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“Sustaining Unity in Nation –
Building through Service, Harmony
and Innovation to Nurture Economy
(SUNSHINE)”,
GREGORIO C. RULLODA
OIC-Senior Vice President
& Chief Finance Executive
Fund Management Sector
The National Health
Insurance Program
(NHIP)
May 23, 2018
Waterfront Hotel, Lahug, Cebu City
VisionBawat Filipino, Miyembro
Bawat Miyembro, Protektado
Kalusugan ng Lahat, Segurado
MissionBenepisyong
Pangkalusugang Sapat
at De-kalidad para sa Lahat
• 9 out of 10 Filipinos are covered –93 million Filipinos have opportunity to
claim PhilHealth benefits
• Wider access to transaction
services – easy and faster way to enroll
and pay
• Improved customer service – more
local PhilHealth offices are rated
“excellent” for being ARTA compliant
POPULATIONCoverage
Bawat Filipino,
MIYEMBRO“
”
0
20
40
60
80
100
120
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Mill
ion
s Population
Enrollment
Coverage
74%82%
84% 67%87% 92% 93%
38%47% 54%
52% 83% 64% 79%72%
75% 69%
Enrollment and Coverage
• More responsive – expanded
benefits to include catastrophic
procedures, emerging diseases and
disaster assistance program
• Clear and predictable – shifted
to a case-based payment system
and actively purchased health care
through contracting
• Participatory and transparent
process for benefit
development - adopted an
explicit priority-setting process to
match the benefits with the needs of
the population
BENEFITPackages
Bawat Miyembro,
PROTEKTADO“
”
• Increased awareness of members’
entitlement to benefits – improved
health-seeking behavior of the poor and
deployed 600 PhilHealth Customer
Assistance Relation and Engagement
Staff (PCARES) as patient navigators
in hospitals nationwide
• Increased utilization of benefits –“no balance billing policy” which saw
an increase in the utilization of the
benefits among the poor
• Assured coverage for all – those
who are financially incapable to pay for
health care services are covered
Kalusugan ng Lahat,
SEGURADO“
”
BENEFITUtilization
NHIP Experience
8
0
20
40
60
80
100
120
140
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Membership (millions)
Contribution
Benefits
Fund Balance
(in billions)
(in billions)
(in billions)
Future Prospects
INCREASE RESOURCES
FOR HEALTH
IMPROVE FINANCIAL
PROTECTION &
CONTAIN COSTS
EXPAND
BENEFITS FAIRLY
STRATEGIC REFORMS
IN HEALTH CARE FINANCING
NHIP Projection, 2017 onwards
11
2017 2018 2019 2020 2021 2022
Benefits • Rationalization
of benefit
payouts
• Intensify
monitoring of
fraudulent claims
• Expansion of EPCB
to other sectors
• Fixed co-payment
Board
approved
Contribution
• Improve
collection
efficiency
• Collection of
Receivables
• 3600 for SP,IP,OW
• 5000 for SC
• Floor at P10k
• No cap
• 2.75%
• 3% • 3.25% • 3.5% • 3.75%
0
50
100
150
200
250
300
350
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Membership (millions)
Contribution
Benefits
Fund Balance
(in billions)
(in billions)
(in billions)
Policy Support
Sustaining coverage of
the remainder of the
population
Increasing cost of health
care/no price control/
weak regulation for health
care services
• Data sharing with other government
agencies (ex. PSA, SSS, GSIS, BIR
etc.)
• Expanded government subsidy for
other sectors (orphans, PWDs,
abandoned and abused minors,
prisoners etc.)
• Expanded Point of Service to include
their premium
• Price regulation of health care services
• Mandatory reporting of cost of
services by hospitals
CHALLENGES COURSE OF ACTION
Policy Support
Rent-seeking provider
behavior
Existing pool of
resources is not enough
• Punitive measures and sanctions
against intentional or unintentional
overbilling
• Harmonization of funding sources
(PCSO, PAGCOR, DSWD, DOH and
LGU) thru the Passage of Universal
Health Care Act
• Reinstatement of imprisonment as a
penalty for erring employers
• Allow PhilHealth to invest in common
stocks
CHALLENGES COURSE OF ACTION
Revised Premium Contributions
Effective the applicable month of January 2018 and onwards,the monthly premium contributions shall be at the rate of 2.75% computedstraight based on the monthly basic salary, with a salary floor of ₱10,000.00and a ceiling of ₱40,000.00, to be equally shared by the employees and theiremployer. With the removal of the salary brackets, computation shall bebased on the following table:
Monthly Basic Salary x 2.75%
Monthly Premium Personal Share Employer Share
₱ 10,000.00 and below ₱ 275.00 ₱ 137.50 ₱ 137.50
₱ 10,000.01to
₱ 39,999.99
₱ 275.00to
₱ 1,099.99
₱ 137.50to
₱ 549.99
₱ 137.50to
₱ 549.99
₱ 40,000.00 and above ₱ 1,100.00 ₱ 550.00 ₱ 550.00
5/26/2018
5/26/2018
5/26/2018
Member Empowerment Form
Requires Pre-Authorization
Day Surgeries, Elective Non-Emergency
Surgical Procedures, Radiotherapy,
Hemodialysis, Outpatient Blood Transfusion and
Primary Care Benefits (soon) with Consultations,
Counselling, CBC, Sputum Microscopy,
Urinalysis, Fecalysis, FBS, Lipid Profile, Chest
X-ray, Drugs and Medicines, etc.
5/26/2018
For more information
www.philhealth.gov.ph
www.facebook.com/PhilHealth
www.twitter.com/@teamphilhealth
5/26/2018
