... for the Poor in the Philippines. The PhilHealth Indigen

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• M a b u h a y !

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• M a b u h a y !

You are invited to view Some good news from our c
ountry,
The Philippines . .
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• M a b u h a y !

You are invited to view Some good news from our c
ountry, The Philippines A Poverty-Alleviation E
ffort
through
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The Locality-Based Subsidized Health Insurance
for the Poor in the Philippines
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The Locality-Based Subsidized Health Insurance
for the Poor in the Philippines

• By Ed Aurelio C. Reyes,
• Writer-Researcher in the Philippines

By Ed Aurelio C. Reyes, Writer-Researcher in t
he Philippines
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The Locality-Based Subsidized Health Insurance
for the Poor in the Philippines
PHILHEALTH
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The Locality-Based Subsidized Health Insurance
for the Poor in the Philippines
The PhilHealth Indigents Programme
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The Locality-Based Subsidized Health Insurance
for the Poor in the Philippines
The PhilHealth Indigents Programme
( Also known as the Sponsored Programme )
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Brief SynopsisBrief Description Premises
Context Factors for SuccessKey
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme
PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors for SuccessKey
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme
PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors for SuccessKey
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme
PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the ContextKey
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme
PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme
BRIEF SYNOPSIS WHAT a health insurance system
(earlier only for employed) now also
covers more and more mostly
unemployed, impoverished people
HOW synergistic partnership of Phil-
Health system and local government
units.
PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme
BRIEF DESCRIPTION Premises The right to health c
are is one of the basic rights upheld by
promulgations of the United Nations, to be
enjoyed by all citizens of member states
regardless of race, creed, gender, age and social
status. In the Philippines, a health services
insurance systemhad earlier been instituted
mainly for the employed sections of the
population
PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme
BRIEF DESCRIPTION Context In the past two decade
s, the Republic adopted a programme of government
decentralization that promoted local government
empowerment and autonomy. Health care was one of
the basic serv-ices that was devolved to the
local government units (LGUs). As a result of
such devolution, the LGUs could now be motivated
to mobilize them-selves for bigger
responsibilities
PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors for SuccessKey
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme
BRIEF DESCRIPTION Context The PhilHealth system
of the national govern-ment started teaming up
with them. LGUs now sponsor payments for a
growing number of indi-gent constituents.
PhilHealth is giving counter-part funds depending
on each LGUs classifi-cation. Thus the system
has been able to extend its coverage to the
impoverished, largely-unemployed, people in the
poorest communities.
PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the ContextKey
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme
BRIEF DESCRIPTION Factors in the Context
Most Crucial Factor Government decentral
ization with local autonomy. It has facili
tated efforts to provide adequate health c
are services to a fast-growing segment of
un-served or under- served citizens.
PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme

• BRIEF DESCRIPTION Factors in the Context
• Historical Factors This addressed extrernal and
  
  
• internal alienation that had festered
• the long-term effects of centuries of
• colonization, with the center of governance
  
  
• was so distant. (The communities had been
• fragmented, having largely lost their
  indige-
  
• nous soul, the bayanihan spirit, which
  had
  
• bound them for thousands of years)

PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme

• BRIEF DESCRIPTION Factors in the Context
• more than a century of defective governance,
• the communities of the Philippines had been
  
  
• fragmented, having largely lost the
  indige-
  
• nous soul, called the bayanihan spirit,
• which had bound them together for thous-
• ands of years and

PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme

• BRIEF DESCRIPTION Factors in the Context
• the people having lost sufficient social
• support for their traditional health care
• systems which were suppressed in favor of
  
  
• western-oriented and highly commercial
• health care systems that have been
• expensive.

PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme

• BRIEF DESCRIPTION Factors in the Context
• Other factors
• the level of maturity in both the government and
  civil society that was enhanced by the People
  Power upheaval in 1986

PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme

• BRIEF DESCRIPTION Factors in the Context
• Other factors
• progress in highlighting the value of the
  peoples own sense of active stakeholdership and
  in teamworking for various endeavors and
  
• the continuing development of technologies of
  broad participation and initiatives for these.

PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the ContextKey
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme

• KEY ELEMENTS
• The Indigent Programme keeps a list of enrolled
  indigents per locality per year, and serves these
  people in two parallel modes
  
• provision of free out-patient treatment of
• indigents at the municipal/city rural or
• local health units, and
• reimbursement by PhilHealth of
• hospitalization expenses.

PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme
KEY ELEMENTS The RHUs of municipalities and City
Health Centers (CHCs), as well as the hospital
facilities involved, undergo an accreditation
process with PhilHealth to insure adequate
capability to immediately deliver the required
services.
PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme
KEY ELEMENTS In the first mode, PhilHealth reimbu
rses substan-tial portions of enrolled indigents
hospital bills, professional fees and medicine
expenses. This usually ranges from 50 percent to
80 percent on ward rates, estimated at an average
of P1,200 (21.8) per annum, per family. Funds to
cover these expenses are obtained from the
premiums paid jointly by the LGU and PhilHealth.
PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme
KEY ELEMENTS In the second mode, the Indigent Pro
gramme uses the capitation (per capita) scheme to
fund out-patient services in RHU/CHC facilities
and for other purposes which are decided by the
recipient LGU. The Indigent Programme pays the
LGU a fixed amount pegged at P300 per capita for
each of its enrolled indigent constituents per
year.
PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme
KEY ELEMENTS This has encouraged LGUs to enrol an
d to expand coverage. However, with upgraded
facilities due to capitation, the enrollees will
later be weaned from the Programme.
PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme
OUTCOMES AND IMPACT With 4 million enrollees this
year, the PhilHealth Indigents Programme has
served approximately 20 million people, about a
quarter of the current population. The regional
breakdown is provided as follows
PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme
OUTCOMES AND IMPACT
PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme

• OUTCOMES AND IMPACT
• LGUs have started spending more and more
• for the upgrading of their health
  facilities.
  
• Even the LGU heads who had complained
• that the premiums they paid were way above
  
  
• actual utilization in hospitalization
  incidence
  
• ventually appreciated the overall effects
  of
  
• the Program on effective prevention through
  
  
• upgraded RHUs/CHCs.

PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme

• OUTCOMES AND IMPACT
• They have also appreciated the overall effects
• of the Program on effective prevention with
  
  
• upgraded RHUs/CHCs and also the immea-
• surable increase in the peoples peace of
• mind, which is part of their health, on
  their
  
• relationship to the government, and their
• increased consciousness about their
• oneness as a community, with its progress
• from their efforts paying for their needs.

PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme
OUTCOMES AND IMPACT Note well The effect last m
entioned carries the potential of being the
single most significant long-term impact of the
Program, starting as it does to counter the
debilitating effects of centuries of the nations
social fragmentation process.
PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme
OUTCOMES AND IMPACT Indeed, we have here a progra
m that concerns providing adequate care for the
physical health of the people, while making
healthier all these communities as such,
empowering the people to care for their overall
health by the power of their own synergy in
collective active stakehold-ership. This is no
less than historical for Philip-pine
nation-building.
PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme
OUTCOMES AND IMPACT All these results are reasons
why the PhilHealth Indigents Programme deserves
to be viewed as a good anti-poverty practice.
PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme
LESSONS LEARNED, REPLICABILITY
Considering the difficulty of the challenge to
promote and implement any government program in
the context of the many adverse factors explained
at the beginning of this report, all the results
stated immediately above demonstrate why this
Programme deserves to be viewed as a good,
anti-poverty practice.
PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme

• LESSONS LEARNED, REPLICABILITY
• The most vital lessons learned from this include
  the following.
  
• First It is crucial to consider well the social,
  
  
• cultural and even historical factors that
• could make or break the success of any
• national government program.

PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme

• LESSONS LEARNED, REPLICABILITY
• Second The logic of decentralization is valid
  
  
• and progressive, and partnership with local
  
  
• government units with growing capabilities
  
  
• and responsibilities was a crucial move
  that
  
• spelled the success of the programme.

PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme

• LESSONS LEARNED, REPLICABILITY
• Third Partnerships all around, embracing
• government, private business sector and
• civil society organizations have given the
  
  
• Programme ensured sustainability and

PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme

• LESSONS LEARNED, REPLICABILITY
• Fourth Education on active stakeholdership
• of individuals, communities, and local
• government units have effectively motivated
  
  
• them to mobilize themselves in a teamwork
• of efforts within a win-win paradigm.

PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme
LESSONS LEARNED, REPLICABILITY
The Programme can be replicated and even
exceeded, provided that these same lessons are
applied and specificities in socio-cultural
factors are clearly acknowledged and adequately
addressed.
PHILHEALTH
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Brief SynopsisBrief Description Premises
Context Factors in the Context Key
ElementsOutcomes and ImpactLessons Learned and
Replicability
The PhilHealth Indigents Programme
THE PHILHEALTH INDIGENTS PROGRAMME

Salamat po! (Thank you!)
PHILHEALTH
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The Locality-Based Subsidized Health Insurance
for the Poor in the Philippines
The PhilHealth Indigents Programme
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The PhilHealth Indigents Programme
PHILHEALTH
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The PhilHealth Indigents Programme
PHILHEALTH
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This was prepared for UNDP by
Prof. Ed Aurelio C. Reyes Initiator General Int
egrator Sycone International (for Synergy in Con
scious Oneness) Lead Founder Executive Director
Saniblakas Pilipinas (Synergy Philippines) Part
-Time Lecturer on History, Cultural Anthropology
Literature International Academy of Management
Economics Co-Chairman Emeritus and Secretary-Ge
neral World Environment Day-Philippines Network
For presentation on October 31, 2007 in Colombo
, Sri Lanka
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END OF PRESENTATION