Founded on February 14, 1995 under RA 7875 or the National Health Insurance Act (NHI), the law creating the Philippine Health Insurance Corp. promised to provide financial access to quality health care services through a social health insurance program.
As such, it was mandated to collect fees initially from members, and later expanded to all including indigents and elderly.
Through the years, its collections were used partly by members to defray part of their hospital bills, medicines and medical procedures, which, however, was drastically reduced to procedures that used the operating room. Forget about room rates and medicines and doctor’s fees.
Those benefits were given only during the first few years of the law.
And just recently, the unused funds of PhilHealth are being diverted to some other uses, which prompted lawmakers to holler against such diversion because people are more in need now of insurance for healthcare services.
As the Philippine Star wrote three days ago: “There has been much hue and cry over the Philhealth’s transfer of P89.9 billion to the National Treasury and no amount of explanation or justification could get the attention and understanding of the public.”
Current realities showed that out of pocket spending of Filipinos nationwide grew by double digit to 17 percent, the fastest growth since 2014, data from the Philippine Statistics Authority showed.
PSA data cited by Business Mirror showed out of pocket house expenses expanding at P593.087 billion in 2023 faster than the 11.3 percent growth of household final consumption expenditure (HFCE) in current prices while out of pocket accounted for 3.2 percent of the P18.61 trillion HFCE.
“These include the following—medicines, food supplements, curative and rehabilitative services, dental care, immunization services, diagnostic services, and other medical goods and services,” the PSA explained.
The PSA noted that the Household out-of-pocket payment had the highest contribution among the health care financing schemes in 2023, with a 44.4-percent share to the total Current Health Expenditure (CHE).
This was followed by government schemes and compulsory contributory health care financing schemes with 42.6 percent share; and Voluntary health care payment schemes with 13 percent.
Health expenses
The country’s Total Health Expenditure (THE), at current prices, amounted to P1.44 trillion in 2023, an increase of 17 percent from the P1.23-trillion expenditure in 2022.
It accounted for a 5.9-percent share of the Gross Domestic Product in 2023.
The CHE contributed 86.3 percent to total health expenditure, while the Health Capital Formation Expenditure (HK) shared 13.7 percent in 2023.
PSA said both CHE and HK recorded increases of 9.2 percent and 113.6 percent, respectively.
On a per capita basis, health spending went up to P11,083 in 2023, an increase of 8.3 percent from the P10,238 expense in 2022, Business Mirror noted.
A study on health expenditure last year by government think tank, Philippine Institute for Development Studies, said out-of-pocket health costs remain a significant expense among households and are “expected to increase for the entire population” in the coming years.
The poor spends more
The PIDS said the elderly, women, rural folks and indigent Filipinos are the ones more likely to be forced to fork out out-of-pocket health expenses since the government does not cover all hospital costs.
The PIDS study examined the financial risk protection of Philippine Health Insurance Corporation (PhilHealth) members and dependents and found that PhilHealth members still pay out-of-pocket because the National Health Insurance Program covers only 40 percent or lower hospital costs.
These costs are also expected to increase in the coming years.
The study computed the “support value” or the percentage of hospital care cost shouldered by PhilHealth using 2018-2021 PhilHealth data along with auxiliary datasets from the Department of Health (DOH), Philippine Statistics Authority, and the Washington-based Institute for Health Metrics and Evaluation.
The average support value is 55.83 percent in the Philippines. But the percentage varies based on PhilHealth membership type, socioeconomic status, patient accommodation, disease classification, hospital ownership and level and location.
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