PhilHealth is a government social insurance system, which aims to provide quality and affordable medical care for all Filipinos. It is increasingly being seen as the hope for the poor and sick Filipinos. This government health insurance scheme (previously Medicare) enlists the employed sectors of society and portions of the unemployed sector.
In a nutshell, the reason behind this social insurance is for the richer and healthier members to subsidize and help the poorer and sicker members. In an idealistic way, the rich helps the poor, the young takes care of the old, and the healthy assists the sick.
With the help of Health Secretary Dr. Enrique Ona, President Noynoy Aquino’s goal is for PhilHealth to provide coverage for all Filipinos. There are six top reasons why all of us should pay our dues and enroll in PhilHealth:
1. PhilHealth is pro-Filipino. Our Constitution states that health is a right of all Filipinos. Therefore, the government should ensure that majority, if not all, Filipinos can enjoy medical services at a low cost. The government can do this through PhilHealth. By paying for in-patient care, PhilHealth can assist in improving our health status.
The Individually Paying Program (IPP) provides a wider coverage for everyone interested in getting PhilHealth insurance. With IPP, a broad segment of the population is encouraged to avail itself of PhilHealth. These include the self-employed, the small entrepreneurs, jeepney drivers, cigarette vendors, household helpers, and overseas Filipino Workers.
2. PhilHealth is affordable: For a premium as low as P100 a month or P300 every three months, you are entitled to in-patient hospital care services of around P15,000 to P20,000 per hospitalization. Many diseases are covered by PhilHealth, including normal birth deliveries, surgeries, cataract operations, newborn care, and practically all kinds of hospitalization.
3. PhilHealth covers your whole family. If the head of the family gets enrolled in PhilHealth, the whole family is automatically covered by the health insurance. The coverage would include the spouse, all legitimate and illegitimate children below 21, and parents over 60 years of age. The main enrollee would get a maximum of 45 days coverage for in-patient care and the dependents can get another 45 days, which is shared between them.
4. PhilHealth is pro-poor: Unlike the Health Maintenance Organization, PhilHealth is pro-poor. Why is this so? The difference lies in the patient selection of these two organizations. The HMO adjusts your premium based on your risk of being sick. Therefore, the elderly and those with lots of illnesses (such as diabetes) will be charged a very high premium while the young and healthy persons will be charged a lower premium. Hence, those at higher risk of becoming sick (mostly the poor) will find it difficult to get insured because of the high premiums while the healthy (mostly the financially secure) can get insured. Thus, we see how the HMOs are selecting and insuring those patients they are “betting” will not get sick. Needless to say, you cannot get free insurance from any HMOs. PhilHealth, on the other hand, is pro-poor and will accept any Filipino even those in the throes of death. Instead of making you pay based on your risk, PhilHealth adjusts your premium based on your income. Therefore, the poor with less income will pay less premium (and get more benefits) while the middle and upper classes will pay a comparatively larger premium. Hence, we see how the PhilHealth system is pro-poor. In addition, the indigent can also avail themselves of the Sponsored Program where the national government and the LGU will share the cost of PhilHealth coverage. Indeed, this is charity at its best.
5. PhilHealth assures quality. Through its accreditation program which includes accrediting hospitals, health providers (doctors, nurses and midwives) and laboratories, PhilHealth ensures that the medical care given by the facility will be of high quality.
6. PhilHealth is supported by experience from other countries. Studies have shown that social health insurance can improve the health status of a nation. We see how Canada, with its national heath insurance, enjoys a superior health status the world over. Many developing countries have also used some variation of social health insurance for their health needs.
On the opposite side of the coin, there are, of course, some challenges facing PhilHealth. These are the need to 1) increase their health package, 2) expand to out-patient care, and 3) increase people’s awareness on PhilHealth’s benefits.
Despite these problems, PhilHealth is the trend and our hope for the future. PhilHealth, based on some estimates, covers 56 percent of the population. (Studies say that the number is between 38 and 87 percent.) One way to ensure the success of PhilHealth is to get more members, especially from the informal sector.
Some forward-looking companies like GlaxoSmithKline Philippines and George Ty (GT) Foundation have sponsored thousands of indigent patients already. As a gift to our household help and drivers, we can also pay for their PhilHealth coverage for a year.
Our medical and economic experts agree PhilHealth is the best way for the country to care for the health of its people. Let us give our full support to PhilHealth and get insured. If we do this, we will not only be helping the poor in our country, we may well be saving our own lives, too.