Filling Potholes on the Road to Universal Health Coverage in the Philippines

Joseph J. Capuno, Aleli D. Kraft*, OA (Owen) O'Donnell

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
159 Downloads (Pure)


The fraction of health-care costs financed from prepayment sources is a critical indicator of progress toward Universal Health Coverage. But it does not tell how prepayment varies with the level of health-care costs and between poorer and richer patients. This paper used survey data from the Philippines to estimate inpatient costs paid by the National Health Insurance Program (aka PhilHealth) in 2013–2017 when attempts were made to extend population, service and financial coverage. The mean fraction of the inpatient bill paid by PhilHealth increased by 21 percentage points. Expansions of population coverage do not appear to have been primarily responsible for this increase. Despite the introduction of a catastrophic cover benefit package, the fraction of inpatient costs that were prepaid increased more at lower costs than at higher costs. PhilHealth payments for inpatient care were pro-rich but became substantially less so, possibly because hospitals were no longer permitted to charge poor patients in excess of reimbursement ceilings. Overall, prepayment of inpatient costs increased and became more pro-poor, reflecting gains in insurance and equity.

Original languageEnglish
Article numbere1911473
Number of pages16
JournalHealth systems and reform
Issue number2
Publication statusPublished - 1 Jul 2021

Bibliographical note

Funding Information:
This work was supported by the Schweizerischer Nationalfonds zur F?rderung der wissenschaftlichen Forschung [Grant 400640_160374].

Publisher Copyright:
© 2021 World Bank. Published with license by Taylor & Francis Group, LLC.


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