The number of Filipinos covered by mandatory health insurance has jumped by more than six times over the past five years, to more or less 38.5 million, according to a government think tank.
The increased enrolment bred optimism that more Filipinos down the line will invest in a health-insurance policy from commercial service providers as the local economy continues to expand and even more Filipinos have access to so-called disposable income.
The mandatory Philippine Health Insurance Corp. (PhilHealth) enrollment of all Filipinos, provided under the National Health Insurance Act of 2013, brings a sense of real optimism about the future of health care, insurance executives said.
The government think tank, Philippine Institute for Development Studies (PIDS), said PhilHealth enrollees and beneficiaries made a quantum leap from 6.3 million in 2004 to 38.5 million in 2011.
Based on available data, out of the 38.5 million members and beneficiaries, 19.6 million were enrolled on a regular Department of Health program, while 18.9 million were households under the National Household Targeting System, whose health-care insurance are sponsored by local government units (LGUs).
According to PIDS Consultant Dr. Raymunda Silfverberg, the 38.5 million enrollees were subsidized by the government through the Priority Development Assistance Fund, or pork barrel, of certain legislators.
“The government really worked hard to cover so much. There are families that are covered by the program when they are not supposed to be in the program and yet there are families which are excluded,” she said.
Instances of exclusion of certain beneficiaries from the program are now being addressed by the Department of Social Welfare and Development, she quickly added.
Compared to neighboring countries, the Philippines is said to be performing well in terms of health-care insurance.
“Under the sponsored program, PhilHealth has expanded the benefits under the primary health-care benefit packages. These are now being utilized by beneficiaries in rural health clinics,” she said, adding that rural health clinics need to be accredited so that LGUs will have reimbursements.
“Thailand took 27 years before they realized they really need an expanded primary health-care” system, she said.
The Philippines is unlike Sweden, Denmark and the United Kingdom whose governments subsidize the entire health insurance.
But services under PhilHealth are hospital-care oriented.
But in terms of primary and out- patient, the coverage is still limited.
“The real issue is whether the private and individually paying members who are receiving very low income will be included in the benefit in primary health care,” Silfverberg said.
Coverage across the regions remain uneven. She noted the “undercoverage” in the provinces of Zamboanga and Quezon, while there’s extreme leakage in the National Capital Region.
The PIDS, said the most covered areas in health insurance were Regions 12, 3 and 4-A.
“In the last decade, the national coverage rate for private employed program was high at 97.8 percent; for the government, it’s 75.75 percent; and for individually paying member, 58.3 percent,” the PIDS said.
The think tank said the lower health cover in the government was due to contractualization.
Dr. Maria Eufemia Yap, director of Health Unit of the Ateneo Graduate School of Business, noted the need to provide social protection and social security for the informal sector, previously known as underground economy.
She also sees that health-maintenance organizations will be more innovative in giving health benefit packages and would cover sectors, especially the small and medium enterprises.