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Expanding PhilHealth Partnerships in the Informal Sector: Innovative Approaches & Collaborations for Better Access

This conceptual framework discusses challenges and solutions in extending health insurance (SHI) to the informal sector in the Philippines, emphasizing partnerships with organized groups to increase coverage, payment flexibility, and quality healthcare access. The initiative aims to minimize adverse selection, strengthen solidarity, and enhance risk-sharing, targeting microfinance groups, cooperatives, NGOs, and other organized entities. By engaging in a triple-win strategy, the program seeks to improve financial stability, accessibility, and membership in the Philippine Health Insurance Corporation.

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Expanding PhilHealth Partnerships in the Informal Sector: Innovative Approaches & Collaborations for Better Access

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  1. Extending SHI to the Informal Sector in the Philippines:the conceptual frameworkCHF Best Practice Workhop 1st February 2007Dar es Salaam, TanzaniaArsenia B. Torres OIC, Office of the Vice President for Membership & MarketingPhilippine Health Insurance Corporationin collaboration withMatthew Jowett (PhD)GTZ Advisor to PhilHealth

  2. Contents • The problem • The response – KaSAPI • Potential reach • Progress and challenges

  3. PhilHealth covers approximately 74% of the population as of 2005 Govt. NPM OFW 12.5% 1.5% 4% IPP 21% Govt. 1,678,880 Private 5,616,220 Sponsored 2,492,356 IPP 2,839,455 OFW 545,429 NPM 196,650 Total 13,368,990 Sponsored Prvt. 42% 19%

  4. 15.5 Million workers or 49% of Labor Force are in the Informal Sector Source: DOLE News dated May 8, 2005

  5. Problems on demand-side • De facto voluntary decision for household. As a result, low coverage levels – approx 14% of the target group enrolled. • Premium $24 per annum for family; generally acceptable but people want to pay weekly/monthly given uncertain income. Many remote communities, with little health infra. • Irregular contributions / coverage: • only one-third of members registered in PhilHealth’s voluntary ‘individual paying programme’ pay regularly • Adverse selection creates financial instability:

  6. Problems on supply-side • Large public sector bureaucracy has limitations in: • Marketing and selling health insurance • Developing flexible payment systems which meet demands of target group • PhilHealth ideally wants annual premium payments (to stabilise irregular payments), but target population want the opposite • Chasing individual households administratively expensive and highly inefficient

  7. EXPANDING PHILHEALTH PARTNERSHIPS WITH ORGANIZED GROUPS

  8. OBJECTIVES • Increase enrollment and sustain membership • Implement an alternative premium payment scheme • Provide Informal Sector access to quality health care • Identify and develop innovative approaches of marketing SHI • Strengthen collaboration with OGs • Minimize adverse selection • Strengthen solidarity and risk sharing

  9. Target clientele • Microfinance groups • Cooperatives • NGOs • People’s Organizations • CBHCOs

  10. Organized Groups and PhilHealth Partners in implementing NHIP (Conceptual framework)                                         Members of OrganizedGroups ORGANIZED GROUPS PhilHealth Premium payment Hosp. & regular outpatient • Recruitment/enrollment • Conduct of IEC/Advocacy • Collection & remittance of members’ contribution • Submission of reports • Capability building (IEC) • ID Generation • Benefit Payment • Group Premium

  11. Monitoring GENERAL STEPS FOR KaSAPI IMPLEMENTATION Benefit Availment Policy Agreement Collection and Remittance Enrollment of Members KaSAPI Training MOA Signing PhilHealth Evaluation and Decision Letter of Intent & Application for Membership Organization’s Board Resolution Attendance in NHIP Orientation Pre-Selection of Organized Groups

  12. Criteria: • No. of members • Size of assets/capital • Clientele • Area of coverage • Track Record • Accredited health facilities ACCREDITATION OF OG Pre-selection of OG

  13. Compliance with legal requirements • Strength of leadership, operational and management systems in place • Assessment/Evaluation • Organizational Stability • Financial Performance • Profitability • Efficiency • Return on Investment • Liquidity

  14. Response to unstable coverage / contributions • Rather than targeting individual households directly, target groups, and mirror employer-employee relationship (admin efficiency gains, limit adverse selection). • Piggy-back on collection systems of microfinance / cooperative organisations who collect very regularly from clients (greater flexibility for client). • This partnership allows PhilHealth to respond to household’s demand to pay small amounts regularly, whilst the organisation remits annual/semi-annual/quarterly payments to PhilHealth. Up to each partner how to organise internally.

  15. Response to adverse selection • Promote mandatory enrolment within microfinance organisation (efficient risk-sharing). Strong demand for health insurance by MFI/Coop management for their members. • Set minimum group size. Currently set at 70% (counter adverse selection). • How to enforce? Offer discounted premium. Similar approach to private health insurance approaching companies. • Should also help to limit coverage instability – partner loses income (through discounted premium) if enrolment drops below 70%.

  16. KaSAPI - triple win Increased, sustained coverage; improved financial stability of Individual Paying Prog PhilHealth More than a nice idea Informal economy workers Partner organisation Fulfil social mission; additional membership; reduced delinquency / bad debts Payment flexibility; lower premium; more benefits; time & hassle savings

  17. Current KaSAPI partners

  18. Consolidated Status of Implementation as of November 2006

  19. Challenges / issues • Internal PhilHealth systems require further strengthening and development. • Policy design needs continually improvement, needs further simplification – but avoid too many policy changes. • Need to manage impact of indigent programme. • Continue to make group enrolment more attractive than individual enrolment e.g. benefits, waiting period. Potential for introduction of technology e.g. electronic ID card, payment through cell phone.

  20. Challenges / issues • Generate broader movement; involve range of stakeholders in implementation e.g. federation of co-operative organisations. • Limitation: drawn towards areas with better health facility infrastructure (exacerbate equity in access?). • Partners potentially have consumer advocacy role for quality health services; link between government and civil society. • The answer to universal coverage? No, but can make significant impact.

  21. HAVE A NICE DAY!

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