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5/5/2015
Preparing the Health System
Financing for ASEAN Integration
Philippine Health Insurance Corporation
Health Financing 101
Revenue
Collection
Pooling
Sustainable
“Bayanihan” or Social
Solidarity
NOW! Time of
economic growth
Size of pool vs.
admin cost vs. cross
subsidy potential
General tax revenue
to subsidize the poor
Single Fund & Equity
Strategic
Purchasing
Pilipino (100M)
Product
Provider
Price volume deal
through contracting
Source: Gottret and Schieber, Health Financing Revisited, World Bank 2006
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5/5/2015
Steady Wins
and Challenges
For UHC, we talk about…
1
Increasing financing for health care
2
Using demand side approach through
health insurance
Increased budget (including sin tax revenues)
Increased private spending through premium
Resolving who the poor are / Capturing the missing middle
Performance-based financing
3
Ensuring supply side improvements
Health Facility Enhancement Program
Income retention/ fiscal autonomy especially for LGU hospitals
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5/5/2015
We
have begun
toto
walk
the
Government
is willing
spend
fortalk…
health
Health Sector Allocation (PhP billions)
Source: DBM
We have begun to walk the talk…
National Health Insurance Coverage
100
87
80
60
40
20
0
2010
2011
2012
2013
2014
Source: CorPlan, PHIC
8 out of 10 Filipinos are already covered by the NHIP.
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5/5/2015
We have begun to walk the talk…
Benefit Payments (in billions)
Source: CorPlan, PHIC
PhilHealth pays out an average of 1.5 billion per week in benefit
payments.
Barriers to Beat
1. Health expenditure remains low – the Philippines
remain as a low spender on health compared to other
regional and middle income economies.
2. Out of pocket spending is still high – the rising cost of
health care services largely contributes to the growing OOP
spending.
3. Poverty incidence has not caught up with overall
improvements – the country’s poverty rate remained one
of the highest in the region despite the decent economic
growth.
4. Recurrent shocks from climate change are highly
expected – climate hazards are becoming a constant threat
to the social and environmental determinants of health.
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2015-2016
Strategic Directions
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5/5/2015
Advancing SHI Reforms
• Mobilize more resources – increasing PhilHealth
coverage, improve collection efficiency; increase payroll
contribution; strengthen actuarial reviews
87
%
Informal Sector Workers
Poor not covered in the NHTS
Indigenous People
Rich
* Coverage as of December 2014
Advancing SHI Reforms
• Increase spending on preventive and health
promoting interventions - expanding primary care
services for all; increase utilization; reduce out-of-pocket
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5/5/2015
Advancing SHI Reforms
• Scale-up provider payment reforms - improve
costing of case rates; no-balance billing; fixed
co-pay; move towards diagnosis-related
groupings (DRGs)
• Leveling the platform for contracting public
and private providers - expand provider
network; income retention in public hospitals
6 Building Blocks for a
Functional Health System
Leadership
and
Governance
Health
Workforce
Health Service
Delivery
Health
Information
System
Access to
Medicines and
Technologies
Health
Financing
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5/5/2015
A Few Points
 Financing reforms cannot be done without taking
into account the other building blocks.
 Health provider autonomy & flexibility is
important to support financing reforms.
 Provider autonomy and support for reforms take
time.
www.philhealth.gov.ph
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