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

Author

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  • Obermann, Konrad
  • Jowett, Matthew R.
  • Alcantara, Maria Ofelia O.
  • Banzon, Eduardo P.
  • Bodart, Claude

Abstract

Very little is known about the Philippine health care system, and in particular its experience with social health insurance (SHI). Having initiated an SHI programme 35 years ago, the Philippines hold many lessons for the development of such schemes in other low and middle-income countries. We analyse the challenges currently facing PhilHealth, the national health insurer. PhilHealth was formed in 1995 as a successor to the Medicare programme and was given a mandate to achieve universal coverage by 2010. To date, PhilHealth has been quite successful in some areas (e.g. enrolment), but lags behind in others (e.g. quality and price control). We conclude that SHI in the Philippines has been a success story so far and provides lessons for countries in a similar situation. For example: (i) SHI is based on value decisions and the clear statement of societal goals can give guidance in the technical execution, (ii) SHI is a financing institution and needs to be treated accordingly, (iii) SHI can be implemented independently of the current economic situation and might actually contribute to economic development, (iv) community-based health care financing schemes should be merged with the national SHI in the long run, and (v) there is a strong need to push for high quality care and improved physical access. No clear suggestions can be given with respect to the benefit catalogue and the balance between economies of scale and decentralisation. Although riddled with many inadequacies, PhilHealth was set up as a strong and largely politically independent institution for the development of SHI. SHI can act as a stabilizing institution in a politically and economically volatile environment.

Suggested Citation

  • Obermann, Konrad & Jowett, Matthew R. & Alcantara, Maria Ofelia O. & Banzon, Eduardo P. & Bodart, Claude, 2006. "Social health insurance in a developing country: The case of the Philippines," Social Science & Medicine, Elsevier, vol. 62(12), pages 3177-3185, June.
  • Handle: RePEc:eee:socmed:v:62:y:2006:i:12:p:3177-3185
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    References listed on IDEAS

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    Cited by:

    1. Adam Wagstaff, 2010. "Social health insurance reexamined," Health Economics, John Wiley & Sons, Ltd., vol. 19(5), pages 503-517.
    2. Flores, Gabriela & O’Donnell, Owen, 2016. "Catastrophic medical expenditure risk," Journal of Health Economics, Elsevier, vol. 46(C), pages 1-15.
    3. Clouston, Sean A.P. & Quesnel-Vallée, Amélie, 2012. "The role of defamilialization in the relationship between partnership and self-rated health: A cross-national comparison of Canada and the United States," Social Science & Medicine, Elsevier, vol. 75(8), pages 1342-1350.
    4. Liu, Jun-Qiang, 2011. "Dynamics of social health insurance development: Examining the determinants of Chinese basic health insurance coverage with panel data," Social Science & Medicine, Elsevier, vol. 73(4), pages 550-558, August.
    5. Wagstaff, Adam, 2007. "Health insurance for the poor : initial impacts of Vietnam's health care fund for the poor," Policy Research Working Paper Series 4134, The World Bank.
    6. Wagstaff, Adam & Lindelow, Magnus & Jun, Gao & Ling, Xu & Juncheng, Qian, 2009. "Extending health insurance to the rural population: An impact evaluation of China's new cooperative medical scheme," Journal of Health Economics, Elsevier, vol. 28(1), pages 1-19, January.
    7. Hou, Xiaohui & Chao, Shiyan, 2011. "Targeted or untargeted? The initial assessment of a targeted health insurance program for the poor in Georgia," Health Policy, Elsevier, vol. 102(2), pages 278-285.
    8. Wagstaff, Adam & Nguyen, Ha Thi Hong & Dao, Huyen & Balesd, Sarah, 2014. "Encouraging health insurance for the informal sector : a cluster randomized trial," Policy Research Working Paper Series 6910, The World Bank.
    9. Van de Poel, Ellen & Van Doorslaer, Eddy & O’Donnell, Owen, 2012. "Measurement of inequity in health care with heterogeneous response of use to need," Journal of Health Economics, Elsevier, vol. 31(4), pages 676-689.
    10. Silfverberg, Denise Valerie, 2015. "Analysis of the Philippine Health Insurance Corporation's Individually Paying Program and Employed Program," Philippine Journal of Development PJD 2013 Vol. 40 Nos. 1-2, Philippine Institute for Development Studies.
    11. Garcia-Diaz, Rocio & Sosa-Rub, Sandra G., 2011. "Analysis of the distributional impact of out-of-pocket health payments: Evidence from a public health insurance program for the poor in Mexico," Journal of Health Economics, Elsevier, vol. 30(4), pages 707-718, July.
    12. Annear, Peter Leslie & Bigdeli, Maryam & Jacobs, Bart, 2011. "A functional model for monitoring equity and effectiveness in purchasing health insurance premiums for the poor: Evidence from Cambodia and the Lao PDR," Health Policy, Elsevier, vol. 102(2), pages 295-303.
    13. Solon, Orville & Peabody, John W. & Woo, Kimberly & Quimbo, Stella A. & Florentino, Jhiedon & Shimkhada, Riti, 2009. "An evaluation of the cost-effectiveness of policy navigators to improve access to care for the poor in the Philippines," Health Policy, Elsevier, vol. 92(1), pages 89-95, September.
    14. Kozhimannil, Katy Backes & Valera, Madeleine R. & Adams, Alyce S. & Ross-Degnan, Dennis, 2009. "The population-level impacts of a national health insurance program and franchise midwife clinics on achievement of prenatal and delivery care standards in the Philippines," Health Policy, Elsevier, vol. 92(1), pages 55-64, September.
    15. Konrad Obermann & Matthew Jowett & Juanito Taleon & Melinda Mercado, 2008. "Lessons for health care reform from the less developed world: the case of the Philippines," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 9(4), pages 343-349, November.
    16. Caballes, Alvin B. & Söllner, Walter & Nañagas, Juan, 2012. "Financial protection mechanisms for inpatients at selected Philippine hospitals," Social Science & Medicine, Elsevier, vol. 75(10), pages 1820-1827.
    17. Omar Galárraga & Sandra Sosa-Rubí & Aarón Salinas-Rodríguez & Sergio Sesma-Vázquez, 2010. "Health insurance for the poor: impact on catastrophic and out-of-pocket health expenditures in Mexico," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(5), pages 437-447, October.
    18. Cabalfin, Michael R., 2016. "Health Financing for the Poor in the Philippines: Final Report," Discussion Papers DP 2016-37, Philippine Institute for Development Studies.
    19. McBain, Florence, 2014. "Health insurance and health environment: India’s subsidized health insurance in a context of limited water and sanitation services," Working Papers 179200, University of Bonn, Center for Development Research (ZEF).

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