PhilHealth can save Philippine health care

It’s an undeniable fact that there are so many poor people in our country. Just imagine, we have an estimated 5.2 million families with a monthly income of P3,460 or less per family. That’s a total of around 25 million Filipinos living in extreme poverty. The second group of 4.1 million families has an average monthly income of between P3,406 and P6,073. This translates to another 20 million Filipinos in deep poverty.

For these 45 million Filipinos, what chance do they have of receiving any semblance of medical care in our country? Where will they find the resources to pay for the high cost of illnesses such as dengue, pneumonia, and heart attack?

Despite this seemingly hopeless situation, there is an institution that can potentially alleviate the health problems of our poor. Experts agree that there is light at the end of the tunnel. The solution lies in PhilHealth.

What Is Philhealth?

PhilHealth is the government’s health insurance system. On February 14, 1995, the Philippine government passed Republic Act 7875, otherwise known as National Health Insurance Act, to institute the National Health Insurance Program for all Filipinos. The law established the Philippine Health Insurance Corporation (PhilHealth) to be a government-owned and controlled corporation, to implement the country’s health insurance program.

The goals of PhilHealth are as follows: 1) to provide health insurance coverage for all Filipinos, 2) to ensure affordable and quality health care services, and 3) to manage its resources economically. If Filipinos will support and enroll in PhilHealth, our country may well be on its way to giving adequate healthcare to an estimated 50 percent of Filipinos living with meager incomes.

How Does It Work?

How can PhilHealth alleviate the health needs of the poor? Simply put, PhilHealth acts like a collective bank, where its members pay an annual fee (called premium) of P1,200 a year. With this money at hand, PhilHealth can then pay a substantial portion of the medical expense of its sick members.

What if many people get sick, will PhilHealth go bankrupt? Probably not. Studies show that, on the average, only one member in every three families will get sick within a year’s time. Therefore, if we all enroll in PhilHealth (putting our P1,200 or, in some cases, P2,400 yearly) then we will actually be giving the government enough resources to pay for the medical expenses of those members who do get sick.

There is one loophole, however. For this national health insurance scheme to work, we should encourage everyone, including the young, the healthy, and the rich, to enroll in PhilHealth.

As one can probably deduce, at the heart of PhilHealth is the noble goal for the richer and healthier members of the population to subsidize the poorer and sicker members. In a Christian-like way, the rich members help the poorer members, the young take care of the old, and the healthy assist the sick.

This is the essence of the PhilHealth logo, which shows two individuals with arms reaching out to each other. This symbolizes the rich helping the poor, the healthy helping the sick, and the young helping the elderly. The logo also forms the letters N, H, and I, which stands for National Health Insurance.

Philhealth Protects Your Family

Since PhilHealth is a government institution, its mandate is primarily to assist its members and not to earn money. As such, you will notice that many of PhilHealth’s policies are geared towards benefiting its members.

First, compared to other health insurance schemes, PhilHealth is very affordable, costing only P1,200 per family per year (this premium is for families earning less than P25,000 a month). In return for this investment, PhilHealth can deduct an average of P20,000 from its member’s hospital expense

Second, PhilHealth gives insurance coverage for the whole family, even an extended family. In fact, PhilHealth covers the parents of its members who are 60 years old and above. And believe it or not, PhilHealth will even pay for the medical care of an illegitimate child. All in all, a member’s family is entitled to 45 accumulated days of hospital stay per year.

Third, PhilHealth assures the quality of its doctors (called service providers) and hospitals, through a strict accreditation system.

Other reasons to support PhilHealth are the increasing changes within PhilHealth to expand its services, which will later include out-patient consultations, and coverage for catastrophic illnesses like a heart attack or a stroke.

These benefits are still in the pipeline, but with the strong leadership of President Benigno Aquino, with Health Secretary Enrique Ona, and PhilHealth president Dr. Rey Aquino, these momentous changes are now closer to becoming a reality.

Challenges Ahead

Just like any corporation, there are issues facing PhilHealth, like problems with late payment to doctors and hospitals. A better information system (already in the works) can hopefully reduce these obstacles.

Where are we now? At present, PhilHealth, based on some estimates, covers 56 percent of the population (studies say that the number is between 38 and 87 percent). If we want PhilHealth to succeed, we need to enroll more members, especially the informal sector, like small business owners, market vendors, drivers, and kasambahays (domestic helpers).

In addition, local government units, corporations, and employers are highly encouraged to enroll their constituents and employees in PhilHealth. This is to ensure that the members and their families will get some medical care if they need it. Perhaps, the next stage for foundations, like Gawad Kalinga, is to raise funds and add PhilHealth coverage to their beneficiaries.

Finally, you may ask: Can PhilHealth achieve its goals? With hard work and prayers, it can. For starters, PhilHealth currently has a reserve fund of P100 billion. But despite this amount, the money needed to care for the health of 90 million Filipinos is staggering and will reach trillions. Hence, PhilHealth still needs our support.

Indeed, the road to healthcare recovery is clear: Enrolling everyone in PhilHealth is the right strategy to answer the health needs of all Filipinos. –Willie T. Ong, MD (The Philippine Star)