1. Healthcare Innovation: Philippine
National Health Insurance
Teodoro J. Herbosa MD FPCS
College of Medicine
University of the Philippines, Manila
Undersecretary (Deputy Minister) of Health (2010-2014)

2. PHILIPPINE HEALTHCARE
✤ Established by the Americans in 1900’s!
✤ Two systems in one: Public Health System for the poor and
Private Health Care for those willing to pay!
✤ 1970s-1990s decline of public health funding and expenditure!
✤ 1991 Decentralization of Public Healthcare to Local government
units!
✤ 1994 National Health Insurance Act Universal Health Care
coverage for all by 2010.

3. PHILIPPINE HEALTH
INSURANCE CORPORATION
✤ Replaced the Medicare Commission of the GSIS/SSS!
✤ Premium based health care insurance!
✤ Initially covered employed persons - shared premium
payments by employee & employer!
✤ Indigents’ premiums shared by National government and local
government!
✤ Premiums were paid by Local Chief Executives only on an
election year

4. PHILIPPINE HEALTH
INSURANCE CORPORATION
✤ Premium was @ US$2/month with hospitalization benefits only!
✤ Only 50% of the population was covered by 2010!
✤ Support value of Reimbursements were about 30% for simple
cases and about 10% for Catastrophic illnesses!
✤ There were cases of fraud!
✤ Health Inequity was further enhanced!
✤ private HMO’s filled a gap

5. THE PHILIPPINE HEALTH AGENDA
Universal Health Care or Kalusugan Pangkalahatan, has three
strategic thrusts:

6. Universal Health Care / Kalusugan Pangkalahatan
Improved Health
especially for the
Poor and
Vulnerable
Secure access
to quality
care at
facilities
Achieve the
public health
MDGs
Provide
financial risk
protection
INTERVENTIONS OF
CARE
Prim
ary
Prevention
and
H
ealth
Prom
otion
Curative
H
ealth
Care
Secondary
Prevention and
Primary Care

7. Universal Health Care
Kalusugan Pangkalatan
Health Risk Financing and Payment schemes reforms
Access to quality and affordable health care -
modernization
Improved Public Health Outcomes focused on Maternal
and Child Health
eHealth National eHealth Strategic Plan and Framework

8. Health Financing
Premium payments of the poor shouldered by National government
Targetting the poorest
Using Sin Tax revenues for sustainable financing
Increased Health expenditure by government
Catastrophic Illness packages
Primary Care Benefit
Case Payment scheme/Capitation payments

9. Improved Benefits packages
In patient benefits
Outpatient benefits
Z Benefits
MDG related benefits