and assess the effect of primary care medicines benefit (for twelve conditions) that has been included as part of the expanded primary care benefit package on prescribing behavior and financial protection before considering additional medicines benefits.

_5.3.4 Match the expansion of health care demand through health insurance with supply-side readiness_ Reaching financial protection goals will require matching the expansion of the demand for health care through health insurance with supply-side readiness, in other words ensuring that there are PhilHealthaccredited health facilities within close geographic proximity of all PhilHealth members. In this regard, there have been great improvements, even within the last year: according to the PhilHealth database, between December 2013 and December 2014, the percentage of towns and municipalities with an outpatient clinic (government or private) that has been accredited by PhilHealth to deliver the primary care benefit package has increased from 79 percent to 93 percent. For the maternity care package, the share increased from 62 percent to 71 percent and for the TB DOTS package (for tuberculosis), the share increased from 67 percent to 75 percent (PHIC 2014, PHIC 2015). Next steps would likely need to involve both further improvements in the share of LGUs with accredited facilities, but also efforts to improve the quality of service delivery within the accredited facilities.

Local governments, which in the decentralized health delivery context of the Philippines are responsible for facility and human resource provision, will need to invest more in the quality of local health facilities. Local government investments can be complemented by the careful targeting, and speedier implementation, of the resources of the Health Facilities Enhancement Program (HFEP) through which the national government supports health facility construction and renovations. Without quality accredited health facilities, PhilHealth members will not be able to benefit from their coverage.

# **6. Conclusion**

With the passage of several landmark policies – expansion of health insurance coverage, the no balance billing policy, a renewed emphasis on primary care, and several provider payment reforms – the Philippines has put itself on the right track to reaching the UHC goal of financial risk protection. Many of these policies are relatively new, having been implemented within the last five years, and it may be too soon to comment on their effectiveness (or lack of effectiveness) in containing out-of-pocket spending and providing financial protection. Indeed, many of the key reforms were implemented only after the 2012 FIES survey, which is the most recent instrument available with which to assess financial protection.

Still, it is clear that up until 2012, the Philippines had been making very little progress towards financial protection and, if anything, going backwards. Every year since 2000, out-of-pocket spending had climbed, catastrophic payments had increased and impoverishing expenditure did not diminish. Consequently, the new reforms are to be applauded.

To speed progress toward financial protection goals, the Philippines could increase efforts to ensure that all those enrolled in PhilHealth know of their eligibility and of their benefits, improve compliance with the ‘no balance billing’ policy, and continue to reform the way that providers are reimbursed in order to further incentivize cost containment. Quick wins in this regard could include increasing benefit awareness by issuing health insurance cards for poor members and increasing the predictability of health expenditures by complementing the no balance billing policy of the poor (equivalent to zero copayments) with a fixed copayment for non-poor members.

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