The role of national health insurance for achieving UHC in the Philippines: a mixed methods analysis

Abstract

Background: Achieving Universal Health Coverage (UHC) has by now become a key health policy goal in many countries and some form of National Health Insurance (NHI) is often used for this. The Philippines has had more than 50 years’ experience with social health insurance and in 1995 established PhilHealth, the country’s national health insurer. Objectives: Analyzing the role of the Philippine NHI scheme in moving towards UHC, identifying potential avenues for improvement as well as indicating challenges and areas for further development. Methods: This paper is based on a mixed methods approach including extensive literature search, data from PhilHealth and other sources, and key informant interviews with staff at PhilHealth, health care providers, and policy experts at national and international level. Results: Major achievements were the expansion of population coverage using an earmarked revenue source (‘Sin Tax’), the introduction of the no-balance-billing to prevent co-payments, and the Health Facilities Enhancement Program to improve quality. The share of PhilHealth in total health expenditures is still only 14%, managing quality and cost of providers remains insufficient, the benefit coverage does not reflect the country’s burden of disease, and financial protection for PhilHealth members is low. The UHC bill would provide a massive jump forward as all Filipinos would then be automatically enrolled in and thus entitled to the benefits of PhilHealth. Conclusions: For expanding a contribution-based NHI beyond formal employment there needs to be a large increase in budget transfers to cover for citizens unable to contribute. The Philippine UHC bill shifts from the idea of contribution leading to entitlement to the idea of citizenship leading to entitlement and can thus be seen as a paradigmatic change in thinking about NHI. There are three areas that we believe are of key importance in developing further NHI: (i) governance, (ii) financial impact, and (iii) strategic purchasing.

Appraising and addressing design and implementation failure in global health: A pragmatic framework

“…Increasing interest across many LMICs to improve financial protection and achieve universal health coverage has led to widespread reforms which adopt social health insurance schemes (SHIS) (Obermann et al, 2018;Ogundeji et al, 2019). Ghana, for example, commenced its social health insurance scheme in 2003, funded primarily by taxation through the National Health Insurance Levy (70%), social security contributions (17%), investment income (8%), and premiums and registration fees (5%) (Alhassan et al, 2016;Okoroh et al, 2018).…”

Social health protection in Cambodia: Challenges of policy design and implementation

“…the case of China), or even without any subsidy and with reliance on a contribution (e.g. the case of the Philippines) (Obermann, Jowett and Kwon, ).…”

Best Practices in Achieving Universal Health Coverage: A Scoping Review

“…Considering the economic conditions of countries, the results of the present study show that most of the interventions have performed in the eld of nancing or nancial protection functions. Thus, most interventions in these countries have focused on the insurance system and targeted the poor people or speci c groups of society [67,75,78,[80][81][82]120]. Also one of the issues that mostly reformed by countries is the payment and premium systems [60,65,99,121].…”

“…That is why nancing function or the nancial protection dimension and interventions in them can be considered as an essential component of achieving UHC. The results of the study showed that successful interventions in the countries under study have positive results such as, reduction in the intensity of care and decrease in length of hospital stay [60,131], elimination of costs of services that cause overuse of health services [65], allocating a large percentage of income to health [80], reducing out-of-pocket payments [132], and so on.…”

“…The study showed that most of the interventions in the eld of population coverage were related to the coverage expansion in speci c groups or diseases [59, 63, 65, 71, 77, 79-82, 92, 136]. Countries are also trying to cover poor households and individuals by implementing mandatory or voluntary insurance programs in order to cover more population [14,80,120,137,138]. Thailand, for example, with the aim of cover its population considering socio-economic conditions, by implementing a 30 Bahat health plan, could increase its insured population from 40-95% within four years, which is also considered one of the most successful interventions in this eld [139].…”