The Philippines is considered as one of the Asian countries which boast a long history of social health insurance system. Former President Fidel V. Ramos signed into law the Republic Act No. 7875, otherwise known as the National Health Insurance Act of 1995, which aims to provide social health insurance coverage to all Filipinos. As compared to its predecessor, the Philippine Medical Care Act of 1969, the National Health Insurance Act offers a more responsive government healthcare program. One of the most salient provisions of the law is the establishment of the Philippine Health Insurance Corporation (PHIC) which is mandated to administer the health insurance program (hereinafter referred to as PhilHealth) of the country in the national and local levels. In keeping with the Kalusugang Pangkalahatan (Universal Healthcare) Program of the current administration, PhilHealth is envisioned to augment financial risk protection to the Filipino healthcare consumers. As its strategic thrusts, the program seeks to expand the enrollment by targeting the underprivileged and the indigents, reduce out-of-pocket spending from the poorer sections of society, and make healthcare services accessible to the public. However the implementation of the program has been time and again challenged by institutional problems and weaknesses.

On the weak poverty targeting policy

One of PhilHealth’s problems is its weak poverty targeting policy which, as an unlikely result, tends to favor the rich instead of the poor. A study (as cited in See, 2010) indicates that a large percentage of PhilHealth funds are going to the well-to-do families and a smaller portion are going to the underprivileged. The study discloses further that “P5.2 billion in PhilHealth reimbursements in 2003 went to the richest 20 per cent of beneficiaries, while only P1.4 billion went to the poorest income quintile.”

This brings to fore two of the program’s weaknesses: leakage and undercoverage. High percentage of leakage and undercoverage is a consequence of poor targeting poverty strategies and insurance coverage. Leakage and undercoverage take place when members are falsely categorized under a certain class (e.g. those who belong to the highest income quintile are classified as indigents). The problem may lie on poor evaluative measures used to assess every individual member as identifying the true poor in urban and rural areas can be difficult. Due to weak targeting policy, there is a high possibility that double enrollments in PhilHealth occur, adding up to the inequitable access to healthcare among the poor. Overtargeting can be as much problematic as double enrollments. In her policy note, Senior Research Fellow Rouselle Lavato writes that “[w]hile an increase in PhilHealth enrollment is laudable, the problem with overtargeting is that the program subsidizes those who can afford to pay.” These problems are made much worse by political interference in choosing beneficiaries and the prevalence of personal interests in the selection which deliberately exclude the needy and underprivileged in the process.

Because of these flaws, more and more people who rightfully deserve to be in the program are relegated to the sidelines. When PhilHealth’s thrust does not point anymore to those who need it the most, the health insurance program becomes pointless.  It is for this reason that the targeting poverty policy of the government should be strengthened to include those who should be highly enrolled in the program. Equitable access to health resources should guide the government in their pursuit to achieving a good targeting strategy. This is one of the keys to establish an effective enrollment system.

On the information and education drive

Though the government takes immense efforts to develop benefit packages for the poor, the efforts seem to be useless. The poorer section of the society is unaware of the benefit packages that allow people who have insufficient income to avail of free medical services such as sputum microscopy, complete blood count, breast examination, consultations on lifestyle medication, and visual screening, among others. Because most of them do not know that they can avail of these services for free, no one bothers to access these services. More often than not, the underprivileged are not enrolled in PhilHealth simply because they do not know the intricacies of the application process or the implementing rules of the program. For instance, they may not know that their parents who are 60 years old and above can be qualified as dependents. For those who are already enrolled, the problem lies on their unfamiliarity to the benefit coverage of their insurance. Given all these, it is important that the information dissemination efforts of the government should target those who are totally unaware of how the program works, especially those who have no Internet access. The education drive should be comprehensive enough to cover all the essential rules and points.

On the lack of health resources

Those who belong to the poorer segments of the society are left with no option but to avail of services which their pockets can afford. As such, they are more likely to visit a public health facility since the cost of public healthcare is relatively less costly compared to private healthcare. Former Health Secretary Alberto Romualdez captures the point: “The near-poor and the lower middle classes can become impoverished to meet out-of-pocket payments for health care. The very poor don’t even have pockets.” Unfortunately, there is scarcity when it comes to public healthcare services and facilities. The lack of medical practitioners and health facilities which cater to the poor is evident in the country’s healthcare system. The poor usually go to rural health units (RHUs) for treatment or advice but PhilHealth accreditation among the RHUs in the country is very rare.

One of the requisites for having a robust health insurance program is the availability of health facilities and services. The health insurance program is doomed to fail if services and facilities are lacking. Improving the enrollment system for PhilHealth and providing affordable and quality healthcare should be the government’s priority. These two should go side by side to achieve efficiency in national health insurance program.


The high probability of being not covered by health insurance among the poor underscores their lack of resource needed for survival (that is, healthcare). It reinforces powerlessness and increases their vulnerability to financial impacts of enormously expensive medical costs, unproductivity, and even mortality. It pushes them further down the social ladder. For those who are poor, health insurance serves as saving grace which can salvage them from the catastrophes of being medically-indebted. Since they experience absence of decent housing, nutritious food, sanitation, and other social safety nets, they are more likely the ones to be confined in a hospital and be susceptible to various diseases. Health insurance is a way of making healthcare affordable for them.

The government should regard the improvement of PhilHealth enrollment system a priority. When efforts are done with consistency, there is a greater chance to not miss targets. When those who need health insurance the most become enrollees, the health insurance program moves a step closer to its goal. If this is to be the government’s priority, the perils of exclusion from healthcare access among the poor will be minimized if not evaded in due time.

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