Background
Methods
Literature search
Year | Title/description |
---|---|
1992 | RA 7432; an act to maximize the contribution of senior citizens to nation building, grand benefits and special privileges, and for other purposes |
1995 | RA 7875; National Health Insurance Act of 1995—creation of PhilHealth with coverage under 50% |
2004 | RA 9257; Expanded Senior Citizens Act of 2003, an act granting additional benefits and privileges to senior citizens and amending RA 7432 |
2004 | RA 9241; an act amending RA 7875, stipulated that indigent contributions shall be subsidized by the local government units (LGUs) and the national government |
2004 | Executive Order 276 s. 2004; “Plan 5/25M” enrolled 4.2 million poor families or 21.2 million individuals into the PhilHealth program, funded by the Department of Budget and Management (DMBM) and Philippine Charity Sweepstakes Office (PCSO) |
2004 | RA 9334; the Congress, through this act, earmarked 2.5% of government revenues from taxes on sin products to the National Health Insurance Program (NHIP) |
2008 | RA 9502; Universally Accessible Cheaper and Quality Medicines Act providing for cheaper and quality medicines and amending other related laws |
2010 | RA 9994; Expanded Senior Citizens’ Act of 2010, stipulating that all indigent senior citizens shall be covered by the NHIP of PhilHealth |
2010 | Department of Health (DOH) Administrative Order (AO) 2010-0036; focused on increasing enrollment coverage, improving availment of benefits and improved facility preparedness through the Health Facility Enhancement Program (HFEP) |
2011 | PhilHealth Circular No. 011-2011; “No Balance Billing Policy” applied to all PhilHealth Sponsored Program members for specified cases |
2012 | PhilHealth Circular No. 048-2012; the Z Benefit Package developed by PhilHealth aimed to increase financial risk protection using cost-effective interventions |
2012 | RA 10351; Sin Tax Law—restructuring the excise tax on alcohol and tobacco products and amending the National Internal Revenue code of 1997 |
2013 | RA 10606; amending RA 7875, shifted subsidizing PhilHealth premiums for Sponsored Program families to the DOH, and the Sin Tax Law to finance expanding of the Sponsored Program |
2014 | RA 10645; an act providing for the mandatory PhilHealth coverage for all senior citizens and amending the Expanded Senior Citizens Act of 2010 |
2019 | RA 11223; Universal Health Care (UHC) Act prescribing reforms in the healthcare system |
Analysis of Philippine National Demographic and Health Survey data
Variables
National Health Insurance Program (NHIP) coverage
Self-reported illness
Healthcare utilization (outpatient care utilization and inpatient care utilization)
Socio-economic variables
Statistical analysis
Variables | 2003 (%), N = 3899 | 2008 (%), N = 4385 | 2013 (%), N = 5564 | 2017 (%), N = 11,369 | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
NHIPa | NHIPa | Self-reported illness | Outpatient use | Inpatient use | NHIPa | Self-reported illness | Outpatient use | Inpatient use | NHIPa | Self-reported illness | Outpatient use | Inpatient use | |
Overall (%) | 9.4 | 35.3 | 20.5 | 13.3 | 8.8 | 57.9 | 27.0 | 15.6 | 8.6 | 87.6 | 28.3 | 18.7 | 12.4 |
Age (years) | |||||||||||||
60–69 | 10.8 | 37.2 | 18.5 | 12.0 | 7.0 | 60.6 | 23.5 | 13.0 | 7.2 | 85.4 | 28.6 | 18.2 | 11.9 |
70–79 | 7.7 | 33.7 | 23.5 | 15.3 | 10.8 | 56.7 | 32.3 | 20.6 | 9.6 | 90.8 | 29.4 | 20.2 | 14.0 |
80 or above | 5.8 | 29.6 | 23.0 | 14.8 | 12.8 | 46.4 | 32.5 | 16.6 | 13.1 | 91.1 | 23.4 | 17.4 | 11.5 |
*** | ** | *** | * | *** | *** | *** | *** | *** | *** | *** | * | ** | |
Gender | |||||||||||||
Male | 12.2 | 36.4 | 19.6 | 13.0 | 9.5 | 60.7 | 26.5 | 13.9 | 8.3 | 87.1 | 36.2 | 24.9 | 18.3 |
Female | 6.9 | 34.4 | 21.2 | 13.5 | 8.2 | 55.8 | 27.4 | 16.9 | 8.7 | 88.0 | 21.9 | 13.7 | 7.7 |
*** | *** | ** | *** | *** | *** | ||||||||
Residence | |||||||||||||
Rural | 6.8 | 32.0 | 22.8 | 13.1 | 9.0 | 57.2 | 29.9 | 16.3 | 8.3 | 87.0 | 29.5 | 18.7 | 13.3 |
Urban | 12.7 | 39.7 | 17.4 | 13.5 | 8.5 | 59.1 | 22.5 | 14.4 | 9.0 | 89.1 | 25.5 | 18.5 | 10.4 |
*** | *** | *** | *** | ** | *** | *** | |||||||
Education | |||||||||||||
No education | 2.9 | 15.3 | 21.4 | 10.3 | 6.3 | 34.5 | 28.3 | 13.2 | 7.6 | 74.1 | 22.7 | 10.5 | 8.4 |
Primary | 5.8 | 28.8 | 20.9 | 12.7 | 8.4 | 53.5 | 28.3 | 15.2 | 8.6 | 86.1 | 29.9 | 18.8 | 12.3 |
Secondary | 12.6 | 42.1 | 21.5 | 14.4 | 10.3 | 57.9 | 25.8 | 15.1 | 8.1 | 87.9 | 29.0 | 19.6 | 14.5 |
Higher | 29.3 | 61.4 | 17.2 | 15.5 | 9.5 | 79.1 | 24.5 | 18.0 | 9.3 | 95.3 | 24.7 | 19.6 | 11.6 |
*** | *** | *** | *** | *** | *** | *** | |||||||
Wealth index | |||||||||||||
Poorest | 4.1 | 20.1 | 24.2 | 10.4 | 6.6 | 48.3 | 29.4 | 12.1 | 6.1 | 81.5 | 29.4 | 16.3 | 10.2 |
Poorer | 5.0 | 28.7 | 23.6 | 12.0 | 8.8 | 52.4 | 27.9 | 15.7 | 7.3 | 86.3 | 30.3 | 18.4 | 12.7 |
Middle | 8.4 | 32.3 | 20.8 | 13.5 | 8.7 | 55.2 | 29.0 | 16.2 | 10.7 | 87.4 | 28.8 | 19.8 | 13.8 |
Richer | 11.0 | 43.5 | 17.9 | 14.6 | 9.9 | 57.5 | 25.7 | 16.5 | 8.7 | 89.4 | 27.7 | 19.0 | 13.8 |
Richest | 18.5 | 50.7 | 16.1 | 15.7 | 9.6 | 72.3 | 24.0 | 16.5 | 9.4 | 94.4 | 24.6 | 20.2 | 12.0 |
*** | *** | *** | * | *** | * | * | ** | *** | *** | ** | ** | ||
Relationship to HHc | |||||||||||||
Self | 12.2 | 36.3 | 22.4 | 14.9 | 9.4 | 60.3 | 29.7 | 17.1 | 8.5 | 88.3 | 39.5 | 28.2 | 19.8 |
Spouse | 7.4 | 41.4 | 22.6 | 13.8 | 8.6 | 65.7 | 27.1 | 16.8 | 8.8 | 89.1 | 16.8 | 6.6 | 2.0 |
Others | 3.5 | 26.3 | 12.9 | 8.2 | 7.1 | 42.2 | 18.8 | 9.6 | 8.5 | 82.6 | 2.9 | 0.6 | 0.4 |
*** | *** | *** | *** | *** | *** | *** | *** | *** | *** | *** | |||
Number of HHc | |||||||||||||
1–2 | 8.7 | 28.8 | 28.3 | 16.4 | 9.5 | 52.4 | 39.6 | 21.7 | 8.8 | 87.5 | 28.1 | 17.5 | 10.6 |
3–4 | 10.3 | 39.3 | 23.2 | 14.5 | 8.3 | 60.1 | 27.3 | 16.9 | 8.9 | 88.9 | 27.4 | 18.4 | 11.7 |
5 or more | 9.1 | 35.8 | 15.1 | 11.1 | 8.7 | 59.1 | 20.8 | 11.7 | 8.2 | 86.6 | 29.1 | 19.7 | 14.4 |
*** | *** | *** | *** | *** | *** | ** | *** | ||||||
NHIPa coverage | |||||||||||||
No | 19.9 | 11.7 | 6.7 | 25.1 | 13.0 | 5.7 | 22.7 | 12.7 | 6.3 | ||||
Yes | 21.5 | 16.2 | 12.6 | 28.5 | 17.4 | 10.7 | 29.1 | 19.5 | 13.3 | ||||
*** | *** | ** | *** | *** | *** | *** | *** | ||||||
Self-reported illness | |||||||||||||
No | 34.9 | 5.2 | 6.9 | 56.8 | 6.2 | 5.9 | 86.6 | 8.7 | 8.4 | ||||
Yes | 37.0 | 44.8 | 16.2 | 61.0 | 40.7 | 15.8 | 90.1 | 43.9 | 22.8 | ||||
*** | *** | ** | *** | *** | *** | *** | *** | ||||||
Outpatient care use | |||||||||||||
No | 34.1 | 13.0 | 6.1 | 56.6 | 19.0 | 6.0 | 86.7 | 19.5 | 8.4 | ||||
Yes | 43.0 | 69.1 | 26.5 | 64.8 | 70.6 | 22.3 | 91.6 | 66.5 | 30.0 | ||||
*** | *** | *** | *** | *** | *** | *** | *** | *** | |||||
Inpatient care use | |||||||||||||
No | 33.8 | 18.8 | 10.7 | 56.6 | 24.9 | 13.2 | 86.7 | 24.9 | 14.9 | ||||
Yes | 50.8 | 37.8 | 40.1 | 72.1 | 50.0 | 40.6 | 93.8 | 51.7 | 44.9 | ||||
*** | *** | *** | *** | *** | *** | *** | *** | *** |
Concentration index
Variables | Concentration index (C) | Absolute contribution to Cc | Percentage contribution to Cc (%) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
2003 | 2008 | 2013 | 2017 | 2003 | 2008 | 2013 | 2017 | 2003 | 2008 | 2013 | 2017 | |
NHIPa coverage | ||||||||||||
Concentration index | 0.3000 | 0.1803 | 0.0806 | 0.0247 | ||||||||
Education | ||||||||||||
Primary | − 0.123 | − 0.187 | − 0.196 | − 0.228 | − 0.010 | − 0.029 | − 0.022 | − 0.015 | − 3.3 | − 15.8 | − 27.3 | − 60.0 |
Secondary | 0.264 | 0.228 | 0.143 | 0.105 | 0.024 | 0.023 | 0.008 | 0.004 | 8.0 | 12.8 | 9.6 | 14.6 |
Higher | 0.602 | 0.564 | 0.525 | 0.530 | 0.164 | 0.091 | 0.054 | 0.024 | 54.8 | 50.7 | 66.8 | 98.6 |
Wealth index | ||||||||||||
Poorer | − 0.455 | − 0.486 | − 0.526 | − 0.485 | − 0.007 | − 0.018 | 0.000 | − 0.003 | − 2.3 | − 10.2 | − 0.4 | − 11.0 |
Middle | − 0.054 | − 0.106 | − 0.137 | − 0.114 | − 0.004 | − 0.005 | − 0.001 | − 0.001 | − 1.4 | − 2.5 | − 1.1 | − 3.1 |
Richer | 0.370 | 0.314 | 0.277 | 0.294 | 0.027 | 0.032 | 0.004 | 0.003 | 9.0 | 17.6 | 4.9 | 10.8 |
Richest | 0.793 | 0.771 | 0.746 | 0.755 | 0.118 | 0.088 | 0.044 | 0.016 | 39.3 | 48.7 | 54.6 | 64.7 |
Self-reported illness | ||||||||||||
Concentration index | − 0.0972 | − 0.0474 | − 0.0965 | |||||||||
Education | ||||||||||||
Primary | − 0.187 | − 0.196 | − 0.228 | − 0.002 | 0.009 | − 0.004 | 2.1 | − 19.3 | 4.2 | |||
Secondary | 0.228 | 0.143 | 0.105 | 0.009 | − 0.005 | 0.000 | − 9.6 | 9.6 | − 0.1 | |||
Higher | 0.564 | 0.525 | 0.530 | 0.002 | − 0.021 | − 0.023 | − 1.7 | 43.8 | 24.4 | |||
Wealth index | ||||||||||||
Poorer | − 0.486 | − 0.526 | − 0.485 | 0.000 | 0.004 | 0.004 | 0.2 | − 8.9 | − 3.9 | |||
Middle | − 0.106 | − 0.137 | − 0.114 | 0.003 | − 0.002 | 0.002 | − 3.5 | 4.6 | − 2.2 | |||
Richer | 0.314 | 0.277 | 0.294 | − 0.015 | 0.002 | − 0.008 | 15.1 | − 4.4 | 8.7 | |||
Richest | 0.771 | 0.746 | 0.755 | − 0.050 | 0.004 | − 0.050 | 51.1 | − 9.1 | 53.1 | |||
Outpatient care utilization | ||||||||||||
Concentration index | 0.0821 | 0.0348 | 0.0347 | |||||||||
Education | ||||||||||||
Primary | − 0.187 | − 0.196 | − 0.228 | − 0.005 | 0.006 | − 0.024 | − 6.5 | 17.3 | − 68.8 | |||
Secondary | 0.228 | 0.143 | 0.105 | 0.002 | − 0.002 | 0.005 | 2.7 | − 5.6 | 13.3 | |||
Higher | 0.564 | 0.525 | 0.530 | 0.004 | 0.005 | 0.000 | 4.5 | 14.8 | 0.4 | |||
Wealth index | ||||||||||||
Poorer | − 0.486 | − 0.526 | − 0.485 | − 0.010 | − 0.026 | − 0.005 | − 12.1 | − 74.8 | − 15.1 | |||
Middle | − 0.106 | − 0.137 | − 0.114 | − 0.004 | − 0.008 | − 0.003 | − 5.3 | − 23.9 | − 9.3 | |||
Richer | 0.314 | 0.277 | 0.294 | 0.029 | 0.021 | 0.013 | 34.7 | 61.6 | 36.7 | |||
Richest | 0.771 | 0.746 | 0.755 | 0.081 | 0.065 | 0.057 | 99.0 | 187.6 | 164.8 | |||
Inpatient care utilization | ||||||||||||
Concentration index | 0.0496 | 0.0625 | − 0.0010 | |||||||||
Education | ||||||||||||
Primary | − 0.187 | − 0.196 | − 0.228 | − 0.016 | − 0.006 | − 0.011 | − 33.0 | − 9.6 | 113.8 | |||
Secondary | 0.228 | 0.143 | 0.105 | 0.012 | − 0.003 | 0.004 | 23.2 | − 4.3 | − 36.8 | |||
Higher | 0.564 | 0.525 | 0.530 | 0.014 | − 0.005 | − 0.001 | 27.8 | − 8.2 | 5.2 | |||
Wealth index | ||||||||||||
Poorer | − 0.486 | − 0.526 | − 0.485 | − 0.013 | − 0.014 | − 0.016 | − 27.2 | − 22.7 | 161.9 | |||
Middle | − 0.106 | − 0.137 | − 0.114 | − 0.003 | − 0.013 | − 0.005 | − 6.1 | − 21.4 | 50.4 | |||
Richer | 0.314 | 0.277 | 0.294 | 0.012 | 0.017 | 0.022 | 23.4 | 27.6 | − 222.2 | |||
Richest | 0.771 | 0.746 | 0.755 | 0.040 | 0.050 | 0.029 | 81.0 | 80.2 | − 291.4 |