“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

THE

PHILHEALTH

STORY

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

actioncenter@philhealth.gov.ph

5/26/2018