2017年-世界发展银行全球_Awareness_of_Health_Insurance_Benefits_in_the_Philippines___What_Do_People_Know_and_How__26页_511kb

报告摘要

Summary of "Awareness of Health Insurance Benefits in the Philippines: What Do People Know and How?"

Core Content

This discussion paper examines the awareness of health insurance benefits among Filipinos, with a particular focus on the poor, who are eligible for government-subsidized health insurance through PhilHealth. The study uses household survey data from 2011 and 2015, as well as administrative records from the Department of Social Welfare and Development (DSWD), to assess how people learn about their coverage and the range of benefits they are aware of.

Main Findings

Sources of Information on PhilHealth Membership

Local government institutions and DSWD programs are the most important sources of information on PhilHealth membership.
- Barangay officials are the primary source, with 34.8% of all subsidized members learning about their coverage from them.
- DSWD's Municipal Links are also significant, especially for the poorest quintiles (29.6%).
PhilHealth-related sources (such as PhilHealth staff in health facilities and the Alaga Ka campaign) are less influential.
- Only 16.2% of subsidized members learned about their membership directly from PhilHealth.
- The Alaga Ka campaign was cited by just 1% of respondents.
Social networks (friends, family, neighbors, etc.) are the least effective source of information on membership status.
- Only 6.1% of subsidized members reported learning from social networks.

Awareness of PhilHealth Benefits

Overall, awareness of the benefit package is low, with most households answering only 11 out of 18 items correctly.
General inpatient services are the most well-known benefit, with over 95% of households aware of this.
Surgical procedures and hospital medicines are also well-known, with around 80% of households aware of these.
Awareness of disease-specific benefits is relatively high, particularly for cancer treatments (68–71% awareness among subsidized groups).
Non-covered benefits such as vitamin supplements, ambulance services, and grocery store discounts are not well known.
- Over 64–68% of poor households and 73% of the general population correctly identified that vitamin supplements are not included.
- About 55% of respondents correctly identified ambulance services as not part of the package.
Primary care checkups/consultations are poorly understood, especially among the poor.
- Awareness of this benefit is the second lowest among all 18 benefits analyzed.
- This is concerning because the poor are the target group for this benefit.
No balance billing policy is relatively well known, with about 75% of poor households aware of it.
- This policy allows poor households to avoid paying extra beyond what PhilHealth reimburses.

Variation by Population Subgroup

Poor households (especially those in the poorest quintiles) have lower awareness of certain benefits compared to the general population.
- Awareness of cancer treatments is 8 percentage points lower for the CCT population.
- Awareness of dengue treatment is 6 percentage points lower.
CCT beneficiaries have lower awareness of specific benefits compared to other groups.
- They are less informed about cancer treatments and dengue treatment than the general population.
- Peer-to-peer sharing within the CCT program is noted as an important mechanism for spreading information, with 14.3% of CCT households learning about PhilHealth coverage from other CCT members.

Key Recommendations

Enhance use of DSWD's Family Development Sessions (FDS) to inform people about the full range of PhilHealth benefits, especially primary care.
Train and incentivize community members to share information about PhilHealth benefits through social networks.
Reassess the design and implementation of the PhilHealth Alaga Ka outreach program to improve effectiveness.
Sustain and scale-up mass media campaigns to increase public awareness of PhilHealth benefits.

Conclusion

Despite the expansion of PhilHealth coverage among the poor, awareness of the benefit package remains limited. The study highlights the need for more targeted and effective communication strategies to ensure that eligible populations understand and can utilize their health insurance benefits. Local government and social networks play a critical role in this process, suggesting that these channels should be leveraged more effectively in future outreach efforts.

Key Information

Data Sources: Household surveys (2011 and 2015) and DSWD administrative data.
Sample Size: 1,780 households (representing 9,177 individuals).
Subgroups Analyzed:
- Poor households (based on income and consumption).
- FIES-poor and NHTS-PR-poor.
- CCT beneficiaries.
PhilHealth Coverage Expansion:
- From 5.2 million to 15.3 million poor families and senior citizens between 2012 and 2015.
- The Sin Tax Law contributed significantly to this expansion.
Benefit Awareness:
- Low awareness of specific benefits such as primary care and disease-specific treatments.
- High awareness of general inpatient services and no-balance billing.
Communication Channels:
- DSWD and local government are the most effective.
- PhilHealth outreach is underutilized.
- Social networks are a key but underused source of information.