The push for better healthcare

The observance of National Health Insurance (NHI) Month serves as the Filipinos’ annual reminder of the government’s commitment to ensuring that no Filipino is left behind when it comes to healthcare. Through the National Health Insurance Program (NHIP), millions of Filipinos — especially those in marginalized and vulnerable sectors — can receive medical support without the burden of high out-of-pocket expenses.

February, often referred to as the month of love, coincides with the observance of NHI Month by the Philippine Health Insurance Corp. (PhilHealth). Established by virtue of Presidential Proclamation No. 1400 s. 2007, the month-long celebration emphasizes the important role of social health insurance in every Filipino’s life.

The theme for this year’s celebrations, “Panatag Kami Dito,” which roughly translates to “we feel secure here,” shows the government’s drive to continuously strengthen social health insurance, giving citizens peace of mind knowing that medical support is within reach when they need it most.

The NHI Month is also held to help spread awareness about the NHIP, emphasizing the various benefits that Filipinos can gain from it. The program, created through Republic Act 7875 or the National Health Insurance Act of 1995, seeks to offer health insurance coverage and guarantee access to affordable and high-quality healthcare services for all Filipinos.

Under Republic Act No. 11223, more famously known as the “Universal Health Care Act,” every Filipino citizen became an automatic member of the NHIP and was granted immediate eligibility for health benefit package, regardless of non-registration or non-membership with PhilHealth.

Exemplified by the Filipino spirit of bayanihan, the NHIP is built on the idea of social solidarity, where everyone — regardless of income, age, health condition, or location — shares the responsibility of supporting one another in accessing healthcare.

While most of the members are direct contributors who pay their monthly premiums to PhilHealth, there are some indirect contributors whose premiums are subsidized by the National Government to ensure that even the most vulnerable sectors — such as indigent families, senior citizens, and persons with disabilities — receive the medical care they need without financial burden.

This commitment to giving Filipinos sufficient healthcare can be seen in PhilHealth’s continuous efforts to provide timely financial support for medical needs. The latest numbers from the state health insurer show that a total of P137.6 billion in benefits claims has been disbursed to over 12,000 accredited healthcare facilities nationwide from Jan. 1 to Oct. 31, 2024.

Additionally, the national average turnaround time for claims processing has significantly improved to 25 days, which is 35 days faster than the 60-day period mandated by Republic Act No. 10606.

“The reduced turnaround time is helping partner hospitals in the country maintain liquidity, ensure a steady supply of medicines and supplies, salaries for health workers and continuous improvement of facilities, which all translate to better services to members,” former PhilHealth president and chief executive officer Emmanuel R. Ledesma, Jr. said in a news release.

Beyond improving claims processing and ensuring financial support for healthcare facilities, PhilHealth also prioritizes expanding its membership coverage to include all Filipinos. Despite the Universal Health Care Act’s mandated coverage rate of 100%, the state think tank Philippine Institute for Development Studies (PIDS) reported in 2022 that membership-to-population coverage in the poorest provinces is only a little over 50%.

Among the island and regional groups with the highest population coverage rates include the National Capital Region, Regions III and IV-A with 98.9%, Luzon with 90.7%, and Visayas with 90.5%. Although Mindanao had a relatively high population coverage at 87.82%, five of its conflict-affected provinces, namely, Maguindanao, Lanao del Sur, Basilan, Sulu, and Tawi-Tawi, registered the lowest PhilHealth coverage at 52% and below according to PIDS.

In addition, Mindanao has the highest proportion of indirect contributors, with 57% consisting mainly of indigent or sponsored members. Individuals classified as indigents, including beneficiaries of government initiatives like the Pantawid Pamilya Pilipino Program (4Ps), are considered more vulnerable to illnesses.

Recognizing these coverage gaps and the need for more accessible healthcare services, PhilHealth has introduced various programs aimed at addressing the specific needs of different sectors. These initiatives not only provide financial support for hospitalization and medical treatments but also focus on preventive care, primary healthcare access, and specialized benefit packages for critical illnesses.

One of the most notable programs by the insurance provider is the PhilHealth Konsultasyong Sulit Tama or the Konsulta package. Konsulta is a primary care benefit package that offers capitation payments to cover free yearly checkups, specific diagnostic tests, and essential medications. This initiative aims to protect Filipinos from chronic illnesses, prevent complications through early detection, and ensure access to affordable medications.

PhilHealth’s Z Benefits Package is also a noteworthy program that eases financial burdens for Filipinos with illnesses perceived as “medically and economically catastrophic.” Introduced in 2012, it provides financial coverage for patients diagnosed with severe and long-term illnesses such as certain types of cancer, end-stage kidney disease requiring dialysis, and severe heart conditions, among others.

Benefits from the package vary depending on the patient’s disease. According to its website, PhilHealth can provide financial assistance of up to P1.4 million for breast cancer treatment, P500,000 for Acute Lymphoblastic Leukemia (ALL), P600,000 for end-stage renal disease requiring kidney transplantation, P550,000 for coronary artery bypass graft surgery, and P175,000 for cervical cancer, among others. These grants cover room and board fees, drugs and laboratory exams, operating room, and professional fees during the entire course of treatment.

Last month, the state health insurer expanded Z benefit packages for both peritoneal dialysis (PD) and kidney transplantation. The Z package for PD now also covers continuous ambulatory peritoneal dialysis and benefits have been set at P389,640 and P510,140 depending on the PD solutions. Meanwhile, Z packages for kidney transplantation were also increased from P600,000 to over P1 million for living organ donor transplantation, and to P2.14 million for deceased organ donor transplantation.

As the nation celebrates NHI Month, individuals from all walks of life are reminded of the significance of healthcare for millions of Filipinos. The Philippines has come a long way in making health insurance more accessible and inclusive, but the journey continues. Through collective support and awareness, the vision of universal health coverage comes closer to reality, ensuring a healthier and more insured future for every Filipino. — Jomarc Angelo M. Corpuz