Health Insurance Membership and Utilization of Selected Households in a Lake Sub-Watershed Area in the Philippines

Health insurance programs serve as a safety net for the financial impact of health care use. These programs also promote equity on health by addressing disparities in access to health care arising from socioeconomic position. This paper describes health insurance membership and utilization in selected households in a lake sub-watershed area in the Philippines. Self-reported membership and utilization were determined from 379 households in the first quarter of 2013. At least one household member was enrolled in a health insurance program in 72.6% of the study households. Membership in the National Health Insurance Program (PhilHealth) was the most common type of insurance (86.2%). Majority (77.4%) did not utilize their health insurance in the previous year, of which 93.4% indicated not needing in-patient or hospital care as the reason for non-utilization. Among households without health insurance, issues related to application and renewal of health insurance membership (36.3%) was the most commonly cited reason for non-enrolment. These findings demonstrate that although a majority of the households are enrolled in health insurance programs, utilization appears to be low. The findings highlight the importance of expanding benefit packages to include outpatient preventive care. Moreover, there is a need to simplify enrollment procedures so as not to disenfranchise eligible households merely on the basis of documentary requirements. Keywords: health financing, social determinants of health Key Messages 1. Membership in the National Health Insurance Program is high, but utilization remains low. 2. Issues related to application and renewal of membership are primary reasons for non-enrollments in the National Health Insurance Program of some households. 3. Enhancement of the National Health Insurance Program can focus on expanding benefits coverage to include outpatient preventive care, and simplifying enrollment procedures.

Amiel Nazer Bermudez

Department of Epidemiology and Biostatistics - College of Public Health - University of the Philippi