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PhilHealth’s Mandatory and Voluntary Programs: The
Pursuit of Universal Coverage
Denise Valerie Silfverberg
Types of Health Insurance
• Mandatory Health Insurance
– Government Employed Program
– Private Employed Program
• Voluntary Health Insurance
– Individually Paying Program
RA 7875, Section 2
“Compulsory Coverage – All citizens of the Philippines shall be required to enroll in the National Health Insurance Program in order to avoid adverse selection and social inequity.”
Why do we need to study these programs?
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Self-employed, total (% of total employed)
Wage and salaried workers, total (% of total employed)
Source: Data from World Bank Databank, 2013
Questions that need to be asked
• Who are enrolling? Who are NOT enrolling?
• Why are they enrolling? Why are they NOT enrolling?
The Picture (the last decade)
0
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
30,000,000
35,000,000
40,000,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Total Employed Population
Wage and Salaried Workers
Total EP Membership
Source: Data from World Bank Databank
National Coverage Rates
Program Coverage Rate
Private Employed Program 97.8%
Government Employed Program 75.7%
Individually Paying Program 58.34%
Regional Coverage: Employed Program
-80
-60
-40
-20
0
20
40
60
Government Employed Program Private Employed Program
Line of Full
Government Employed Program: What can be done?
Enrolment of casual and contractual employees
Monitoring of Local
Government Units
• NHIA 2013, Section 28
• “It shall be mandatory for all government agencies to include the payment of premium contribution in their respective annual appropriations.”
Private Employed Program: What can be done?
Monitoring medium-sized establishments
Targeting of certain sectors
Monitoring casualization
• Article 280 of the Labor Code of the Philippines
• “Any employee who has rendered at least one year of service, whether such service is continuous or broken, shall be considered a regular employee with respect to the activity in which he is employed and his employment shall continue while such activity exists.”
Regional Coverage: Individually Paying Program
-120
-100
-80
-60
-40
-20
0
20
40
IPP (Conservative Estimate of Dependents) IPP (Liberal Estimate of Dependents)
Line of Full
Availability of health care
resources an issue.
Government:
Provision of mobile clinics
Augmentation of district hospitals
PhilHealth:
Assist in accreditation process of closes health care facilities
Information campaign:
Nearest health facilities
What can be availed
Certain sectors are more prone to undercoverage.
Targeting certain employment sectors:
Agriculture
Employed in manual labor
Design sector-specific programs similar to the Kalusugang Sigurado
at Abot-Kaya sa PhilHealth Insurance (Kasapi)
Coverage from NDHS
38.34
61.62
44.01
51.57
15.01
48.1
0
10
20
30
40
50
60
70
2008 2013 2008 2013 2008 2013
PhilHealth (Any) PhilHealth Paying (WI>2) PhilHealth Sponsored (WI<3)
High Out-of-Pocket Expenditures
National Government
Local Government
National Health Insurance Program
Employees' Compensation
Private Out-of-Pocket
Private Insurance
Health Maintenance Organizations
Private Establishments
Private Schools
Grants
PhilHealth Paying Coverage Distribution
0%
20%
40%
60%
80%
100%
Y2008
Y2013
Dependent
Principal Member
PhilHealth Sponsored Coverage Distribution
0%
20%
40%
60%
80%
100%
Y2008
Y2013
Dependent
Principal Member