Only 63% of Pinoys got PhilHealth assistance in 2018, says study

by Jovic Yee, Philippine Daily Inquirer, Jun 27, 2019

MANILA, Philippines — Despite claims by Philippine Health Insurance Corp. (PhilHealth) that it already provides near universal health coverage, still two-thirds of Filipinos spent their own money just to cover all their medical needs, according to a survey by a health care provider.

A Wellness Index study by PhilCare released on Wednesday said this was a financial burden to families as nearly 38 percent used their savings for hospital bills, while another 25 percent had to seek help from other people.

The study interviewed 1,350 heads of households nationwide and had a margin of error of plus or minus 3 percent.

Nineteen percent of the respondents said a family member was hospitalized last year and that of those hospitalized, only 63 percent were able to rely on PhilHealth to augment their hospitalization expenses last year.

PhilHealth has said that 98 percent of 104.5 million Filipinos in 2018 were enrolled and entitled to various medical and health care packages from the state-run company.

Lack of information

According to PhilCare lead researcher Fernando Paragas, the disparity between those covered by PhilHealth and those who were able to avail themselves of the company’s benefits may be due to a “lack of information” among the public on what they are entitled to receive from the state insurer.

“When you’re in the hospital, there’s already a lot going through your mind. There’s a need to clarify what can be charged [to PhilHealth]; what should be the process when you’re in the hospital; where you should go. That should be automatic, but obviously, it’s not,” Paragas said.

PhilHealth’s own data showed that in 2018, the company’s support value dropped to 42 percent from 55 percent in the previous year. This meant that during the same period the patients’ out-of-pocket expenses grew from 45 percent to 58 percent.

Paragas said most of those who did not receive PhilHealth benefits were forced to shell out at least P30,000, or the equivalent of a month’s salary.

He added that only 15 percent of those who paid for their hospitalization were covered by a health maintenance organization.

Vicious cycle

In the study, which sought to determine the level of perceived health and wellness of Filipinos, the respondents described their overall state of well-being as “somewhat good.”

Paragas said that the result might have been affected by the people’s concerns on whether they could afford to get sick.

He noted that 40 percent of the respondents said they were unsure if they could afford to pay their hospital bills, while 35 percent were uncertain if they could spend for regular medical checkups.

“It’s a vicious cycle. That’s why you can’t really say that you have a good overall health and well-being because you have this worry that if someone [in your family] gets sick, you don’t have the resources to pay for the hospital needs,” he said.

Solution? Wage hike

To help relieve this financial burden, Paragas suggested a salary increase for workers, considering that the respondents somehow agreed that their incomes were sufficient to cover only their basic expenses.

In Metro Manila, a worker earns a minimum wage of only P537 daily, or P13,962 a month—the highest rate in the country.

“There’s not much disposable income. They have a few savings but when they get sick they would spend that and it’s back to zero,” Paragas said.

With the rollout this year of the universal health care program, Paragas said one challenge for PhilHealth was how it could better inform the public about the benefits that they were entitled to receive.

He added that hospitals should also do their share to provide the public a more “holistic health care.”