Philippine Journal of Internal Medicine

Editorial

PhilHealth Can Save Philippine Healthcare

Dr. Willie T. Ong, MPH, FPCP

Its 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. Thats a total of around 25 million
Filipinos living in extreme poverty. The second group of
4.1 million families have an average monthly income of
between P3,406 to 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 attacks?

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

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 takes care of the old,
and the healthy assists 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.

What is PhilHealth?

PhilHealth is the governments 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 countrys health insurance program.

The goals of PhilHealth are as follows: (1) to be able
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% of Filipinos living with meager incomes.

Philhealth Protects Your Family:

Since PhilHealth is a government institution, its
mandate is primary to assist its members and not to earn
money. As such, you will notice that many of PhilHealths
policies are geared for the benefit of 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 members
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
members 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-patients 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.

How PhilHealth Works:

How can PhilHealth alleviate the health needs of the
poor? Simply put, it is as if PhilHealth acts like a collective
bank, where its members will 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 years 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

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Philippine Journal of Internal Medicine

Editorial

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% of the population (Studies
say that the number is between 38% and 87%). 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.

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 100 billion pesos. But
despite this amount, the money needed to care for the
health of 90 million Filipinos is staggering and will reach
the trillions. Hence, PhilHealth still needs our support.
Indeed, the road to healthcare recovery is clear: Enrolling
everyone in PhilHealth is the right strategy to solve the
health needs of all Filipinos.

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