The Philippine Health Insurance Corporation is a government-owned and controlled body responsible for providing health insurance coverage to Filipinos. It is mandated to make healthcare accessible and affordable. This role was emphasized in the Department of Health’s campaign for Universal Health Care or Kalusugan Pangkalahatan, comprised of sustained health financing, responsive health system, and better health outcomes. To pursue its mandate, Philhealth introduced reforms in the payment system and expanded benefit packages, among others.
Philhealth continuously faces pressure from growing membership, rising benefit payments, and issues of fraudulent claims. The expansion in the number of poor and near-poor members, as well as the inclusion of senior citizens through the Sponsored Program come with an increase in the coverage rate, as well as utilization. Philhealth’s Actuarial Valuation Report 2014 presents the factors related to fund generation and resource depletion, and scenarios on the Agency’s future financial standing. This paper discusses the reforms in Philhealth’s benefit and premium collection systems. Likewise, it tackles implications of the assumptions made in the report, while showing challenges and possible directions. >>read complete document