Here’s a pop quiz to check your knowledge about PhilHealth, our national health insurance system. Give your answers to the following questions, then read on to find out which of them you got right.
Can domestic employees (your yaya, driver) be enrolled? Can a sidewalk vendor enroll herself? What about overseas Filipino workers? Can an illegitimate child be a beneficiary?
I recently had to call a friend, Dr. Madeline Valera at Philippine Health Insurance Corp. (PhilHealth) to ask some of those questions and ended up with a lot of information that I thought I should use two columns to share with readers. Dr. Valera, senior vice president for health finance policy, is proud of what PhilHealth is doing right now, but she is also full of dreams around how PhilHealth could do more.
Social solidarityFor all the cynicism people have about our public health care system, I have to say PhilHealth does make a difference. It’s evolved through the years, expanding the number of medical procedures that are reimbursable and extending PhilHealth to self-employed people and the informal sector.
Before we go into specifics about who and what can be covered, I did want to talk a bit about the principles that guide public health insurance, which will allow me to push readers to explore how they can use PhilHealth to help others.
Government health care systems vary across the world, the strongest ones built on a national health care system financed by government, through contributions of its citizens. Many European countries use such a system, with citizens paying a fixed amount of their income, ranging from 7 percent to 12 percent, going to the national health service. That percentage may seem high but in those countries people do get many benefits—for example, paying a fixed price for each prescription (regardless of the type of medicine), and getting almost all hospital services for free. They even get a transportation allowance!
Our system, unfortunately, is more closely patterned after the United States’, where health care is left largely to the private sector and, supposedly, free-market competition. The assumption here is that competition leads to better health care.
In a way, that assumption is true . . . but only if you can afford the private hospitals. If you can’t, then you better have coverage from health maintenance organizations (which we have as well in the Philippines) but which have many limitations, including the cost of premiums. The last resort you have in such a system would be government health insurance and public institutions but in both the US and the Philippines, even that system is inaccessible.
Health insurance is based on social solidarity, the rich paying more to help the poorer members of society. Not only that, there is solidarity in the sense that young, healthy people pay for the greater health risks of children, the elderly, the chronically ill (e.g., someone with a very serious kidney disease), and the disabled. Social solidarity through health insurance becomes even more important in times of a financial crisis. Just think, for example, of the overseas workers losing their jobs abroad and coming home with some savings that can be wiped out completely with one major illness.
The financial crisis has certainly made Americans rethink their health care, wondering if maybe a bit of “socialistic” health care might not be too bad. Public health insurance does benefit individuals and society. After all, if you don’t do your share to help take care of the elderly or the poor, then you still end up losing because the entire country ends up with too many unhealthy people. That’s actually what’s happening in the Philippines, with the poor having to run to politicians for doles (which actually come from our taxes), or to richer relatives and kinder employers, as many of my readers have experienced. In all these cases, the help is limited and can pay only for substandard care, sometimes leading to even more expenses.
Who can enroll?Who can enroll in PhilHealth? The answer is simple: anyone can, as long as you pay the premiums, which are based on income and range from P100 to P750 a month. You can be self-employed as a sidewalk vendor, in which case you pay the total premium yourself; or you can be a corporate executive who will pay P375 a month while your company pays another P375. Overseas workers can also enroll, and this is important for the families they leave behind, as well as for themselves, because hospitalization expenses incurred overseas can also be reimbursed, subject to certain limitations.
There is a cap on monthly premiums, meaning the rate is the same for anyone with a monthly income of P30,000 and above. This cap has been criticized by the likes of former health secretary Alberto Romualdez, and rightly so since in a way those earning P30,000 a month are actually subsidizing someone earning P300,000 a month.
What you do need to know is that paying premiums for a quarter, which is the minimum, doesn’t automatically allow you to reimburse medical expenses. Self-employed PhilHealth members need to have paid a year’s premiums while those who are employed by someone else need only to have paid six months. Those sponsored by local governments units (many politicians offer such sponsorship for a few months or a year, especially as elections approach) or who are overseas workers and pay premiums on an annual basis are entitled to benefits right after enrollment.
These differences are important. If you’re self-employed then, you cannot just enroll in PhilHealth when you find yourself pregnant, hoping to have your hospital delivery covered. But if you are working for someone, and have been remitting premiums for at least six months, you are covered.
This takes us to potential beneficiaries. PhilHealth’s enrollment forms emphasize that you can only enroll someone you are married to, described in Tagalog as “tunay na asawa,” as long as he or she is not a PhilHealth member. You can also enroll children below the age of 21, whether they are legitimate (“anak na galing sa tunay na asawa”) or illegitimate, unemployed and single. (Those distinctions are important: that means if you have an 18-year-old child who is married, he or she will have to take out Philhealth individually. ) PhilHealth also allows children over the age of 21, but who have a congenital disability, to be covered as a parent’s beneficiary.
Finally, a PhilHealth member can enroll their parents (as well as step-parents) who are over the age of 60, who are not PhilHealth members and who earn less than P1,000 a month. Note that someone over the age of 60 and made 120 monthly contributions to PhilHealth will now be covered for the rest of his or her life, without paying any more premiums.
By Michael Tan, Pinoy Kasi, Philippine Daily Inquirer, May 20, 2009
