Evolving A Single Health

Insurance Fund in the Philippines

Ruben John A. Basa

PhilHealth

September 2016

Disclaimer: The views expressed in this paper/presentation are the views

of the author and do not necessarily reflect the views or policies of the
Asian Development Bank (ADB), or its Board of Governors, or the
governments they represent. ADB does not guarantee the accuracy of
the data included in this paper and accepts no responsibility for any
consequence of their use. Terminology used may not necessarily be
consistent with ADB official terms.

About 4 out 5 Filipinos are mandatorily

covered2016
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Employed
(payroll deductions)

Seniors
(sin tax)

Poor
(sin tax)

Only about 20% of the population are not automatically

covered
90% of the population currently covered by
PhilHealth

Our benefit payments have doubled in 3 years

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97.03
78.18
55.46

2013 - P55.46 billion

2014 - P78.18 billion
2015 - 97.03 billion

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But prior to PhilHealth,

there was Medicare

Social Security in the Philippines

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2016
GSIS
SSS

1936

1957

Provides life insurance,

retirement and separation
benefits
GSIS for government
employees
SSS for private employees

Medicare

1969

ECC

1974

Medical
benefits

Covers work-related
injuries, sickness,
disability or death

Administered by
GSIS and SSS

Administered by
GSIS and SSS

Pag-IBIG

1978

Housing
benefits

The Medicare Program

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August 1969
Republic Act 6111 established the
Philippine Medical Care Plan (Medicare)
The mandate was to gradually provide comprehensive
medical care according to the needs of the patients

Medicare Program I

Medicare Program II

Employed in government
and private sectors

All others not covered by

Program I

After 20 years of implementation

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The Medicare program for private employees
was better managed
Longer actuarial life
Shorter processing time for claims
DOUBLE benefit ceilings even if premiums are the
same

Was not able to expand beyond the formal

sector

The birth of PhilHealth

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Republic Act 7875 of 1995 created the National
Health Insurance Program
Transferred the Medicare programs (funds and
operations) from SSS and GSIS to PhilHealth
October 1997 - for government employees from GSIS
April 1998 - for private employees from SSS

Transferred to PhilHealth
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Transferred:
Funds, as actuarially
determined
Personnel who opted to

Excluding:
Database
IT system
During transition, collection
of premiums for a fee

And now
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Biggest

Equal
Benefits

PhilHealth as the biggest

social security program
in the Philippines;
including the poor and
the informal economy

Same benefits since

1999 for all members

The birth of PhilHealth

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In contrast, SSS officials reluctantly turned over their more
extensive Medicare operations and bigger assets They anticipated
that more would be spent administratively by PhilHealth considering
that it would have to put up its own personnel and operating
infastructures.
Moreover, SSS officials considered unfair that the Medicare funds
they had prudently accumulated in the past years would be spent
away to subsidize new PhilHealth beneficiaries who have never
contributed to SSS before.
Horace Templo
former SSS Actuary
in an article published August 2016 in the Manila Standard

Postscript
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If Medicare functions were successfully merged into
one program:
How about the employees compensation program still
currently administered by SSS and GSIS?
Or even merging the SSS and GSIS together?

And one more thing

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August 28, 2016
Hotline 8888

Agencies with Most Complaints

1
2
3
4
5

SSS

Bureau of Internal
Revenue

7
8
9
10

Manila & QC LGUs

Land Transportation
Pag IBIG
Land Registration

Foreign Affairs
GSIS
Phil National Police
Commission on Elections

Thank you

johnbasa@gmail.com