PhilHealth Reforms to Ensure Fund Sustainability

THE President and Chief Executive Officer of the Philippine Health Insurance Corporation (PhilHealth) Alexander A. Padilla today assured the public that the National Health Insurance Program (NHIP) fund remains stable and that it is able to fully pay for the benefit claims of its members.

In 2015, the PhilHealth paid PhP 97B, up from P77B the year before. The Sin Tax Funds has allowed PhilHealth membership coverage to expand benefits to the poor and the senior citizens. Republic Act 10645 or the amendment to the Senior Citizens Act enabled the universal enrolment of senior citizens and specifies that “funds necessary to ensure the enrollment of all senior citizens not currently covered by any existing category shall be sourced from the National Health Insurance Fund of PhilHealth from proceeds of Republic Act No. 10351, otherwise known as the Sin Tax law.”

To date, the NHIP has provided coverage to 93 million members and dependents, representing 92 percent of the projected 2015 population of about 101 million.

Padilla however said that while premium collections in 2015 reached PhP 96B, there is still a need to improve the consistency of payments by the different member-sectors. Collections had increased starting in 2013, when the National Government started paying the premiums of poor Filipinos under the National Household Targeting System as a result of additional revenues from Sin Taxes.

Padilla is cognizant that like any corporation, PhilHealth needs to continuously look at ways to improve operational efficiencies in collection, claims processing and benefit development. For instance, it has developed a strategic, operational analysis and reporting tool which provides real-time information on membership coverage, claims and collections. It is hopeful that this tool, as well as new policies and parameters on benefits, will help address some major problems. Furthermore, as PhilHealth is a social health insurance, wherein membership is assured without any pre-conditions, it must now be more discerning of the health care providers it will entrust with the care of the millions of Filipinos who depend on PhilHealth for health security.

It has also enhanced its information technology (IT) systems, introduced steps to ease member registration and employer remittance processes, and espoused anti-red tape initiatives particularly in the frontline offices. It has also strengthened its fraud prevention and control mechanisms such as filing the appropriate cases, imposing fines and penalties to erring health care professionals and institutions to protect the health insurance funds.

Padilla also issued an appeal to the sense of social solidarity from the members who earn more. He also appealed to companies to regularly remit the proper premiums to PhilHealth. The Philippines has the lowest social health insurance premium rates in Asia and the last time these rates were increased, particularly in the employed sector, was about two (2) years ago. Despite the status quo in premium contribution rates, PhilHealth has expanded its case rates to cover over 4,000 medical conditions and surgical procedures, and introduced at least 13 Z Benefit Packages to provide financial risk protection for members coping with illnesses requiring prolonged treatment and management.

He also asked the public to report fraud and anomalies and to refrain from allowing themselves to be made part of any fraudulent or abusive practices, to help protect the fund. “The PhilHealth fund is ours to share during the time when health problems arise. We need to ensure that no one takes advantage and commits fraud, because doing so would deprive another member of his right to health,” Padilla said.

The PhilHealth Chief also bared the results of the PhilHealth module from a recent nationwide survey conducted by a reputable survey firm which showed that net public satisfaction on the support and protection that PhilHealth provides to its members and dependents was at +80 as of 4th Quarter 2015.

The same survey also showed that public awareness on the different benefit packages that PhilHealth provides increased from 2014 figures. These packages included maternity care which increased from 64% in 2014 to 71% in 2015; inpatient services from 61% to 64%; newborn care from 52% to 56%; TB-DOTS from 36% to 45%; outpatient packages from 39% to 43%; Z benefits from 34% to 37%; malaria from 35% to 37%; and HIV/AIDS package from 25% to 30%. Also included in the upward trend was the public’s awareness level on the No Balance Billing (NBB) policy which rose from 43% in 2014 to 55% in 2015.

(Sgd.) ALEXANDER A. PADILLA
President and CEO