Analyzing Outpatient Care in the Philippines: Evidence from Social Health Insurance Data

This report estimated the utilization of outpatient benefits from the Philippine Health Insurance Corporation and examined variations across local governments. Utilization patterns were analyzed based on key socio-demographic and economic characteristics to better understand healthcare inequalities. The findings reveal several key insights. First, outpatient utilization rates exhibit significant geographic variation, with disparities reaching up to fivefold, indicating persistent inequities in access to care. Second, about 70 percent of outpatient claims are attributed to kidney-related conditions, largely driven by the rapid expansion of hemodialysis benefits in recent years. Third, regarding Konsulta, the comprehensive primary care benefit package under the UHC Law has registered participation from only about a quarter of the population, with fewer than 2 percent profiled through a First Patient Encounter. These results highlight critical inefficiencies and inequities in the delivery of outpatient services and the need for policy reforms to strengthen outpatient and primary healthcare to improve overall health system performance. Comments to this paper are welcome within 60 days from the date of posting. Email publications@pids.gov.ph.