PhilHealth: Ensuring healthcare financing

This refers to the news item titled “Group laments poor state of healthcare in PH,” more specifically the part subtitled “PhilHealth ineffective” (News, 7/25/14).

We agree with Dr. Ernesto Domingo: Everyone should be enrolled in the National Health Insurance Program (NHIP). Anchored on the basic principle of social solidarity to ensure that all Filipinos are provided with health insurance coverage and are able to avail themselves of quality healthcare services, the NHIP advocates risk-sharing and pooling of resources for the benefit of all Filipinos. It is on this basic principle that the NHIP has been implemented over the last 19 years.

As in most progressive countries, the Philippines’ social health insurance program is a mix of tax-based and premium-based approaches to ensure sustainability. The tax-based component is the legislated appropriation of a significant portion of sin taxes for the annual premium contribution of the poorest segment of society. Where before, the premium contribution of poor families was jointly shouldered by the national government and local government units (LGUs), now it is wholly shouldered by the former.

The LGUs, on the other hand, pay for the annual premium contribution of the “near poor” in their communities to make sure that no one is left behind as far as access to quality healthcare is concerned. This move by the national government contributed to the phenomenal increase in the number of less privileged families enrolled in the NHIP—from 5.2 million in 2013 to 14.7 million in 2014.

On the other hand, the premium-based component is where the social solidarity concept comes to life, with the rich subsidizing the poor, and the healthy subsidizing the sick. This is made even more pronounced with the enactment of Republic Act No. 10606 (the National Health Insurance Act of 2013) which provides for mandatory coverage for all Filipinos.

PhilHealth takes its role in ensuring healthcare financing under the Universal Health Care (UHC) seriously. Our most important step toward making sure that even those who are not yet enrolled with the NHIP are able to avail themselves of healthcare benefits is the Point-of-Care enrollment scheme which is now being practiced in government hospitals. Less privileged patients are assessed by the hospital’s social welfare office; if validated to be indigent indeed, they are automatically enrolled, with the hospital sponsoring their annual premium contributions for a year.

To date, our membership counts 82 percent of the entire Philippine population, and we are proud to say that we have already instituted measures at the point-of-service level to assist our members with their PhilHealth concerns. Our PhilHealth Customer Assistance, Relations and Empowerment Staff (or Cares) have become valuable extra hands for our members in the hospitals.

We have also institutionalized the use of the Health Care Institution Portal in our accredited hospitals where our members can readily check on their benefits eligibility. These and other initiatives are designed to make the PhilHealth experience truly convenient for our members.

We hope we have adequately addressed Domingo’s concern.
—ISRAEL FRANCIS A. PARGAS, MD,

OIC-vice president,

Corporate Affairs Group,

Philippine Health Insurance Corp.