Coverage expanded further in early 2015 when a new 2014 law mandating government-sponsored health insurance for all senior citizens over 60 years of age (not already covered by PhilHealth) come into effect (PHIC 2014).

According to the PhilHealth database, by the end of 2014, 86 million (equivalent to around 85 percent of the population) were beneficiaries (either members or dependents) of PhilHealth. Of these, 43.7 million were indigents, i.e., people below the relevant poverty threshold of the NHTS-PR list and eligible for 100 percent government-subsidized health insurance. Other membership categories include formal sector employees (in government, private sector and working overseas) whose contributions are collected automatically through payroll deductions or other means (27 million), the so-called “informal sector” (which includes not only those employed in the informal economy, but also migrant workers and selfearning individuals and anyone else who is responsible for directly paying their premiums themselves (7.4 million), sponsored members whose premiums are paid by a third party such as a church, local government entity or individual (2.1 million), lifetime members, i.e. retirees who because of a solid contribution record no longer have to pay premiums (1.6 million), and other senior citizens who are also now fully government subsidized (4.3 million).

The second set of policy developments relate to the expansion of the generosity of the PhilHealth benefit package. The package currently includes coverage on an inpatient basis of a wide range of medical cases and surgical procedures at accredited public and private providers; maternity care and newborn care benefits; a few specific outpatient interventions (such as treatment for tuberculosis, rabies, and leptospirosis); a so-called catastrophic “z-benefit” package which includes certain types of cancers, some cardiovascular surgeries, dialysis and kidney transplants, among others; and a primary care benefit package which has recently been expanded to include also screening and treatment for some noncommunicable diseases (such as breast cancer and cervical cancer) and a small medicines benefit. The benefit package for subsidized (poor/indigent) members and non-subsidized members is the same, with the exception that indigent members benefit from a “no balance billing” policy (introduced in 2011). This policy states that PhilHealth-accredited providers (both government and private) are prohibited from charging the poor any fees or charges over and above what is reimbursed by the PhilHealth benefit package (PHIC 2011a, PHIC 2011b, PHIC 2014a).

Insurance premiums are set proportional to income. For the formal sector, annual contributions range between PHP2,400 and PHP10,500 per family, with contributions split equally between employers and employees. Other members pay either PHP2,400 or 3,600, depending on whether their monthly incomes exceed PHP25,000.

There are a number of other policies which, if implemented well, will also help make progress toward financial protection goals. These include the Department of Health’s initiatives to reduce medicines prices such as reference pricing, ceilings on the prices of certain drugs, and the promotion of the use of generic medicines (Picazo 2011)<sup>2</sup> , as well as a shift in the payment of providers at the hospital level from fee-for-

> This situation arises because of the definition of dependents used for insurance purposes which excludes, for example, children over the age of 21, as well as grandchildren or grandparents of the principal member.

> 2 These include, among others, a Generics Act (1988) to mandate the use of generics terminology in prescriptions, the mandatory use of a national drug formulary in the public sector (2006), the Cheaper Medicines Act (2008) intended to increase competition in the pharmaceutical sector, an administrative order to introduce referencing pricing for drug selection, the Presidential executive order on maximum drug retail prices, as well as specific

3