The challenges of the Philippines' social health insurance programme in the era of Universal Health Coverage

Objective: To quantitatively and qualitatively describe some of the challenges faced by the Philippines' health insurance programme, PhilHealth, in the era of Universal Health Coverage. Methods: A descriptive study using a mixture of quantitative and qualitative methods. Quantitative data were collected from various sources and semi-structured interviews were conducted among staff of relevant organisations. We focused particularly on the enrolment process among eligible individuals and the system of reimbursement in five local government units (LGUs). Results: The proportion of individuals enrolled as 'poor' exceeded the number officially assessed as being poor by 1-11 times in almost all of the LGUs evaluated. Interviews revealed 'politically indigent' individuals, i.e., the enrolment of non-poor individuals as poor. Several health centres were not receiving reimbursements from PhilHealth, likely due to structural and political deficiencies in the process of claiming and receiving reimbursements. Conclusion: The composition of the sponsored and indigent membership groups requires closer examination to determine whether people who are truly marginalised are left without health coverage. PhilHealth also needs to improve its reaccreditation and reimbursement systems and processes so that health centres can appreciate the benefits of becoming PhilHealth-accredited service providers.