Healthcare Innovation: Philippine National Health Insurance

Teodoro J. Herbosa MD FPCS College of Medicine University of the Philippines, Manila Undersecretary (Deputy Minister) of Health (2010-2014)

PHILIPPINE HEALTHCARE

✤ Established by the Americans in 1900’s!

✤ Two systems in one: Public Health System for the poor and Private Health Care for those willing to pay!

✤ 1970s-1990s decline of public health funding and expenditure!

✤ 1991 Decentralization of Public Healthcare to Local government units!

✤ 1994 National Health Insurance Act Universal Health Care coverage for all by 2010.

PHILIPPINE HEALTH INSURANCE CORPORATION

✤ Replaced the Medicare Commission of the GSIS/SSS!

✤ Premium based health care insurance!

✤ Initially covered employed persons - shared premium payments by employee & employer!

✤ Indigents’ premiums shared by National government and local government!

✤ Premiums were paid by Local Chief Executives only on an election year

PHILIPPINE HEALTH INSURANCE CORPORATION

✤ Premium was @ US$2/month with hospitalization benefits only!

✤ Only 50% of the population was covered by 2010!

✤ Support value of Reimbursements were about 30% for simple cases and about 10% for Catastrophic illnesses!

✤ There were cases of fraud!

✤ Health Inequity was further enhanced!

✤ private HMO’s filled a gap

THE PHILIPPINE HEALTH AGENDAUniversal Health Care or Kalusugan Pangkalahatan, has three

strategic thrusts:

Universal Health Care / Kalusugan Pangkalahatan

Improved Health especially for the

Poor and Vulnerable

Secure access to quality

care at facilities

Achieve the public health

MDGs

Provide financial risk

protection

INTERVENTIONS OF CARE

Prim

ary

Prev

entio

n an

d

Health

Pro

mot

ion Curative

Health Care

Secondary Prevention and Primary Care

Universal Health CareKalusugan Pangkalatan

Health Risk Financing and Payment schemes reforms

Access to quality and affordable health care - modernization

Improved Public Health Outcomes focused on Maternal and Child Health

eHealth National eHealth Strategic Plan and Framework

Health FinancingPremium payments of the poor shouldered by National government

Targetting the poorest

Using Sin Tax revenues for sustainable financing

Increased Health expenditure by government

Catastrophic Illness packages

Primary Care Benefit

Case Payment scheme/Capitation payments

Improved Benefits packages

In patient benefits

Outpatient benefits

Z Benefits

MDG related benefits