The National Health Insurance Program in The Philippines: Critical Challenges and Future Directions
The National Health Insurance Program in The Philippines: Critical Challenges and Future Directions
The National Health Insurance Program in The Philippines: Critical Challenges and Future Directions
Maricel T. Fernandez
Alex B. Brillantes Jr
Abigail Modino
PIDS HSRM Knowledge-Sharing Seminar
01 July 2014, PIDS, Makati City
Access to health care not only promotes good health and longevity, but
as an investment in human capital, also contributes to labor force
productivity, employment and, eventually, economic growth in the long
run (PDP, 2011)
Earlier on, there were attempt to pass UHC policies beginning with
Medicare and the Primary Health Care Act in 1979.
Since then, a number of laws have been passed the landmark legislation
of which was the National Health Insurance Act of 1995 (Republic Act
7875). The latest law was the National Health Insurance Act of
2013 (Republic Act10606) passed in July 2013.
Paper Outline
Objectives
Methodology and Initial Review of Previous Studies
Overview of the Health Sector in the Philippines
Methodology
unequal access to
health services and the
large share of
household out of
pocket spending in
total health
expenditures.
(Manasan, 2011).
The
The NHIP
OFW
50%
Lifetime Program
40%
Individually Paying
Sponsored Program
Employed
30%
20%
10%
0%
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Source: PhilHealth Corplan
In other words . . .
Membership Categories
RA 9241
23
Employed
Sponsored,
Individually Paying
Overseas Filipinos
Lifetime
RA 10606
Formal Sector
Indigents
Sponsored
Informal Sector
Lifetime
Membership Categories
Categories
Qualified Members
Formal Sector
Informal Sector
Lifetime
Member who has reached the age of retirement under the law and has
paid at least one hundred twenty (120) monthly premium contributions
Retirees/ Pensioners from the Government Sector
Retirees/ Pensioners from the Private Sector
Uniformed Members of the AFP, PNP, BJMP and BFP
24
Membership Categories
Categories
Qualified Members
Sponsored
Indigents
25
Members of the informal economy from the lower income segment who do
not qualify for full subsidy under the means test rule of the DSWD
(Premium Source: NG and / or LGUs and / or Legislative Sponsor)
Orphans, abandoned minors, out-of-school youths, street children, PWDs,
senior citizens, battered women under DSWD custody or any of its
accredited
(Premium Source: DSWD)
Women about to give birth (and as determined by means test recognized
by DSWD)
(Premium Source: NG and / or LGUs and / or Legislative Sponsor)
Barangay health workers, nutrition scholars, volunteers, etc.
(Premium Source: LGU)
Changes
Formal
Informal
Lifetime
Any person who has reached the age of retirement and has paid at least
120 monthly contributions shall be qualified as a Lifetime Member. The
number of monthly contributions required as a Lifetime Member may be
increased in accordance with an actuarial study to sustain the financial
viability of the Program.
The law mandates the Corporation to set up funds at the appropriate time:
(a) to secure benefit payouts to lifetime members and (b) fund to secure
payouts to lifetime members.
Sponsored
Indigents
26
Other changes
Dependents
Parents who are 60 years old or above, whose income is below an
amount determined by the Corporation are qualified dependents.
In addition: Parents with permanent disability that render them totally
dependent on the member for subsistence are also considered qualified
dependents
Emancipated Individual / Single Parent
Any person below 21, married or unmarried, but with a child, should be
enrolled as a separate member
30
Administrative issues
39