: Developer of own DRG
Supasit Pannarunothai
Naresuan University
Thailand
Supasit Pannarunothai was a professor of community medicine at Faculty of Medicine, Naresuan University. Having earned Doctor of Medicine from Faculty of Medicine Ramathibodi Hospital, Mahidol University; Master of Science (Public Health) from National University of Singapore; and Doctor of Philosophy from London School of Hygiene and Tropical Medicine, his research focuses on health equity, health care financing, casemix systems and universal health coverage. His research and development on diagnosis related group has helped push inpatient hospital payment mechanism for universal coverage policy in Thailand. He had served as dean of the Faculty of Medicine, Naresuan University for two terms. He is now Chairman of Centre for Health Equity Monitoring foundation.
Indonesia case study: Experiences with INACBG
Kalsum Komaryani
Ministry of Health
Indonesia
Session 4: ICT as the enabler for payment reform
Engr. Jovita Aragona
PhilHealth
Engineer Jovita Aragona graduated from the University of Santo Tomas with the degree of Bachelor of Science in Industrial Engineering. She finished her Masters in Information System from the University of the Philippines Open University. She is at present the Senior Vice President - Chief Information Officer of the Philippine Health Insurance Corporation or PhilHealth, COBIT5 Foundation Certified, and TOGAF9 Certified.
Ms. Aragona has over 27 years of experience in Information Technology works related to Project Management, Systems Engineering / Process Improvement, System Design and Analysis, Quality Assurance, Software Development, Systems Testing, ICT Training, Systems Implementation, ICT Standards Setting, Policy Formulation, Technical Assistance and Support, Operations Management, and Systems Maintenance.
She was the principal author of the Philippine eHealth Strategic Framework and Plan and Health Enterprise Architecture.
Dr. Alvin B. Marcelo
Asia eHealth Information Network
Dr. Alvin B. Marcelo is a general and trauma surgeon by training who is currently executive director of the Asia eHealth Information Network (www.aehin.org). Prior to this, he served as Senior Vice-President and Chief Information Officer of the Philippine Health Insurance Corporation (PhilHealth).
As the director of the University of the Philippines Manila National Telehealth Center and chief of the Medical Informatics Unit, Dr. Marcelo established the Master of Science in Health Informatics program and conducted local and international research in the field of eHealth and health information systems development.
He took his postdoctoral fellowship in medical informatics at the National Library of Medicine in Bethesda, Maryland with research interests in telepathology, mobile computing, and bibliometric analysis of MEDLINE content.
Dr. Marcelo also manages the International Open Source Network for ASEAN+3, a centre of excellence in free and/or open source software established by UNDP, and advises the Community Health Information Tracking System (or CHITS) , a Stockholm Challenge finalist in the health category in 2006.
He is the Philippine representative to the Asia Pacific Association for Medical Informatics (APAMI) and the International Medical Informatics Association (IMIA).
Dr. Marcelo is certified in the governance of enterprise IT (CGEIT - www.isaca.org), The Open Group Architecture Framework (TOGAF - www.opengroup.org), and Archimate, and COBIT5 Implementation.
E-Health systems and their role is strategic purchasing and beyond
Zlatan Sabic
World Bank
Zlatan Šabić, Public Information Systems Specialist. Prior to joining the Bank, Zlatan was Associate Professor at the School of Business and Economics at the University of Sarajevo, with more than 25 years of experience as both practitioner and scholar in strategic use of information technologies and planning of information systems development. Dr. Šabić is one of the South East Europe regional leaders in introducing the eGovernment (co-author of SEE eAgenda and eAgenda+, regional information society strategic development protocols), experienced in policy formation, strategic planning, but also managing the IT implementation. He has an experience of advising the governments in more than 20 countries in Europe, Asia, Middle East, South America and Caribbean, with more than 18 years in supporting the preparation and implementation of healthcare, social protection and education projects, additionally specialized in eHealth systems, social protection registries, and use of IT in education.
Australia case study: Tariff setting and providers’ performance monitoring
Dr. Ric Marshall
Health Sciences University of Sydney
South Korea case study: ICT to improve fraud detection and performance monitoring
John Ryu
HIRA International Group
South Korea
Session 5: Plenary “Way forward for the Philippines”: A Dialogue
Dr. Ofelia Alcantara
Health Perspective Inc.
“Understanding Integrated care – a Provider’s Perspective”
Gerard La Forgia
Aceso Global
With over 30 years of experience, Gerard La Forgia has worked in over 40 countries, leading and managing healthcare projects and conducting policy-relevant research. He was Lead Health Specialist at the World Bank for three of its largest clients - Brazil, China, and India – providing him with unique knowledge and experience to tackle major health system challenges. He led World Bank strategic efforts and engagement with senior public officials and has designed and overseen an agenda in research, evaluation and policy analysis.
Currently, as the Chief Technical Officer for Aceso Global, he is leading the design of service delivery reform for the government of India. Dr. La Forgia has demonstrated technical leadership in service delivery reform, extension of insurance coverage, integrated care network design, M&E framework design, health financing and health service quality improvement. He has a Sc.D. degree in Health Service Administration from the University of Pittsburgh.
Dr. Madeleine de Rosas-Valera
Infant and Pediatric Association of the Philippines
Ateneo School of Business
Dr. Madeleine de Rosas-Valera, was a former Senior Vice President of PhilHealth who initiated the use of Health Technology Assessment in the Philippine National Health Insurance in 1999 as a tool to ensure appropriate use of technologies in the social insurance benefit and in the promotion of quality insurance. Dr. Valera also introduced provider payment mechanism to PHIC such as Diagnosis Related Grouping (DRG), global budget for OFW outpatient benefits. As an advocate of Quality in healthcare, Dr. Valera supervised the development of the PHIC QA Benchbook for institutional providers accreditation.
As a former Undersecretary of Health, Dr. Valera, institutionalized HTA and Drug Price Reference Index in the Department of Health for drugs and medicines procurement and inclusion of drugs in the National Drug Formulary.
She has over 20 years experience in Health Policy Development, Pharmaceutical Management, Health Systems Strengthening, Public Health Administration, Public-Private Partnership and International and Regional Coordination, Disaster Prevention/ Preparedness and Public Health Financing, Primary Health Care and Quality Assurance.
Presently, Dr. Valera is the Executive Director of infant and pediatric Association of the Philippines, Faculty of Ateneo School of Business and serves as Consultant and Adviser to USAID, WHO-WPRO, ADB, Department of Health, Philippine Health Insurance Corporation, Private Hospital Association of the Philippines, Hospital Management Asia, Zuellig Family Foundation and National Privacy Commission.