The elderly, women, rural folks and poor Filipinos are the ones who are more likely to suffer from shelling out-of-pocket health expenses since the government does not cover all hospital costs, according to the Philippine Institute for Development Studies (PIDS).
In a study, 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 examined the financial risk protection of Philippine Health Insurance Corporation (PhilHealth) members and dependents.
The PIDS researchers found that PhilHealth members still pay out-of-pocket because the National Health Insurance Program covers only 40 percent or lower hospital costs. These costs are also expected to increase in the coming years.
“Effective financial protection in a health system should reduce out-of-pocket patient costs that are not covered by insurance as much as possible,” they said.
The study computed the “support value” or the percentage of hospital care cost shouldered by PhilHealth using 2018-2021 PhilHealth data along with auxiliary datasets from the Department of Health (DOH), Philippine Statistics Authority, and the Washington-based Institute for Health Metrics and Evaluation.
The average support value is 55.83 percent in the Philippines. But the percentage varies based on PhilHealth membership type, socioeconomic status, patient accommodation, disease classification, hospital ownership and level and location.
The study found that indirect contributors have lower support value than direct contributors on average, but at-risk subpopulations enjoy “more consistent coverage” due to existing benefits offered to indigents and sponsored beneficiaries.
Based on the findings, elderly members, who have less income yet incur the biggest health expenses, got the lowest support value in public and private hospitals.
Women face higher financial risk due to lower income and higher hospital admission rates across all age brackets for “avoidable conditions” that could have been addressed through outpatient and preventive care.
The authors said the high admission rates suggest an “ineffective and inefficient” primary health-care system, making health care “more expensive” for patients and the health system.
People in provinces where most PhilHealth members are indirect contributors possess higher financial risk because they have less income for health care.
The study added that Filipinos in rural areas are likely to spend more because of the “maldistribution” of primary care facilities and accredited hospitals that “do not cover the costs of all services.” Only 43 percent of Level 1 hospitals, which offer minimum healthcare services, are government-owned.
“Some benefit packages are only available in government-owned hospitals. PhilHealth should endeavor to develop benefit packages responsive to the health needs of different subpopulations and available across hospital levels and ownership,” the authors said.
To address the “financial risks of catastrophic health expenses,” the authors recommended a “strategic shift” in PhilHealth’s service purchasing and revenue generation to guarantee sufficient funds for all covered diseases.
They also advocated shifting from case-based to diagnosis-related groups-based systems to address the varying range of support value across related diseases.
The researchers also recommended providing essential services outside of hospitals, investing in health literacy, and increasing the support value for elderly beneficiaries.
