PhilHealth

PhilHealth must improve enrollment in the formal economy to achieve full coverage – PIDS study

If you wish to know more about this study, you may download the Policy Note here.

Gauging the efficacy of enrollment in PhilHealth’s Employed Program will help policymakers in the health sector determine a more effective approach in achieving the goal of universal coverage.

Last year, PhilHealth officials iterated their commitment to achieving universal coverage by 2016. President Benigno Aquino III signed an amendment of the National Health Insurance Act highlighting the responsibility of the national government to cover the health insurance premiums of Filipinos in the informal sector.

However, full coverage in the formal sector also needs due attention and improvement. Thirty percent of PhilHealth’s members come from the formal economy where enrollment is mandatory. But based on a study by state think tank Philippine Institute for Development Studies (PIDS), “full coverage” is “yet to be achieved”.

The private sector currently sits at 95-percent coverage, while the government employed sector sits at 75 percent. Denise Valerie Silverberg, author of the study, argues that examining the level of PhilHealth coverage and enrollment in the formal sector will help policymakers bridge that gap.

Silfverberg surmised that the gap in coverage can be explained by looking at how some agencies comply with labor policy. For example, the low coverage rates may be attributed to the significant number of contractual employees in government who do not enjoy the benefits of being enrolled in PhilHealth.

The perpetuation of contractual employees—something the private sector is just as guilty— allows firms and agencies to stall enrollment of employees into the PhilHealth Employed Program and withhold “appropriate benefits”. 

But companies deliberately shortchanging employees are not just the only flaws. Variations of enrollment rate can also be produced by characteristics that set the private and government sector apart, and other factors like establishment size and area.

For the private sector, sectoral employment, nature of employment, union coverage, union-employees ration, and number of employees all influence variations of coverage rate. But in the provinces, it is the size of the firm that matters.

“More employees hired by medium-sized establishments lead to a higher likelihood for the province to have lower coverage,” Silfverberg pointed out, “On the contrary, the greater the number of employees in large-sized enterprises, the more likely it is for the province to have higher coverage levels.”

Silfverberg concluded that before the country can work toward full coverage, policymakers must find a way to address the problems that impede effective implementation of the national health insurance program. Enrollment should be more targeted, depending on the sectors where undercoverage occurs the most.

Monitoring by PhilHealth should also be strengthened. Medium-sized establishments, surmised by Silfverberg, are more likely to short change employees when it comes to health insurance enrollment if they are not closely monitored.

Employers have to be held accountable to follow the labor code provision on employee regularization. The rules are often undermined by resorting to a six-month cycle to prevent employees from being regularized, and to refrain from giving them their due benefits.

Employers—both public and private—should enroll their employees into the program, whether they are regular or casual.  Compliance at the local government level should be also closely monitored. After all, it would be harder to close the gap if government units themselves do not implement the health insurance program in their own offices.