Transcript KaSAPI - Social Protection

KaSAPI
Extending PhilHealth’s Coverage
to Workers in the Informal Economy
Philippines
Annie A. Asanza, MD
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Context
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Population
36.7m (1970)
85.2m (2005)
Life expectancy
58.1 (1970)
70.0 (2005)
GDP PPP $
1,345 (1975)
5,300 (2005)
Income Gini
46.1 (1957)
51.1 (1964)
46.6 (2003)
Tax revenues (as
% GDP)
Poverty level
Governance
Growth rate =
2.3%
10.1% (1990)
16.3% (2004)
36.8%
Local Government Code 1991
Labour Force
Wage Earners
49.8%(2000) 22% (2000)
50.5% (2006)
Own-account
Workers
50.2%(2000) 78% (2000)
49.5% (2006)
Country Context
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55% from private sources
37.5% from government
8% from SHI
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EDSA
Revolution
Local
Government
Code
Growth of community-base health financing schemes
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KaSAPI
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Year 2003 low coverage of informal economy
workers through the Individually Paying Program
PhilHealth embarked on a tie-up with small credit
cooperatives for enrollment of their members
Tested with 11 cooperatives in 2 regions
Cooperatives were evaluated based on financial
indicators used for cooperatives by the
Department of Finance  allowing them to
perform functions i.e. marketing, collection
based on their classification
Cooperatives gets an incentive for every new
member and amount remitted to PhilHealth
PhilHealth Organized Group
Interface (POGI)
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Cooperatives used loans to pay for PhilHealth
premiums high default rate
High administrative cost for partner
organization groups
Not attractive enough  high out of pocket
spending due to expensive medicines &
unregulated practice of health care providers
Low awareness on health insurance 
increase advocacy on its advatages and
benefits
Strengthen PhilHealth’s administrative
capacity
ILO-GTZ-WHO Evaluation of POGI
March 2005
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Only 77% of IPP
members are actively
paying.
1500000
Approximately only 19%
of informal economy
workers are covered by
PhilHealth.
1000000
500000
Own
Account Workers
0
Registered IPP Members
Paying IPP
MANDATE FOR UNIVERSAL COVERAGE
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Problems on demand-side
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De facto voluntary decision for household. As a result,
low coverage levels – approx 14% of the target group
enrolled.
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Premium $20 per annum for family; generally acceptable
but people want to pay weekly/monthly given uncertain
income. Many remote communities, with little health
infra.
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Irregular contributions / coverage:
 only two-third of members registered in PhilHealth’s
voluntary ‘individual paying programme’ pay regularly

Adverse selection creates financial instability:
 Estimated that programme targeting informal sector
made 121% loss in 2005
174% increase in number of paid
claims (IPP 2002-05)
Utilization Rate
5.2
1.9
Year
Claim Value
12% increase in average claim
value (IPP 2002-05)
Year
Problems on supply-side
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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
Response to unstable coverage /
contributions
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Rather than targeting individual households
directly, target groups, and mirror employeremployee relationship (admin efficiency gains,
limit adverse selection).
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Piggy-back on collection systems of microfinance
/ cooperative organisations who collect very
regularly from clients (greater flexibility for
client).
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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 adverse selection
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Promote mandatory enrolment within
microfinance organisation (efficient risksharing). Strong demand for health insurance
by MFI/Coop management for their members.
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Set minimum group size. Currently set at 70%
(counter adverse selection).
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How to enforce? Offer discounted premium.
Similar approach to private health insurance
approaching companies.
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Should also help to limit coverage instability –
partner loses income (through discounted
premium) if enrolment drops below 70%.
Kalusugang
Sigurado at
Abot-Kaya sa
PhilHealth
Insurance
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5,000,000
4,000,000
3,000,000
2,000,000
APPROXIMATELY, ONLY 56%
OF WAGE EARNERS AND
SALARIED WORKERS ARE
COVERED.
1,000,000
-
Wage Earners & Salaried Workers
Mandate for universal coverage
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X…
X
VII
I…
II
-
N…
PhilHealth has extended
1,000,000.00
sponsorship to more
families than it should.
500,000.00
Families Living Below the
Poverty Line
Sponsored Families
MANDATE FOR UNIVERSAL COVERAGE
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Protection from financial
implications of illness
“Increased” benefits for
KaSAPI members
Flexibility of payment
Time and hassle
savings
Lower premium
Informal
Economy
Workers
Increased and
sustained coverage
Improved financial
stability of the NHIP
Fulfilment of social
mission – reduce
members’
vulnerability
Financial stability
Administrative efficiency
PhilHealth
Microfinance
Institution
Stable health insurance organization
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
National Health Insurance Act
◦ Universal coverage by 2015
◦ Partnership with community based health care
organizations, health management
organizations, local government units
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KaSAPI is a partnership
◦ Microfinance institutions
◦ Cooperatives
◦ Rural Banks
Mandate for Universal Coverage
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PhilHealth Board Resolution 719 approved
September 2004
 KaSAPI launched on September 2005 in 7
pilot regions
 At present, 15 partners …. And counting
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KaSAPI
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Organized Groups and PhilHealth
Partners in implementing NHIP
(Conceptual framework)
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Members of Organized Groups
ORGANIZED
GROUPS
PhilHealth
• Recruitment/enrollment
• Capability building (IEC)
• Conduct of IEC/Advocacy
• ID Generation
• Collection & remittance of
members’ contribution
• Benefit Payment
• Group Premium Rate
• Submission of reports
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Mode of Payment
ANNUAL
PERCENT OF
GROUP SIZE
MEMBERS
BAND
ENROLLED
85%
8A
4000 & up
70%
7A
85%
6A
3000-3999
70%
5A
85%
4A
2000-2999
70%
3A
85%
2A
1000-1999
70%
1A
ONE-YEAR
1,083
1,089
1,094
1,100
1,106
1,112
1,117
1,123
GROUP PREMIUM
Three
Annual
Quarters
1,083
812
1,089
816
1,094
821
1,100
825
1,106
829
1,112
834
1,117
838
1,123
842
Mode of Payment
SEMI-ANNUAL
GROUP PREMIUM
PERCENT OF
GROUP SIZE
MEMBERS
BAND
ONE-YEAR
Semi-Annual
ENROLLED
85%
8S
1,094
547
4000 & up
70%
7S
1,100
550
85%
6S
1,106
553
3000-3999
70%
5S
1,112
556
85%
4S
1,117
559
2000-2999
70%
3S
1,123
562
85%
2S
1,129
565
1000-1999
70%
1S
1,135
567
Mode of Payment
QUARTERLY
PERCENT OF
GROUP SIZE
MEMBERS
BAND
ENROLLED
85%
8Q
4000 & up
70%
7Q
85%
6Q
3000-3999
70%
5Q
85%
4Q
2000-2999
70%
3Q
85%
2Q
1000-1999
70%
1Q
Two
Quarters
541
544
547
550
553
556
559
562
One
Quarter
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275
276
278
279
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One
Quarter
274
275
276
278
279
281
282
284
GROUP PREMIUM
ONE-YEAR
Quarterly
1,105
1,111
1,117
1,123
1,129
1,135
1,141
1,147
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285
287
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Conference on Extending Social
Health Insurance to Informal
Economy Workers – Manila,
October 2006
Involvement of other
partners in the program 
DOF, DOLE, NEDA, DBP,
RBAP, MFC, NATCCO,
PinoyME, labour groups
http://www.gtzhealth-philippines.org
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PhilHealth
◦ Immersion to different types of organized
groups
◦ Training of trainers on “Social Health Insurance
Advocates and Champions (SHIAC) for
Organized Groups”
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Organized Groups
◦ SHIAC
◦ Understanding PhilHealth
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Process Review
◦ In preparation of a national roll out by 2008
Capacity Development
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PhilHealth needed data to support claim
the illness is bad for business among MFIs
 Findings
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◦ Illness is perceived to be a cause of loan
default and drop outs from OGs
◦ Illness, by client or family member, is among
causes of loan default by members
◦ Illness will affect clients more than MFIs
Study: Illness as a Cause of Loan
Default
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Out of a potential 600,000 members from
the 14 OG(s), we have enrolled 4,500 as
of September 2007
◦ Partners were also in a pilot mode, limiting
enrollment to certain areas
◦ Program is voluntary in almost all partners
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Only NGO-MFIs have reached at least the
minimum 700 enrollees
◦ Frequent contacts with members increase
awareness, facilitates easier collection and
monitoring
What have we achieved so far?
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Feedback mechanism on the type and
quality of care given by accredited health
providers
◦ Members found a venue to voice out their
concerns through the OGs
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Membership to PhilHealth by people from
“geographically isolated areas” are
facilitated
What have we achieved so far?
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High drop out rate especially among those
opting to pay on a quarterly basis
◦ Premiums are tied to loans particularly with
MFIs
◦ Partners are now considering financing through
savings, dividends or outright payment
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Administratively taxing for OGs and
PhilHealth
◦ Social marketing activities
◦ Administrative work – seamless integration of
IT system not yet fully there
What are our current challenges?
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Lack of public documents that would
qualify dependents as beneficiaries
 Exclusion of groups that do not qualify the
evaluation criteria
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◦ Workers’ associations
◦ smaller groups like cooperatives that do not
reach minimum number of members = 1000
 Creating a consortium to reach 1000 members is
very difficult
What are our current challenges?
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Premium financing
• Small, frequent payments; sources of financing premiums other than loans
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Access to adequate quality health care
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Accredited health facilities and professionals
Planned implementation of a quality standards
Feedback mechanisms
Improvement of PhilHealth’s current benefit package
Universality
• Extension to informal economy workers
• Equitable scheme
Performance (design and implementation of sound management
information system)
 Inclusion in national strategies, legal framework
 Social marketing
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• Developing marketing messages for members, leaders of community
organizations…PhilHealth officials
Checklist
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http://www.gtzhealth-philippines.org
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