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Study identifies gender, level of income, type of membership, as predictors of Philhealth underutilization

Philippine Health Insurance Corporation (PHILHEALTH) (c)

Researchers from University of the Philippines Manila found that gender, level of income, and type of membership are significant predictors of underutilization of Philhealth benefits.

While Philippine Health Insurance Corporation’s (Philhealth) goal is providing access to quality health care to the poor, the study found that underutilization was highest in the lowest income groups and sponsored members of Philhealth. Ideally, sponsored members or the qualified indigents belonging to the lowest 25% of the Philippine population, should be able to maximize insurance benefits since they are particularly prone to ill-health but they are the ones unable to utilize benefits from Philhealth, according to researchers.  

Moreover, the study revealed that underutilization is more prevalent among males since females have better health seeking behavior.

Underutilization stemmed from the lack of knowledge on benefits and filling insurance claims and non-approval of file claims despite one’s entitlement to do so. The health insurance underutilization weakens effective distribution of public resources highlighting the need for improved mechanism to enable access to quality health care.

According to researchers, dissemination of information on benefits, filing of claims, and services offered by Philhealth should be heightened to increase awareness among Filipinos.

The PhilHealth administers the National Health Insurance Program (NHIP) to provide health insurance coverage and ensure affordable, acceptable, available, and accessible health care services for all citizens of the Philippines.

However, even with the NHIP in place, Philhealth is still struggling in its mission to provide universal health coverage for all Filipinos because of severe underutilization of Philhealth benefits. 

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