Social health insurance in a developing country: The case of the Philippines

Obermann, Konrad; Jowett, Matthew; Alcantara, Maria Ofelia O.; Banzon, Eduardo; Bodart, Claude

doi:10.1016/j.socscimed.2005.11.047

Cited by 86 publications

(77 citation statements)

References 11 publications

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“…This has led to a complex triangle of coordination, responsibilities and governance. While the DOH provides services, formally supervises and at the same time receives reimbursements from PhilHealth, the LGUs also provide services, receive reimbursements from PhilHealth and are crucial in helping PhilHealth to achieve high coverage rates throughout the provinces [4,6]. …”

Section: Resultsmentioning

confidence: 99%

“…So far, there has been no process for systematic updating of the benefit package, and additional benefits have been included incrementally and on an ad hoc basis [32] with political influences or lobbying from particular stakeholders being important drivers in the development of the benefit package [4] and, despite some recent initiatives like the Tsekap, overall the package is not geared towards tackling the country’s burden of disease, improving health outcomes, responding to the needs of the population or enhancing financial risk protection [32]. …”

Section: Resultsmentioning

confidence: 99%

“…PhilHealth and all other government spending account for only about one-third of all health expenditures; thus public health expenditure stands at only 1.5% of GDP (compared to the Organisation for Economic Co-operation and Development [OECD] average of about 5.5% and Thailand at about 3.2%). While PhilHealth, as a single purchaser, could have had a more direct impact on service delivery, it has not yet flexed its muscles in pushing for more accountability, quality and price transparency [4]. It would substantially improve the corporation’s bargaining power and clout in defining quality and prices, were it to manage all the combined government funds.…”

Section: Discussionmentioning

confidence: 99%

“…A 2006 paper concluded that in many aspects PhilHealth could be seen as a successful and well-functioning organization, but a number of challenges remain [4]. …”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…A 2006 paper concluded that in many aspects PhilHealth could be seen as a successful and well-functioning organization, but a number of challenges remain [4]. …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Obermann

Jowett

Kwon

2018

Global Health Action

Self Cite

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“…Health insurance schemes undertake various initiatives to reach the vulnerable segments of the populations, such as discount cards, exemption schemes or free enrolment for vulnerable populations. For example, targeted policies of the National Health Insurance Program in the Philippines [32][33][34] and the Thai universal coverage scheme 34 increased the number of insured indigents and poor. In other countries, social inclusion is not achieved to the same extent, and in Cameroon, 35 …”

Section: Impact Of Health Insurancementioning

confidence: 99%

The impact of health insurance in Africa and Asia: a systematic review

Spaan¹,

Mathijssen²,

Tromp³

et al. 2012

Bull World Health Org

233

227

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Social health insurance reexamined

Wagstaff

2009

Health Economics

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Social health insurance (SHI) is enjoying something of a revival in parts of the developing world. Many countries that have in the past relied largely on tax finance (and out-of-pocket payments) have introduced SHI, or are thinking about doing so. And countries with SHI already in place are making vigorous efforts to extend coverage to the informal sector. Ironically, this revival is occurring at a time when the traditional SHI countries in Europe have either already reduced payroll financing in favor of general revenues, or are in the process of doing so. This paper examines how SHI fares in health-care delivery, revenue collection, covering the formal sector, and its impacts on the labor market. It argues that SHI does not necessarily deliver good quality care at a low cost, partly because of poor regulation of SHI purchasers. It suggests that the costs of collecting revenues can be substantial, even in the formal sector where non-enrollment and evasion are commonplace, and that while SHI can cover the formal sector and the poor relatively easily, it fares badly in terms of covering the non-poor informal sector workers until the economy has reached a high level of economic development. The paper also argues that SHI can have negative labor market effects.

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Social health insurance in a developing country: The case of the Philippines

Cited by 86 publications

References 11 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

The impact of health insurance in Africa and Asia: a systematic review

Social health insurance reexamined

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