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Health Financing for the Poor in the Philippines: Final Report

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  • Cabalfin, Michael R.

Abstract

Indigent membership in PhilHealth has surged in recent years, driven by the nation-wide identification of the poor. However, the massive identification has led to the enrollment of more members than official poverty estimates, resulting in leakages in the government's social health insurance subsidy. The massive enrollment has been facilitated by the incremental revenues from the revised sin tax law. Subsidy for the poor now comprises over a third of the national health insurance fund, effectively subsidizing health-care services for other members, especially the informal sector. Hospitals also enroll the poor as well as the near poor in PhilHealth at point of care and may oversubscribe the poor given the higher reimbursement relative to the premium subsidy. The poor are covered by a No Balance Billing policy in which they are not liable to pay hospital fees over the case rate. Despite this, close to half of the poor still incur out-of-pocket expenses, especially for medication. Close to three-fourths of the poor are also covered by the Primary Care Benefit 2 Package, which pays for outpatient medicines for certain illnesses to prevent catastrophic conditions. Finally, close to 1 percent of the benefits for the poor is estimated to fall under the Z benefit package, which subsidizes catastrophic illnesses.

Suggested Citation

  • Cabalfin, Michael R., 2016. "Health Financing for the Poor in the Philippines: Final Report," Discussion Papers DP 2016-37, Philippine Institute for Development Studies.
  • Handle: RePEc:phd:dpaper:dp_2016-37
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    File URL: https://www.pids.gov.ph/publication/discussion-papers/health-financing-for-the-poor-in-the-philippines-final-report
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    References listed on IDEAS

    as
    1. 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.
    2. Dalmacion, Godofreda & Juban, Noel R. & Zordilla, Zenith, 2014. "Reconnaissance Study on the Implementation of Case-Based Payments," Discussion Papers DP 2014-42, Philippine Institute for Development Studies.
    3. Manasan, Rosario G., 2011. "Expanding Social Health Insurance Coverage: New Issues and Challenges," Discussion Papers DP 2011-21, Philippine Institute for Development Studies.
    4. Silfverberg, Raymunda R., 2014. "The Sponsored Program of the Philippine National Health Insurance - Analyses of the Actual Coverage and Variations Across Regions and Provinces," Discussion Papers DP 2014-19, Philippine Institute for Development Studies.
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    More about this item

    Keywords

    Philippines; poverty; PhilHealth; social protection; health insurance; health-care services; Primary Care Benefit 2 Package; No Balance Billing; sin tax law; vin;
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