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

Market Failures in Health Insurance

• Adverse Selection Enrolment

• Moral Hazard Utilization

Voluntary Mandatory

- To circumvent adverse selection

- To get past behavioral issues

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

Private Employed Program

Government Employed Program

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

Individually Paying Program

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)

Greater number of private hospitals, higher coverage.

Income level is not an important determinant.

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

Catastrophic Health Expenditures

2003

• FIES: 0.8%

• WHS: 8.3%

PhilHealth Coverage Distribution

0%

20%

40%

60%

80%

100%

Y2008

Y2013

Dependent

Principal Member

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

Corroboration with an individual-level analysis.

We have partially answered WHY.

We need to answer WHO.