Health Insurance scenario in Philippines

1. Healthcare System of Philippines
Presented by-
Dr.Bhamini Thukral

2. Healthcare Governance structure
 A decentralized health delivery system
 DOH-apex regulatory authority
 Develop national plans, technical standards
and healthcare guidelines for all Filipinos.
 LGUs and Private sector agencies-act as
adjuncts
 CHDs (Centers for Health Department)
 RHUs (Rural Health Units)-exist in every
municipality to improve access to healthcare

3. Pyramidal organization structure for the
three levels of healthcare
National
Health Services Tertiary care
Regional Health Services
Secondary care
District Health Services
Rural(Local
Hospital)Services
Primary care
RHUs
Barangay Health Stations

4. Primary level of healthcare
 Serves as the foundation of healthcare based
upon which progressive levels of care are
restructured.
 Function of primary health workers at 3
levels:-
a)Village or grass root health worker
b)Intermediate level health worker
c)First line hospital personnel

5. Health outcomes
 In a state of double disease burden
 Communicable diseases are the major causes
of morbidity and mortality in Philippines.
Morbidity rate in communicable diseases-42.8
/100,000 population(2009)
 Morbidity Rate in Non Communicable
Diseases-90.4/100,000 population.(2009)
 Maternal mortality rate(MMR)-94
deaths/100,000 live births(2009)
 Unlikely for Philippines to accomplish targets
for 2015 MDG

6. Healthcare budget
 Low efficiency in health spending.
 Health expenditure- 3.8% of GDP
 Tax funding system adopted by Department of
Finance and Internal Revenue Allotment in
case of Local Governments.
 three major groups of healthcare payers: (i)
national and local governments, (ii) social
health insurance, (iii) private sources.

7. Health expenditure outlay
Private
Expenditure Government
59.1% Expenditure
28.7%
Out Of Social
Pocket Insurance
Expenditure Expenditure
48.4% 11.0%

8. Health Insurance Sector
 National Health Insurance Programme (NHIP)
 Philippine Health Insurance Corporation,
commonly known as PhilHealth which
administers the NHIP
 The types of Healthcare/Health Insurance
plans in Philippines-(a) PhilHealth (b)Private
health insurance
(c)Health Maintenance Organization (d)
International health insurance (e) Expatriate
health insurance
 Microhealthinsurance –MIPSS

9. Health improvement plans
 SHIELD (Sustainable Health Improvement
through Empowerment and Local
Development) project in ARMM –Philippine
government’s Sector development agenda for
health, USAID funded-5 year project
 Integrated Community Health Services Project
(ICHSP) and the National Centre for Health
Facility Development (NCHFD)- to strengthen
referral system , enhance local planning,
decision making and monitoring.

10. Key Challenges in healthcare
 prevailing conditions of inequity in health
status
 poor infrastructure in the healthcare sector
which needs to be worked upon to attract
more tourists
 lack of IT governance structures
 diseases emerging new communicable
diseases adding to the existent prevalence of
communicable
 common solitary governing body is required to
be set up to coordinate activities of human
resources
 wide gap between the rich and the poor in

11. Inter- sectoral linkage