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PhilHealth Issues

The document summarizes key information about PhilHealth, the Philippine government agency responsible for administering the country's national health insurance program. It discusses that PhilHealth was created through the 1995 National Health Insurance Act to provide universal healthcare coverage. It collects premiums and accredits healthcare providers. The document also outlines PhilHealth's vision of coverage for all Filipinos, its social solidarity principle of the healthy subsidizing the sick, its expanding coverage rates, and membership programs. It concludes by identifying some issues facing PhilHealth like corruption, premium hikes, non-reimbursement of claims, and a tedious claims process.

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Amiel dionisio
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46 views

PhilHealth Issues

The document summarizes key information about PhilHealth, the Philippine government agency responsible for administering the country's national health insurance program. It discusses that PhilHealth was created through the 1995 National Health Insurance Act to provide universal healthcare coverage. It collects premiums and accredits healthcare providers. The document also outlines PhilHealth's vision of coverage for all Filipinos, its social solidarity principle of the healthy subsidizing the sick, its expanding coverage rates, and membership programs. It concludes by identifying some issues facing PhilHealth like corruption, premium hikes, non-reimbursement of claims, and a tedious claims process.

Uploaded by

Amiel dionisio
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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PHILHEALTH ISSUES

MPA-HM 505
Current Issues and Problems in Health
PHILIPPINE HEALTH INSURANCE
CORPORATION (PHILHEALTH)
• is a Government Owned and Controlled Corporation (GOCC) created through
the National Health Insurance (NHI) Act of 1995 or Republic Act 7875
• is a tax-exempt, government-owned, government-controlled corporation attached
to the Department of Health (DOH), funded primarily through premiums from
members and general taxation
• holds sole responsibility for collecting premiums, accrediting service providers,
establishing benefit packages, processing claims and reimbursing health care
service providers for their services.
• It is the administrator of the National Health Insurance Program (NHIP) which
was established to provide health insurance coverage for all Filipinos and ensure
affordable, acceptable, available, and accessible health care services for all
citizens of the Philippines.
R.A 7875: “NATIONAL
HEALTH INSURANCE ACT “
• The law that instituted the National Health Insurance Program for
All Filipinos and establishing the Philippine Health Insurance
Corporation on Feb. 14, 1995. It was later amended by R.A. 9241
in 2004 and the latest R.A. 10606 in 2013
VISION
STATEMENT:
“Bawat Pilipino, Miyembro Bawat Miyembro, Protektado
Kalusugan ng Lahat, Segurado”
SOCIAL SOLIDARITY IN
HEALTH
• healthy subsidize the sick;
• earning more subsidize those who earn less; and
• those who have no income are subsidized by the government
PHILHEALTH COVERAGE

83% 86% 92% 100%

2004 2010 2016 2022


ALL FILIPINOS COVERED

Prior to 2019, PhilHealth has primarily reported “coverage rate” or the


entitlement of members based on premium payments. But with the
signing of the UHC Act (RA11223), all Filipinos are already
automatically included under the National Health Insurance
Program (NHIP) – making PhilHealth’s coverage rate at 100%.
PhilHealth Membership Program
1. Formal economy - enrolled by their respective employers
2. Informal Economy - applies for membership on their own
3. Sponsored Members - sponsors facilitate their enrollment
4. Indigents - the Department of Social Welfare and Development (DSWD) is
tasked by the National Government to facilitate their enrollment
5. Lifetime Member- need to apply for membership to qualify under this
category
6. Senior Citizens - need to apply for membership to qualify under this
category
PhilHealth Range of Benefits
• Inpatient Benefits
• Outpatient Benefits
• Primary Care Benefits
• Z Benefits
• MDG Benefits and other Special Benefits Packages
PHILHEALTH ISSUES

• Corruption Issues
• Premium Hike Issue
• Non-reimbursement of claims
• Tedious and Complicated Process of Claims
• Overcounting the poor / Presence of Political indigents
• Fixed Rate Pay
THANK YOU

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