2015年-世界发展银行全球_Universal_Health_Coverage_in_the_Philippines___Progress_on_Financial_Protection_Goals_29页_1mb

Summary of "Universal Health Coverage in the Philippines: Progress on Financial Protection Goals"

Core Content

This working paper by Caryn Bredenkamp and Leander R. Buisman analyzes the progress of the Philippines toward achieving financial protection in its universal health coverage (UHC) strategy, using data from multiple household surveys between 2000 and 2012. The study focuses on health insurance coverage, out-of-pocket (OOP) spending, catastrophic payments, and impoverishing health expenditures.

Main Findings

1. Health Insurance Coverage

• Between 2008 and 2013, health insurance coverage increased significantly, reaching 61% of the population by 2013.
• The largest increases in coverage occurred among poorer population segments, indicating a shift toward pro-poor access.
• The concentration index of health insurance coverage changed from being pro-rich (0.21 in 2008) to neither pro-rich nor pro-poor (0.04 in 2013), suggesting more equitable coverage over time.

2. Out-of-Pocket Spending

• OOP health spending increased by 150% in real terms from 2000 to 2012.
• In 2012, the mean OOP spending was PHP 8,360, up from PHP 1,951 in 2000.
• The poorest quintile spent PHP 823 on medicines, while the wealthiest quintile spent PHP 15,070.
• Medicines account for nearly two-thirds of total health spending and up to three-quarters among the poor.

3. Catastrophic Payments

• The incidence of catastrophic payments (defined as OOP spending exceeding 10% of total consumption or 40% of non-food consumption) trebled from 2.5% in 2000 to 7.7% in 2012.
• The concentration index for catastrophic payments was 0.338 at the 10% threshold and 0.259 at the 40% threshold in 2012, indicating that these payments are more concentrated among the better-off.
• Despite this, catastrophic payments have risen for all income groups, including the poor, which is a concern since the poor are less able to cope with such costs.

4. Impoverishing Health Expenditure

• In 2012, OOP health spending added 1.5 percentage points to the poverty rate using the US$2.00 per day poverty line.
• The poverty gap also increased, but not significantly, suggesting that the rise in poverty is mainly due to more households being pushed below the poverty line, not deeper poverty among existing poor.
• A Pen's Parade diagram shows that while health spending contributes to poverty among the poorest 40%, it also affects some upper-income households, though likely not to a severe degree in the long term.

Key Policy Developments

• The National Health Insurance Program (NHIP) was expanded to cover 5.2 million poor families in 2010 and 14.7 million by 2014.
• A new law in 2014 introduced government-sponsored health insurance for all senior citizens over 60 years of age.
• Benefit packages were expanded to include non-communicable diseases and generic medicines.
• Provider payment reforms were introduced to shift from fee-for-service to case-based payments to reduce costs.
• A "no balance billing" policy was introduced for the poor in 2011, ensuring they are not charged extra by PhilHealth-accredited providers.

Methodological Approach

• Data were collected from Family Income and Expenditure Surveys (FIES), National Demographic and Health Surveys (NDHS), and Family Health Surveys (FHS).
• Out-of-pocket spending is defined as direct household purchases of health services or goods.
• Catastrophic payments are measured using two thresholds: 10% of total consumption and 40% of non-food consumption.
• Impoverishing health expenditure is assessed using poverty headcount and poverty gap metrics, both gross and net of OOP health spending.
• The concentration index is used to assess equity in financial protection outcomes.

Policy Implications

• While recent policies have improved health insurance coverage and reduced financial risk, OOP spending remains a major issue.
• Medicines are the primary driver of OOP health spending, and catastrophic payments are largely due to high medicine costs.
• Quick wins could include:
  • Issuing health insurance cards for the poor to increase awareness.
  • Introducing a fixed copayment for non-poor members.
• Supply-side investments are necessary for long-term progress.
• A comprehensive analysis of the pharmaceutical sector is recommended to address the financial burden of medicines.

Regional Comparison

• The Philippines performs similar to other middle-income countries in the region (Indonesia, Thailand, Vietnam) in terms of financial protection outcomes.
• However, it lags behind in healthcare access, such as skilled birth attendance and antenatal care.
• Other countries have seen reductions in OOP and catastrophic payments with expanded coverage, while the Philippines has not yet achieved the same.

Conclusion

Despite progress in health insurance coverage and policy reforms, the Philippines still faces significant challenges in achieving financial protection for all. Medicines continue to be a major financial burden, and catastrophic health payments have increased substantially. The poor are disproportionately affected, and while coverage has improved, equity remains a concern. Further policy action and investment are required to ensure that financial protection is effective and inclusive.