Philippines

Total Population: 98.3 million Population Coverage: 93 percent Membership: Full Member

Expanding the depth and breadth of coverage.

The Philippine Health Corporation launched in 1995 with the aim of placing a renewed emphasis on achieving universal coverage.

The Context

The Philippine Health Insurance Corporation, or PhilHealth, was created in 1995 to administer the National Health Insurance Program, which aims to provide financial access to health services to all Filipinos. In 1998, PhilHealth established the Sponsored Program to provide coverage for the poor. In 2004, the Philippines passed a law to mandate subsidized coverage of the indigent, and PhilHealth campaigned with the Local Government Units to enroll the poor in their jurisdiction, while the Department of Health invested in the local health service delivery and strengthened its regulatory function (Lagrada, 2009). In 2013, another law was passed requiring PhilHealth to extend the subsidy to the poor and near-poor and to mobilize sin tax revenue to finance the subsidies for these groups. In response to these legal mandates, PhilHealth has streamlined its enrollment processes and has used targeted outreach to poor and vulnerable groups with the aim of achieving UHC.

Key Reforms

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 nearly comprehensive coverage for the indigent category of beneficiaries. All other beneficiaries have access to nearly comprehensive services, as well, excluding some outpatient care.

In terms of the delivery system, since the private sector is a major player in the delivery of health services, PhilHealth has introduced an accreditation program for private hospitals.

In 2000 and 2005, changes were implemented as a series of incremental reforms to improve the existing systems without fundamentally changing how health financing and delivery works in the Philippines including:

  • Expanded central government subsidy for the enrolment of the poor to encourage acceleration of efforts for universal coverage
  • Creation of local health service delivery/planning units to reduce fragmentation in health services delivery
  • Stronger DoH role in regulation, including the implementation of performance-based grants to LGUs

Impact: Cross-Country Knowledge Sharing

In November 2012, the Philippines Health Insurance Corporation (PhilHealth) issued a press release about its “crucial” collaboration with the Joint Learning Network for Universal Health Coverage (JLN) to develop a national health data dictionary. According to Dr. Alvin B. Marcelo, PhilHealth Chief Information and Technology Executive, “without a data dictionary, confusion and misinterpretations are common.” With the openHDD, PhilHealth can create new strategies “to improve universal health coverage.”

PhilHealth’s adoption of openHDD is an international partnership embraced at the highest level of the PhilHealth Corporation. With continued success; the partnership will continue to garner real benefits for the Filipino people and the advancement of universal health coverage in the Philippines. Watch the video below to see a brief interview with Dr. Alvin Marcelo on the importance of ICT within PhilHealth.

Governance

The scheme is entirely administered by PhilHealth, a government corporation attached to the Department of Health. PhilHealth collects premiums, accredits providers, sets the benefits packages and provider payment mechanisms, processes claims, and reimburses providers for their services. PhilHealth is responsible for oversight and administration of public-sector insurance schemes. It has a governing board chaired by the Secretary of Health with representation from other government departments (ministries) and agencies, and the private sector including the Overseas Filipino Workers (OFW) sector. PhilHealth (accountable to DoH) is responsible for central management, strategic planning, operations, and financial management functions of the National Health Insurance Program (NHIP). Regional officers manage contributions, conduct marketing, process the claims and pay the providers accordingly.

Financing

PhilHealth is financed primarily through contributions from members of Formal and Informal Economy Members (see membership categories below). In 2013, a law was passed to mobilize sin tax revenue to pay for the premium of the indigent, poor, and near-poor populations. Sin tax revenue is expected to increase each year through 2018, enabling PhilHealth to provide coverage for an increasing share of poor and vulnerable populations. The poor families are identified by the Department of Social Welfare and Development through the National Household Targeting System for Poverty Reduction (NHTS-PR). The premium for these poor families to be enrolled is calculated and incorporated in the DOH budget for the succeeding year. During the fiscal year, the PhilHealth bills the Department of Budget and Management for the costs incurred to cover the indigent, poor, and other vulnerable groups under the PhilHealth Indigent and Sponsored membership categories. Psa-fertility rate