Health Care Statistics
World Health Statistics
Country Profile
Social health insurance was originally introduced in the Philippines in 1969 and resulted in the establishment of the Medicare program which had two parts: One for formal sector workers and another aimed to reach out to informal sector workers and the poor. This was managed by the Philippines Medical Care Commission. This program was quite successful at enrolling formal sector workers but less successful at enrolling informal sector workers and the poor.
Social health insurance was originally introduced in the Philippines in 1969 and resulted in the establishment of the Medicare program which had two parts: One for formal sector workers and another aimed to reach out to informal sector workers and the poor. This was managed by the Philippines Medical Care Commission. This program was quite successful at enrolling formal sector workers but less successful at enrolling informal sector workers and the poor. Benefits were also limited largely to hospital care. A new wave of Philippines health reforms began in 1991 when the Local Government Code was adopted by the government and essentially resulted in the transfer of health facilities to local government units (LGUs).
Prior to this major reform, all health facilities in the country were managed by the National Department of Health (DoH) and the health system operated like the British National Health Service. As a result of the decentralization, LGUs became responsible for financing and managing health facilities. However, within LGUs, different local government units are responsible for different types of facilities. For example, “barangay” health units at the most local level (e.g., community-level health providers) are managed by local municipal governments; in the next level up, rural health units are also managed by municipal governments; at the higher levels, city hospitals are managed by city governments, “provincial” hospitals are managed by the provincial government, and finally, regional hospitals and medical centers are managed by the national Department of Health (DoH). This decentralization has contributed to fragmentation in the structure of health service delivery.
Philippines
Historical Context
Social health insurance was originally introduced in the Philippines in 1969 and resulted in the establishment of the Medicare program which had two parts: One for formal sector workers and another aimed to reach out to informal sector workers and the poor. This was managed by the Philippines Medical Care Commission. This program was quite successful at enrolling formal sector workers but less successful at enrolling informal sector workers and the poor. Benefits were also limited largely to hospital care. A new wave of Philippines health reforms began in 1991 when the Local Government Code was adopted by the government and essentially resulted in the transfer of health facilities to local government units (LGUs).
Prior to this major reform, all health facilities in the country were managed by the National Department of Health (DoH) and the health system operated like the British National Health Service. As a result of the decentralization, LGUs became responsible for financing and managing health facilities. However, within LGUs, different local government units are responsible for different types of facilities. For example, “barangay” health units at the most local level (e.g., community-level health providers) are managed by local municipal governments; in the next level up, rural health units are also managed by municipal governments; at the higher levels, city hospitals are managed by city governments, “provincial” hospitals are managed by the provincial government, and finally, regional hospitals and medical centers are managed by the national Department of Health (DoH). This decentralization has contributed to fragmentation in the structure of health service delivery.
The Philippine Health Corporation, or PhilHealth, was created in 1995 with the aim of placing a renewed emphasis on achieving universal coverage. In 2000 and 2005, additional reform efforts were outlined to make decentralization and health insurance reform work more effectively, including an expanded government subsidy for the enrollment of the poor, the creation of local health service delivery/planning units to reduce fragmentation, and a stronger DoH role in regulation. PhilHealth now covers roughly 75 million Filipinos, or 83% of the population.
The Philippine Health Corporation, or PhilHealth, was created in 1995 with the aim of placing a renewed emphasis on achieving universal coverage. In 2000 and 2005, additional reform efforts were outlined to make decentralization and health insurance reform work more effectively, including an expanded government subsidy for the enrollment of the poor, the creation of local health service delivery/planning units to reduce fragmentation, and a stronger DoH role in regulation. PhilHealth now covers roughly 75 million Filipinos, or 83% of the population.
Since PhilHealth’s creation, several developments have occurred in terms of expanding both the breadth and depth of health coverage. In terms of the population coverage, PhilHealth now has four categories of enrollees: formal sector, indigents, retirees, and the individual paying program (IPP) for those not eligible for the other three categories. PhilHealth is financed primarily through general government revenues, with contributions split between central and local governments. Member contributions are required of formal sector workers and those in the individual paying program; the contributions of retirees and indigents are fully subsidized by the government.
Since 1995, several improvements have been made to the benefits package and delivery system. For example, PhilHealth now has an Outpatient and Diagnostic Package limited to indigent enrollees. This new addition creates comprehensive coverage for the indigent category of beneficiaries. All other beneficiaries have access to nearly comprehensive services, as well, excluding some outpatient care.
While the public healthcare delivery system in the Philippines is largely decentralized, the PhilHealth program is managed centrally. PhilHealth is responsible for collections and operations activities, and the Department of Health (DoH) contributes to oversight activities.
In 2000 and 2005, additional reform efforts have not fundamentally changed how health financing and delivery works in the Philippines, but have been implemented as a series of incremental reforms to improve the existing financing and delivery systems. Some of these incremental reforms include an expanded central government subsidy for the poor , the creation of local health service delivery/planning units to reduce fragmentation, and a stronger DoH role in regulation.
Philippines
Summary of Reforms
The Philippine Health Corporation, or PhilHealth, was created in 1995 with the aim of placing a renewed emphasis on achieving universal coverage. In 2000 and 2005, additional reform efforts were outlined to make decentralization and health insurance reform work more effectively, including an expanded government subsidy for the enrollment of the poor, the creation of local health service delivery/planning units to reduce fragmentation, and a stronger DoH role in regulation. PhilHealth now covers roughly 75 million Filipinos, or 83% of the population.
Since PhilHealth’s creation, several developments have occurred in terms of expanding both the breadth and depth of health coverage. In terms of the population coverage, PhilHealth now has four categories of enrollees: formal sector, indigents, retirees, and the individual paying program (IPP) for those not eligible for the other three categories. PhilHealth is financed primarily through general government revenues, with contributions split between central and local governments. Member contributions are required of formal sector workers and those in the individual paying program; the contributions of retirees and indigents are fully subsidized by the government.
Since 1995, several improvements have been made to the benefits package and delivery system. For example, PhilHealth now has an Outpatient and Diagnostic Package limited to indigent enrollees. This new addition creates comprehensive coverage for the indigent category of beneficiaries. All other beneficiaries have access to nearly comprehensive services, as well, excluding some outpatient care.
While the public healthcare delivery system in the Philippines is largely decentralized, the PhilHealth program is managed centrally. PhilHealth is responsible for collections and operations activities, and the Department of Health (DoH) contributes to oversight activities.
In 2000 and 2005, additional reform efforts have not fundamentally changed how health financing and delivery works in the Philippines, but have been implemented as a series of incremental reforms to improve the existing financing and delivery systems. Some of these incremental reforms include an expanded central government subsidy for the poor , the creation of local health service delivery/planning units to reduce fragmentation, and a stronger DoH role in regulation.
While the Philippines has made substantial progress toward increasing access to care and financial protection through the PhilHealth program, it has been exploring several reforms to attain universal coverage, improve the equity of the system and increase the level of financial protection provided. In the coming years, the Philippines will focus on ensuring that registered members and their dependents retain their eligibility for health insurance benefits by improving collection efficiency.
While the Philippines has made substantial progress toward increasing access to care and financial protection through the PhilHealth program, it has been exploring several reforms to attain universal coverage, improve the equity of the system and increase the level of financial protection provided. In the coming years, the Philippines will focus on ensuring that registered members and their dependents retain their eligibility for health insurance benefits by improving collection efficiency. PhilHealth is also improving its targeting by adopting proxy means test results of the Department of Social Welfare and Development as the primary basis for defining and identifying the poor.
Interestingly, out of pocket payments have traditionally been around 40-50 percent in the health system in the Philippines; available data shows that there have not been major shifts in these numbers since 1995. This could be due to incomprehensive outpatient benefits for some populations, the fact that “balance billing” is allowed by providers, and other such design features.
PhilHealth recognizes that managing membership and benefits are information-heavy processes and thus prioritizes simplifying business processes particularly claims processing and in improving information systems.
PhilHealth plans to improve its collections capabilities in the coming years, to ensure that registered members and their dependents retain their enrollment, and improve the overall efficiency of the system. PhilHealth recognizes that it can leverage large benefit payments with explicit contracts with health care providers that will assure minimal co-payments from members and allow a shift to case payments.
PhilHealth is also supporting advocacy through the Department of Health that the national government fully finance health insurance subsidies for the poor and let the local governments focus in improving local level health facilities.
Philippines
The Way Forward
While the Philippines has made substantial progress toward increasing access to care and financial protection through the PhilHealth program, it has been exploring several reforms to attain universal coverage, improve the equity of the system and increase the level of financial protection provided. In the coming years, the Philippines will focus on ensuring that registered members and their dependents retain their eligibility for health insurance benefits by improving collection efficiency. PhilHealth is also improving its targeting by adopting proxy means test results of the Department of Social Welfare and Development as the primary basis for defining and identifying the poor.
Interestingly, out of pocket payments have traditionally been around 40-50 percent in the health system in the Philippines; available data shows that there have not been major shifts in these numbers since 1995. This could be due to incomprehensive outpatient benefits for some populations, the fact that “balance billing” is allowed by providers, and other such design features.
PhilHealth recognizes that managing membership and benefits are information-heavy processes and thus prioritizes simplifying business processes particularly claims processing and in improving information systems.
PhilHealth plans to improve its collections capabilities in the coming years, to ensure that registered members and their dependents retain their enrollment, and improve the overall efficiency of the system. PhilHealth recognizes that it can leverage large benefit payments with explicit contracts with health care providers that will assure minimal co-payments from members and allow a shift to case payments.
PhilHealth is also supporting advocacy through the Department of Health that the national government fully finance health insurance subsidies for the poor and let the local governments focus in improving local level health facilities.