Financial protection from health spending in the Philippines: policies and progress

Bredenkamp, Caryn; Buisman, Leander R.

doi:10.1093/heapol/czw011

Cited by 38 publications

(41 citation statements)

References 8 publications

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“…At a more general level, Bredenkamp and Buisman [20] report that OOP health spending in the Philippines increased by 150% (real) from 2000 to 2012, mainly due to spending on medicines. As a result, the percentage of people incurring catastrophic payments has tripled (from 2.5% in 2000 to 7.7% in 2012) and in 2012, OOP spending on health pushed more than 1.5 million people into poverty.…”

Section: Resultsmentioning

confidence: 99%

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

Obermann

Jowett

Kwon

2018

Global Health Action

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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.

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Section: Resultsmentioning

confidence: 99%

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

Obermann

Jowett

Kwon

2018

Global Health Action

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“…Costs due to medicine have been shown to reduce adherence to medication and demand for health services by patients with NCDs . Past studies conducted in LMICs have however shown that social health insurance schemes do not comprehensively cover the costs for medicines and that OOP costs, which are majorly contributed by medicines, are a hindrance to attainment of universal health coverage in many low resource settings . Indeed, any reductions or removal of medicine costs is likely to increase access to DM health care services, but additional resources will be required to cover any concomitant increase in service utilization.…”

Section: Discussionmentioning

confidence: 99%

Patient costs of diabetes mellitus care in public health care facilities in Kenya

Oyando

Njoroge

Nguhiu

et al. 2019

Health Planning & Management

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Objective: To estimate the direct and indirect costs of diabetes mellitus care at five public health facilities in Kenya. Methods:We conducted a cross-sectional study in two counties where diabetes patients aged 18 years and above were interviewed. Data on care-seeking costs were obtained from 163 patients seeking diabetes care at five public facilities using the cost-of-illness approach. Medicines and user charges were classified as direct health care costs while expenses on transport, food, and accommodation were classified as direct non-health care costs. Productivity losses due to diabetes were classified as indirect costs. We computed annual direct and indirect costs borne by these patients. Results: More than half (57.7%) of sampled patients had hypertension comorbidity. Overall, the mean annual direct patient cost was KES 53 907 (95% CI, 43 625.4-64 188.6) (US$ 528.5 [95% CI, 427.7-629.3]). Medicines accounted for 52.4%, transport 22.6%, user charges 17.5%, and food 7.5% of total direct costs. Overall mean annual indirect cost was KES 23 174 (95% CI, 20 910-25 438.8) (US$ 227.2 [95% CI, 205-249.4]). Patients reporting hypertension comorbidity incurred higher costs compared with diabetes---This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Int J Health Plann Mgmt. 2020;35:290-308. wileyonlinelibrary.com/journal/hpm 290 only patients. The incidence of catastrophic costs was 63.1% (95% CI, 55.7-70.7) and increased to 75.4% (95% CI, 68.3-82.1) when transport costs were included. Conclusion: There are substantial direct and indirect costs borne by diabetic patients in seeking care from public facilities in Kenya. High incidence of catastrophic costs suggests diabetes services are unaffordable to majority of diabetic patients and illustrate the urgent need to improve financial risk protection to ensure access to care.

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“…This is a reflection of global trends, where the NCD burden is steadily increasing and fertility rates are decreasing. 11 The rise of NCDs puts a greater strain on the health system, as chronic care is required. Insufficient investments in addressing risk factors and preventive care exacerbate the problem.…”

Section: Discussionmentioning

confidence: 99%

“…Incidence of catastrophic health expenditure leapt from 2.5% to 7.7% from 2000 to 2012. 11 The Philippine National Health Accounts show that out-of-pocket health spending as a proportion of total country health expenditure increased from 52.7% in 2010 to 55.8% in 2014. 12,13 In September 2015, senior officials in PHIC recognized its inefficiencies in decision making and requested that UNICEFPhilippines commission a consultancy to make priority setting for expanding service coverage more systematic.…”

Section: Introductionmentioning

confidence: 99%

Priority Setting for Health Service Coverage Decisions Supported by Public Spending: Experience from the Philippines

Wong¹,

Uy²,

Haw³

et al. 2017

Health Systems & Reform

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Abstract-Achievement of universal health coverage requires better allocative efficiency in health systems. Countries like the Philippines, however, do not have quality local data for these decisions. We present a method that applies existing global data, e.g., Global Burden of Disease and Disease Control Priorities project, into creating a local priority list of diseases and interventions that may be useful in providing a rational plan for expanding coverage of health services paid by public financing. In the context of the Philippines, this refers to the Department of Health for vertical programs like immunization and disease control, and the Philippine Health Insurance Corporation for inpatient and outpatient health services. We found that the top 48 (or 22%) of diseases account for 80% of total disability-adjusted life years (DALYs), reflecting a well-known concept in management, the Pareto principle. Due to its simplicity and widespread applicability, the Pareto principle facilitated interest in rational priority setting among high-level officials in the Philippine health sector. Priority setting must not be limited to disease burden and cost-effectiveness criteria. Our lists can be used after further deliberation and stakeholder consultation. Priority setting is a complex, value-laden process, and a purely utilitarian approach to prioritization may lead to further deterioration in the health status of vulnerable populations. We recommend that DOH and PHIC set up a joint, independent agency primarily responsible for implementing a sustainable, transparent, and participatory priority-setting process that will advise them on future service coverage expansions.

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Financial protection from health spending in the Philippines: policies and progress

Cited by 38 publications

References 8 publications

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

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

Patient costs of diabetes mellitus care in public health care facilities in Kenya

Priority Setting for Health Service Coverage Decisions Supported by Public Spending: Experience from the Philippines

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