Health insurance in the Philippines:bold policies and socio-economic realities

Abstract

In 1995, the Philippines government legislated to create an income-rated and predominantly employment-baseduniversal health insurance program over a 15-year period. The program was intended to provide more and betterhealth care than was available through a combination of existing insurance schemes that covered less than half of thepopulation, and partially subsidised services provided by government facilities and funded from general taxation.The legislation was well intentioned, and the program has some skilful and imaginative staff. However, there aresignificant barriers to success including low average and widely dispersed incomes, improving but still unsatisfactoryhealth status, weak government health care services, and the sometimes negative impact of for-profit agencies.We review progress to date and conclude that, although membership numbers and benefit rates have increased, accessis still inadequate and copayments are high. We argue that strong and innovative steps are needed if the Program'sgoals are to be realised. In particular, we suggest that the focus should be on more formal and explicit rationing thattakes account of cost per quality-adjusted life-year; and radical adjustment of financial incentives for care providersincluding capitation and per case payment based on costed clinical pathways for high-volume case types. Finally, wecomment briefly on lessons that might be learned by both The Philippines and Australia.