MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) barely covers half of the population in five provinces, according to a study by the state think tank Philippine Institute for Development Studies (PIDS).
Based on the study, titled “Spatiotemporal Analysis of Health Service Coverage in the Philippines,” Mindanao had the lowest PhilHealth population coverage with 87.82%.
The Greater Manila — composed of Metro Manila, Central Luzon, and Calabarzon — has 98.9%, Luzon 90.7%, and the Visayas 90.5%.
Five provinces have 52% or lower PhilHealth coverage — Maguindanao, Lanao del Sur, Basilan, Sulu, and Tawi-Tawi.
The study was conducted by PIDS senior research fellow Valerie Gilbert Ulep, supervising research specialist Jhanna Uy, and research consultants Clarisa Joy Flaminiano, Vicente Alberto Puyat, and Victor Andrew Antonio.
Challenge to PhilHealth
“This could pose a challenge for PhilHealth in endeavoring to raise member registration for these priority areas and achieve universal population coverage of the NHIP [National Health Insurance Program] in the country,” the authors said in the study.
The authors also pointed out that the 52 percent coverage pales in comparison to the target 100 percent of the healthcare coverage guaranteed by the Universal Healthcare Act.
“RA 11223 states that all Filipinos are automatically enrolled under the National Health Insurance Program — which makes the PhilHealth [target] coverage rate 100 percent. But after looking into PhilHealth’s registered beneficiaries data from 2018 to 2021, we identified geographic discrepancies in the population coverage across provinces,” the study said.
The study also showed that Mindanao has the largest share of indirect contributors, mostly indigent or sponsored, at 57%.
These indigents and beneficiaries of government programs like the Pantawid Pamilya Pilipino Program were noted to be “at higher risk of contracting diseases.”
The most poverty-stricken provinces also have low population coverage, with only senior citizens, indigents, or sponsored beneficiaries as members.
According to the authors, the disparity in PhilHealth’s coverage is driven by several factors — employment, poverty incidence, wage rates, and process inefficiencies in the classification and enrolment of indigents and sponsored members.
Apart from this, Filipinos in rural areas also have fewer options for healthcare services as PhilHealth-accredited facilities are “disproportionately located in urban areas.”
Because of this, the study urged PhilHealth and the Department of Health to focus on improving healthcare coverage in the poorest provinces and among indigents in poor urban areas to achieve universal healthcare.
They suggested improving PhilHealth’s membership enrollment, especially in priority areas like Mindanao.
The study authors emphasized using standardized equity measures, like poverty incidence, in national allocation and prioritization frameworks of projects and activities for equity and efficiency across health programs.
They also stressed the need to use standardized equity measures, like poverty incidence, in national allocation and prioritization frameworks of projects and activities for equity and efficiency across health programs.
“PhilHealth, in collaboration with other government agencies, must ensure the accuracy, validity, and consistency of data on indigents at both national and subnational levels to improve healthcare equity throughout the country,” they said.