PMID- 23048125
OWN - NLM
STAT- MEDLINE
DCOM- 20140526
LR  - 20130815
IS  - 1460-2237 (Electronic)
IS  - 0268-1080 (Linking)
VI  - 28
IP  - 5
DP  - 2013 Aug
TI  - Out-of-pocket medical expenses for inpatient care among beneficiaries of the 
      National Health Insurance Program in the Philippines.
PG  - 536-48
LID - 10.1093/heapol/czs092 [doi]
AB  - OBJECTIVE The National Health Insurance Program (NHIP) in the Philippines is a 
      social health insurance system partially subsidized by tax-based financing which 
      offers benefits on a fee-for-service basis up to a fixed ceiling. This paper 
      quantifies the extent to which beneficiaries of the NHIP incur out-of-pocket 
      expenses for inpatient care, and examines the characteristics of beneficiaries 
      making these payments and the hospitals in which these payments are typically 
      made. METHODS Probit and ordinary least squares regression analyses were carried 
      out on 94 531 insurance claims from Benguet province and Baguio city during the 
      period 2007 to 2009. RESULTS Eighty-six per cent of claims involved an 
      out-of-pocket payment. The median figure for out-of-pocket payments was 
      Philippine Pesos (PHP) 3016 (US$67), with this figure varying widely 
      [inter-quartile range (IQR): PHP 9393 (US$209)]. Thirteen per cent of claims 
      involved very large out-of-pocket payments exceeding PHP 19 213 (US$428)-the 
      equivalent of 10% of the average annual household income in the region. 
      Membership type, disease severity, age and residential location of the patient, 
      length of hospitalization, and ownership and level of the hospital were all 
      significantly associated with making out-of-pocket payments and/or the size of 
      these payments. CONCLUSION Although the current NHIP reduces the size of 
      out-of-pocket payments, NHIP beneficiaries are not completely free from the risk 
      of large out-of-pocket payments (as the size of these payments varies widely and 
      can be extremely large), despite NHIP's attempts to mitigate this by setting 
      different benefit ceilings based on the level of the hospital and the severity of 
      the disease. To reduce these large out-of-pocket payments and to increase 
      financial risk protection further, it is essential to ensure more investment for 
      health from social health insurance and/or tax-based government funding as well 
      as shifting the provider payment mechanism from a fee-for-service to a case-based 
      payment method (which up until now has only been partially implemented).
FAU - Tobe, Makoto
AU  - Tobe M
AD  - Department of Global Health Policy, Graduate School of Medicine, University of 
      Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan. makoto.tobe@aya.yale.edu
FAU - Stickley, Andrew
AU  - Stickley A
FAU - del Rosario, Rodolfo B Jr
AU  - del Rosario RB Jr
FAU - Shibuya, Kenji
AU  - Shibuya K
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20121009
PL  - England
TA  - Health Policy Plan
JT  - Health policy and planning
JID - 8610614
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Female
MH  - *Financing, Personal
MH  - Hospitalization/*economics
MH  - Humans
MH  - Insurance Claim Review
MH  - Male
MH  - Middle Aged
MH  - *National Health Programs
MH  - Philippines
MH  - Regression Analysis
MH  - Young Adult
OTO - NOTNLM
OT  - National Health Insurance Program
OT  - Philippines
OT  - insurance claim records
OT  - out-of-pocket payment
EDAT- 2012/10/11 06:00
MHDA- 2014/05/27 06:00
CRDT- 2012/10/11 06:00
PHST- 2012/10/11 06:00 [entrez]
PHST- 2012/10/11 06:00 [pubmed]
PHST- 2014/05/27 06:00 [medline]
AID - czs092 [pii]
AID - 10.1093/heapol/czs092 [doi]
PST - ppublish
SO  - Health Policy Plan. 2013 Aug;28(5):536-48. doi: 10.1093/heapol/czs092. Epub 2012 
      Oct 9.