published by the National Anti-Poverty Commission

Issue # 8

Why Poor Mothers Fail to

Enjoy PhilHealth Bene its
Lian Jumil D. Rivera

BARRIERS TO PHILHEALTH BENEFIT UTILIZATION AND FULL FINANCIAL SUPPORT

To the poor, health care had simply meant accessing whatever free services were available
at the nearest health facilities. Very few had been able to complete treatments because the
costs of diagnostic tests and medicines came out of their own pockets. Health insurance
was practically unheard of.
But change had come. Signicant reforms introduced under the Aquino government saw
Philhealth, the national health insurance program, increasing its coverage to 92% of the
population, the highest since it started in 1995. Half of those now covered are poor
families enrolled under the Indigent Program, their premiums fully subsidized by the
1
national government using additional revenues from the
Sin Tax.1
Expanding the benet packages to cover more illnesses, including catastrophic ones that
require expensive and long-term treatments, has increased PhilHealth's total benet
2
payout by three-fold: from P31 billion in 2010 to P97 billion in 2015. Several policies were
put in place to facilitate the access of vulnerable groupsespecially poor families and
women about to give birthto quality healthcare.
However, it appears that health insurance
coverage is still no guarantee that those who
need it most will seek medical care. Even the
benets that they are supposed to receive
from the health insurance company are not
deemed adequate.
The National Anti-Poverty Commission
(NAPC) conducted a series of surveys in
2015 to determine the barriers that indigent
PhilHealth beneciariesparticularly
pregnant mothersface when seeking
healthcare. The ndings showed that seven
in ten indigent mothers went to a health
facility to give birth, but only four in ten used
their PhilHealth card for maternal care
services.
The survey was conducted among 1,130
indigent mothers in 12 cities and
municipalities nationwide. The ages of
participating mothers were between 15 to 49
years old. They are either members or
dependents of members under PhilHealth's
Indigent or Sponsored Program. Except for
some respondents in three survey areas who
gave birth between 2010 to the present, the
interviewees delivered their babies in the
past 12 months prior to the survey period.
1

Households enlisted as poor in the National Household Targeting System for Poverty Reduction are
automatically enrolled under PhilHealth's Indigent Program as mandated by Republic Act (RA) No. 10606
or the National Health Insurance Act of 2013. Their premiums are sourced from the Sin Tax revenues based
on RA 10351; Source: PhilHealth Stats & Charts, 2015

PhilHealth Stats & Charts, various years

BARRIERS TO PHILHEALTH BENEFIT UTILIZATION AND FULL FINANCIAL SUPPORT

Delivery at home and the lack of accredited facilities

As of 2015, only 752 public hospitals and inrmaries had been accredited by PhilHealth;
eight in 10 cities and municipalities nationwide had at least one accredited outpatient clinic
for maternal care services.
The survey among the mothers found that many of them gave birth at home despite the
heightened campaign for facility-based delivery. Many of them went to health care facilities
but were not able to avail themselves of the benets because the facilities were not
accredited by PhilHealth.
Health facilities were also usually inaccessible to families living in remote areas. The only
option was the barangay health station (BHS), which was not PhilHealth accredited because
it did not comply with the accreditation standards of PhilHealth.
This highlights the importance of investing on the quality of services of the BHS. It is the
most feasible point of care for the poorest population in faraway places.

BARRIERS TO PHILHEALTH BENEFIT UTILIZATION AND FULL FINANCIAL SUPPORT

Lack of access to right information

The PhilHealth Alaga Ka campaign and the
Family Development Sessions for
beneciaries of Pantawid Pamilyang Pilipino
Program (4Ps) were attempts to inform the
poor. However, the impact of these efforts
are yet to be seen.

their own pocket to pay for medicines and

supplies bought outside the health facility.
Assuming that the pregnant mother was
employed, she also lost P481 of her wage
for the day and spent P69 for
transportation.5 The total out-of-pocket
expenses was P2,825, onerous for a poor
family that can only spare 2% of its total
annual expenses to healthcare.6

The survey found that four in every ten

respondents were not aware of the
PhilHealth benets for pregnant mothers and
their infants. Still, those who knew of their
benets were discouraged from using their
PhilHealth card. They either lacked
documentary requirements or thought that
there was a limit to the number of birth
deliveries covered by PhilHealth.

But these mothers should not have spent

their own resources in the rst place
because PhilHealth has a No Balance
Billing (NBB) policy. It is supposed to
ensure that beneciaries will not pay any
amount for healthcare services in public
health facilities.
In 2015, only half of indigent PhilHealth
beneciaries was able to avail themselves
of the NBB.7 Clearly, there are still gaps in
the policy implementation that need to be
addressed.

As far back as 2014, PhilHealth had already

relaxed its birth parity rule, which had set
coverage only up to the fourth childbirth, to
include all childbirths of a motherbeneciary.3 Crucial details such as this
should be emphasized during information
dissemination and posted in strategic areas
in hospitals and healthcare facilities.

Reducing the indirect costs spares the

family from worrying about the expenses
of seeking healthcare. Essential services
should be available at the BHS and rural
health units, and ensure that these
facilities get PhilHealth accreditation.

More families could have used their

PhilHealth card had they known about their
membership, benets, and availment
process. Currently, PhilHealth only requires
indigent beneciaries to present either their
PhilHealth ID or their Member Data Record to
access benets.

The people will get the most of the

benets of the NBB policy if healthcare
providers have complete diagnostic and
treatment facilities, and medical supplies
for indigents. To this end, NAPC has been
advocating for the proper implementation
of income retention, a provision in the
Republic Act No. 7875, as amended,
mandating local government units to allow
their local health service providers to
retain all PhilHealth reimbursements.

Out-of-pocket costs of health care

The indirect cost of health care is another
reason why poor families forego their
PhilHealth benets. This includes the
perceived out-of-pocket expenses,
transportation costs, and lost wages.4
Survey ndings showed that mothers who
used their PhilHealth card for childbirth still
spent an average amount of P2,275 from

4
5

6
7

PhilHealth Circular No. 22, series of 2014

Similar ndings by Villaverde, 2012 and Wang et al., 2012
P481 is the minimum wage rate for workers in the non-agriculture sector in the National Capital
Region as of April 2015; P69 is the average cost of transportation to any facility in 2013, according to
the 2013 NDHS
Family Income and Expenditure Survey, 2012
PhilHealth Stats & Charts, 2015

BARRIERS TO PHILHEALTH BENEFIT UTILIZATION AND FULL FINANCIAL SUPPORT

The said income should be used to defray operating costs, maintain or upgrade facilities
and equipment, and improve service quality.8
In support of NAPC's advocacy, the Department of Health made income retention a
mandatory requirement in the 2016 Health Facility Enhancement Program (HFEP)
Availment Guidelines. With income retention as HFEP conditionality, the local health service
providers can further enhance their capabilities and provide incentives to their health
personnel as they gain more exibility and independence with their revenues.
Local evidence-based strategies
Most of the barriers to benet utilization were common across all the surveyed localities.
However, in a highly urbanized city where there are more accredited facilities than the other
areas, childbirths were facility-based and the utilization rate was relatively high. Mothers in
these areas incurred the highest out-of-pocket payment for medicines compared to other
areas.
Meanwhile, in rural areas where access to facilities are limited, more mothers delivered at
home or at the BHS. In Palimbang, Sultan Kudarat for example, 69%9of the surveyed
mothers gave birth at home and another 16% gave birth in a barangay health station. As of
December 2015, there were still no PhilHealth-accredited hospitals, inrmaries, and
outpatient lying-in clinics there. Consequently, it has the lowest PhilHealth utilization rate at
8%.10
Some barriers are better addressed by local action rather than national policy and program
enhancements.For instance, the LGU's utilization of their hospitals' income from PhilHealth
can help build more facilities serving the remote areas. The information campaign about
getting access to healthcare through PhilHealth should be held at the barangay level.
Looking through a local lens in understanding the problem and proposing solutions was
deemed more effective given the country's devolved healthcare system. Thus, NAPC
proposes that the survey instrument be further enhanced into a standard tool that the LGUs
can use to analyze the factors affecting the underutilization of PhilHealth benets in their
locality. Insights from the survey should be integrated in the local health plans, with clear
arrangements on accountability among the various stakeholders.

Income retention is based on Article VIII Section 34-A of Republic Act No. 7875, as amended by RA
9241 and RA 10606 or the National Health Insurance Act of 2013
N=64
Note though that the survey in this area includes some respondents who had given birth more than
12 months prior to the survey period but between 2010 to present.

10

BARRIERS TO PHILHEALTH BENEFIT UTILIZATION AND FULL FINANCIAL SUPPORT

There are gains in the reforms, and we have national-level gures to support this. Yet, if we look
closer, we nd that there are still gaps in the mechanisms that are supposed to deliver these
reforms to the smallest communities. NAPC will continue to push for local evidence-based
strategies to ensure that the vulnerable sectors fully benet from the nancial risk protection
that PhilHealth provides.

About the Author:

Lian Jumil D. Rivera is a staff of the Policy, Monitoring and Social Technology
Service Unit (PMSTS) of NAPC. She is a graduate of Psychology at the
University of the Philippines, Diliman and is pursuing a Master's degree in the
same eld, also in UP. Her professional interests are advocacies on public
health and social protection. Her doodles, cartoons and drawings delight her
colleagues.

References
Philippine Health Insurance Corporation. 2010-2015. [Tables and graph illustrations on PhilHealth
membership and benets]. PhilHealth Stats & Charts. Accessed at
http://www.philhealth.gov.ph/about_us/statsncharts/
Philippine Health Insurance Corporation. 2014. PhilHealth Circular No. 22 Series of 2014.
Philippine Statistics Authority. 2013. [Tables]. 2012 FIES (Statistical Tables). Accessed at
https://psa.gov.ph/content/2012-es-statistical-tables
Philippine Statistics Authority & ICF International. 2014. Philippines National Demographic and Health
Survey 2013. Manila, Philippines, and Rockville, Maryland, USA: PSA and ICF International.
Quimbo, S., Florentino, J., Peabody, J. W., Shimkhada, R., Panelo, C., & Solon, O. 2008. Underutilization of
social insurance among the poor: Evidence from the Philippines. Plos ONE, 3(10), e3379.
doi:10.1371/journal.pone.0003379
Shaikh, B. T. & Hatcher, J. 2005. Health seeking behaviour and health service utilization in Pakistan:
Challenging the policy makers. Journal of Public Health, 27(1), 49-54.
Soeung, S. C., Grundy, J., Sokhom, H., Blanc, D. C., & Thor, R. 2012. The social determinants of health
and health service access: An in depth study in four communities in Phnom Penh Cambodia.
International Journal for Equity in Health, 11(46), 1-10.
Villaverde, M. C., Vergeire, M. & de los Santos, M. 2012. Health Promotion and Non-communicable
Diseases in the Philippines: Current Status and Priority Policy Interventions and Actions. Quezon
City, Philippines: Ateneo de Manila University & Health Justice Philippines.
Wang, H., Liu, Y., Zhu, Y., Xue, L. Dale, M., Sipsma, H., & Bradley, E. 2012. Health insurance benet design
and healthcare utilization in northern rural China. Plos ONE, 7(11), 1-7.

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