The data suggest that there has not been much progress on financial protection goals in the Philippines over the last 17 years, at least as measured using the catastrophic and impoverishing health expenditure methodologies, nor in reducing the amount that Filipinos spend out-of-pocket on health. Also, while the overall incidence of catastrophic payments is not unusually high from a regional perspective, the large amounts of money spent on health-related costs among those who incur catastrophic spending suggests a great vulnerability among this segment of the population.

While the data used in this analysis are the most recent available data for the Philippines, they pre-date or are coincident with many of the recent pro-poor reforms of the Department of Health and PhilHealth, including the recent large expansion of nationally-subsidized health insurance and some of the more recent additions to the PhilHealth benefit package. Consequently, the results of this analysis do not yet reflect the impact of recent policies aimed at enhancing financial protection. Rather, the results of the analysis serve as validation that recent reforms were very much needed and also as motivation to ensure that these policies are well-implemented.

What additional steps can be taken to ensure that recent policies translate into better financial protection for all Filipinos?

_5.3.1 Ensure that all PhilHealth beneficiaries know of their entitlement and their benefits, especially the poor_ First and foremost, efforts need to be made to ensure that all PhilHealth members know that they are covered and know of their full range of benefits. This applies particularly to the poor and near-poor who are members by virtue of their poverty status (and have their premiums paid directly by the national government) and not by virtue of having actively enrolled, either by themselves or indirectly through their employer.

Indeed, household survey data confirm that not all PhilHealth beneficiaries know of their benefits. In 2011, when the PhilHealth database reported almost 80 million members (equivalent to around 80 percent of the population), only 49 percent of survey respondents (households) reported having PhilHealth (authors’ estimates, using FHS 2011)<sup>10</sup> . Worse, the share of the poorest quintile reporting health insurance coverage was only 37 percent, despite the fact that this group should be completed covered by tax-subsidized insurance (authors’ estimates, using FHS 2011)<sup>11</sup> . By 2013, when the PhilHealth database was reporting around 83 million beneficiaries (equivalent to around 83 percent of the population), survey data showed an insurance coverage rate of 61 percent of the population (authors’ estimates, using DHS 2013). If the share of eligible members who know of their entitlement to coverage is so low, then the number of people with full knowledge of their range of benefits – a factor which influences whether one uses one’s insurance when seeking care – would be even smaller.

PhilHealth is implementing a number of activities to improve benefit awareness. These include radio, television and newspaper advertisements, information sessions for the beneficiaries of the conditional

> 10 Estimates from the PhilHealth database and household surveys are not expected to be exactly the same since surveys use households as the unit of analysis whereas PhilHealth enrolls families. However, this factor cannot account for the very large differences observed, however.

> 11 The asset index that the FHS uses to categorize households into quintiles does not have the same components as the proxy means test that is used to classify households as “poor” for the purposes of health insurance subsidies, but, again, this does not fully account for the low level of coverage observed among this group.

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