Extending SHI to the Informal Sector in the Philippines:
the conceptual frameworkCHF Best Practice Workhop
1st February 2007Dar es Salaam, Tanzania
Arsenia B. Torres OIC, Office of the Vice President for Membership & Marketing
Philippine Health Insurance Corporation
in collaboration with
Matthew Jowett (PhD)GTZ Advisor to PhilHealth
The problem
The response – KaSAPI
Potential reach
Progress and challenges
Contents
PhilHealth covers approximately 74% of the population as of 2005
Govt. 1,678,880Private 5,616,220Sponsored 2,492,356IPP 2,839,455OFW 545,429NPM 196,650Total 13,368,990
OFW4%
Sponsored
19%
Prvt.42%
IPP
21%
NPM1.5%
Govt.
12.5%
15.5 Million workers or 49% of Labor Force are in the Informal Sector
Source: DOLE News dated May 8, 2005
De facto voluntary decision for household. As a result, low coverage levels – approx 14% of the target group enrolled.
Premium $24 per annum for family; generally acceptable but people want to pay weekly/monthly given uncertain income. Many remote communities, with little health infra.
Irregular contributions / coverage: only one-third of members registered in PhilHealth’s
voluntary ‘individual paying programme’ pay regularly
Adverse selection creates financial instability:
Problems on demand-side
Large public sector bureaucracy has limitations in:
Marketing and selling health insurance
Developing flexible payment systems which meet demands of target group
PhilHealth ideally wants annual premium payments (to stabilise irregular payments), but target population want the opposite
Chasing individual households administratively expensive and highly inefficient
Problems on supply-side
EXPANDING PHILHEALTH PARTNERSHIPS WITH ORGANIZED GROUPS
OBJECTIVES
• Increase enrollment and sustain membership
• Implement an alternative premium payment scheme
• Provide Informal Sector access to quality health care
• Identify and develop innovative approaches of marketing SHI
• Strengthen collaboration with OGs
• Minimize adverse selection
• Strengthen solidarity and risk sharing
Target clientele
Microfinance groups Cooperatives NGOs People’s Organizations CBHCOs
• Recruitment/enrollment
• Conduct of IEC/Advocacy
• Collection & remittance of members’ contribution
• Submission of reports
Premium payment
ORGANIZED GROUPS
PhilHealth
Members of Organized Groups
• Capability building (IEC)
• ID Generation
• Benefit Payment
• Group Premium
Organized Groups and PhilHealth
Partners in implementing NHIP(Conceptual framework)
Hosp. & regular outpatient
MOA Signing
KaSAPI Training
Letter of Intent & Application for Membership
Pre-Selection of Organized Groups
Attendance in NHIP Orientation
Organization’s Board Resolution
PhilHealth Evaluation and Decision
Enrollment of Members
Collection and Remittance
Policy Agreement
Monitoring
GENERAL STEPS FOR KaSAPI IMPLEMENTATION
Benefit Availment
1. Pre-selection of OG
Criteria:
No. of members Size of assets/capital
Clientele
Track Record Accredited health facilities
Area of coverage
ACCREDITATION OF OG
Organizational Stability
• Compliance with legal requirements
• Strength of leadership, operational and management systems in place
Financial Performance
• Efficiency
• Liquidity
• Profitability
• Return on Investment
Assessment/Evaluation
Rather than targeting individual households directly, target groups, and mirror employer-employee relationship (admin efficiency gains, limit adverse selection).
Piggy-back on collection systems of microfinance / cooperative organisations who collect very regularly from clients (greater flexibility for client).
This partnership allows PhilHealth to respond to household’s demand to pay small amounts regularly, whilst the organisation remits annual/semi-annual/quarterly payments to PhilHealth. Up to each partner how to organise internally.
Response to unstable coverage / contributions
Promote mandatory enrolment within microfinance organisation (efficient risk-sharing). Strong demand for health insurance by MFI/Coop management for their members.
Set minimum group size. Currently set at 70% (counter adverse selection).
How to enforce? Offer discounted premium. Similar approach to private health insurance approaching companies.
Should also help to limit coverage instability – partner loses income (through discounted premium) if enrolment drops below 70%.
Response to adverse selection
KaSAPI - triple win
Fulfil social mission; additional
membership; reduced delinquency / bad
debts
PhilHealth
Partner organisation
Informal economy workers
Increased, sustained coverage; improved financial stability of Individual Paying Prog
Payment flexibility; lower premium; more benefits; time & hassle savings
More than a
nice idea
Current KaSAPI partners
PS OO BRLI &
AAE MOA KT EM CR PA BA M K IPP Drop
ISta. Cruz Savings & Development Cooperative
MOA signed October 27, 2006
Nueva Segovia Consortium of Cooperatives
MOA signed October 27, 2006
IIIAlay Sa Kaunlaran, Inc. (ASKI) 812 Total collection = P911,876.00 (annual)Sta. Martin de Tours MPC
IVACenter for Agriculture and Rural 745 44 Drop: shift to employed.Development - Mutual Benefit Assn. 203 M1bs submitted to PhilHealth for validation
VIIITulay Sa Kauswagan, Inc. (TSKI) 808 Total collection = P231,896 (quarterly)Aguyog St. Francis Xavier MPC 26 > 70% of GS. Members enrolled under SP by LGUPerpetual Help MPCGreen Bank 292 Did not meet 70% of GS
XOro Integrated Cooperative (OIC)Oro Savings and Sharing Cooperative (OSSC)
1,422 potential PhilHealth members
XIMindanao Environmental Development Foundation (MED Found)
Under negotiations
Bansalan Cooperative Society MOA signed December 13, 2006CARAGA
Green Bank 168 Did not meet 70% of GSBaug CARP Beneficiaries MPC MOA signed November 9, 2006
TOTAL 1,620 1,231 44
PRO/OGStages of Implementation
REMARKSEnrollment
Consolidated Status of Implementationas of November 2006
Internal PhilHealth systems require further strengthening and development.
Policy design needs continually improvement, needs further simplification – but avoid too many policy changes.
Need to manage impact of indigent programme.
Continue to make group enrolment more attractive than individual enrolment e.g. benefits, waiting period. Potential for introduction of technology e.g. electronic ID card, payment through cell phone.
Challenges / issues
Generate broader movement; involve range of stakeholders in implementation e.g. federation of co-operative organisations.
Limitation: drawn towards areas with better health facility infrastructure (exacerbate equity in access?).
Partners potentially have consumer advocacy role for quality health services; link between government and civil society.
The answer to universal coverage? No, but can make significant impact.
Challenges / issues
HAVE A NICE DAY!