A study on the effect of demographic risk to the sustainability of the Philippine National Health Insurance Program

• Main Author: Marquez, Mark Laurence Andrada
• Format: text
• Language: English
• Published: Animo Repository 2013
• Subjects: Health insurance—Philippines—Finance; Financial risk—Philippines; Insurance
• Online Access: https://animorepository.dlsu.edu.ph/etd_masteral/4481; https://animorepository.dlsu.edu.ph/context/etd_masteral/article/11319/viewcontent/CDTG005449_F_Redacted.pdf
• Institution: De La Salle University

Through Republic Act No. 7875, or the National Health Insurance Act, a social health insurance program has been institutionalized to provide universal coverage and access to quality healthcare facilities for all Filipinos. At present, the Philippine National Health Insurance Program covers the employed sector, voluntary members, overseas Filipino workers, the poor, retired or senior citizens, and their dependents. However, universal coverage entails exposing the Program to demographic risks or uncontrollable changes to the population such as population aging or decrease in the number of employed citizens/contributing members. The study investigated the possible effects of changes to the demography of PhilHealths membership vis-a-vis the sustainability of the Program in terms of its collected premiums and claims incurred. Monthly records of membership, premium collections, and claims from 1998 to 2010 were extracted from PhilHealth database and were used to formulate multivariate regression models wherein the collections is the dependent variable of one model, claims for the other, and the different sectors of the PhilHealth membership, e.g. employed and voluntary sectors, serves as the independent variables of both models. The models are then subjected to Analysis of Variance (ANOVA) and t-test to determine the significance of the model and its variables, respectively. The study showed statistically that both models are significant. Furthermore, the resulting model showed that the employed, voluntary and OFW sector variables are significant. On the other hand, the resulting claims regression models employed, voluntary, OFW, sponsored and lifetime sector variables were found to be significant. Accordingly, the voluntary and OFW sectors contributes the most to the collections model, and the lifetime members notably decreases the claims amount. Since the Program follows the social insurance approach, it adheres to the principle of social adequacy, i.e. benefits among members are shared equally regardless of the contributions made. This brings about subsidies which in turn results to a dependency relationship among members. To quantitatively represent the dependency relationship between the PhilHealth membership, the NHIP real dependency ratio was derived based on the economic real dependency ratio. Afterwards, the NHIP real dependency ratios were computed using the gathered membership data. To establish the relationship between the NHIP real dependency ratio and collections and claims, regression models were likewise developed where the collections and claims are the dependent variables, while the dependency ratio is the independent variable. Using ANOVA and t-test, the study found that the two models were both statistically significant as well as their independent variables. Further analysis of the collections and claims models behavior revealed that at ratios 0.98, 1.72, and 2.5, collections and claims became equal. Moreover, the study showed that collections exceed claims if the NHIP real dependency ratio is less than 0.98 or if the ratio falls between 1.72 and 2.5. Hence, the models suggest that the NHIP membership dependency ratio should lie within the said ranges in order to sustain the Program. The models were then subjected to sensitivity analysis, wherein the models were simulated using different scenarios which depict changes in the membership demographics, for instance, effect of increase in employment rates, or there is an increase in the number of retiring citizens. The study demonstrated the various results of the simulations under different scenarios. Lastly, the study also touched on whether the claims of lifetime or retiree members will exceed the Programs collections. Using t-test, results showed that the claims of lifetime members will not surpass collections hence, the observed risk does not necessarily pose an immediate threat to the sustainability of the Program. In addition, the study revealed that PhilHealth membership are generally young and more than a majority falls in the working age throughout the data period covered, i.e. retiring or ageing members are replaced by younger members.