Press Releases Archived (January 2016)

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State think tank Philippine Institute for Development Studies, in partnership with the International Initiative for Impact Evaluation (3ie), is conducting a technical course on impact evaluation (IE) on January 4-15, 2016, at the PIDS office in Eton Centris, Quezon City.

IE is a special type of research that allows policymakers and program implementers to ascertain whether a particular program is achieving its objectives and whether the results are attributable to the intervention.

Around 30 participants from selected regional state universities and colleges (SUCs) and other government agencies are attending the course. Aside from covering the concepts of IE, the course teaches participants commonly used econometric and statistical methods to evaluate the impacts of social and other programs in developing countries. These include both randomized and nonrandomized IE methods.

At the end of the course, participants will be able to understand what impact evaluation is and the different techniques used for impact evaluations.

In her statement at the opening of the two-week course, PIDS Vice President and Senior Research Fellow Marife Ballesteros said that aside from learning how to design and conduct IE, participants will also be able to acquire better appreciation on the role of evaluation in program and policy development. She likewise emphasized that this course will enhance participants critical thinking, particularly in asking how and why certain programs need to be undertaken.

Delivery of the course consists of lectures, class exercises, and group work. Most exercises involve case studies using data from actual programs that are discussed in the lectures. Participants are also asked to determine options for evaluations for their own programs.

The Philippine government, in its efforts to promote greater transparency and accountability, has started doing IE in 2014 through a project of PIDS. Spearheaded by the National Economic and Development Authority (NEDA) and the Department of Budget and Management (DBM), the project involves the conduct of IE studies on key government programs and projects and capacity-building programs for various government agencies and selected SUCs.

So far, more than 300 staff from NEDA, DBM, and other agencies have been trained on conducting IE. ###

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Improving the enrollment rate for the individually paying program (IPP) of the Philippine Health Insurance Corp. (PhilHealth) is an important component of the government`s goal of achieving universal health care for the country. The country aims to attain universal health care by 2016 when some 100 million Filipinos shall have been enrolled with PhilHealth.

However, one of the biggest stumbling blocks in achieving this goal is the low coverage rate in PhilHealth`s IPP, the voluntary component of the country`s social health insurance. Those enrolled in the IPP scheme are individuals who opt to pay for their own membership. They generally include the self-employed, self-earning, and those in occupations without a formal employer-employee relationship.

According to a study by state think tank Philippine Institute for Development Studies (PIDS), the informal sector represents around 43-50 percent of the total labor force. Thus, having a 56-58 percent coverage rate for IPP at the national level at present indicates that over 40 percent of the population who do not qualify as dependents and are not employed in the formal sector have no health insurance coverage.

The study also noted that given the voluntary nature of the IPP, it has become an important point of focus for the expansion of the social health insurance in achieving universal coverage. The IPP contrasts with PhilHealth`s employed program where health insurance coverage for employees is mandatory.

Thus, for better and more efficient targeting of the sectors of the population that are otherwise difficult to capture, PIDS researcher and author of the study, Denise Valerie Silfverberg, looked into the determinants of enrollment into the IPP.

According to Silfverberg, the availability of health-care resources appears to be an important consideration in terms of the level of IPP coverage, particularly in provinces. Bed-population and health professional-population ratios come out significantly positive. This result is an indication of the importance of having the resources at reasonable proximity, she noted.

Silfverberg further explained that in order for individuals to take the decision to enroll into health insurance scheme, they must first see its value. Thus, availability and accessibility of health-care services, she said, is a crucial determinant in the decision to avail or not to avail of health insurance.

For certain provinces that are more geographically constrained, government providers can address this problem through the provision of mobile clinics or the augmentation of district hospitals especially in geographically isolated areas. Both can be done through public-private partnership, the author recommended.

The PIDS study also observed that the greater the number of private hospitals, the more likely it is for the province to have higher coverage rates. This indicates that the existence of private hospitals seemingly encourages individuals to enroll into the health insurance scheme, presumably with the notion that if care is sought, they can avail of private medical services with the use of PhilHealth.

This recommendation is not to undermine government health services providers. By supporting the health insurance system, and in effect promoting enrollment, the consumers are able to decide which services to avail of. This fosters market competition that could encourage unsustainable public health services providers to innovate in order to compete with the rest of the market, Silfverberg maintained.

The study also concluded that income levels do not appear to be a factor in determining the level of insurance coverage of a province. This is demonstrated by two results--the magnitude and significance of the average household income of the nonpoor population and the real income per capita of the province.

Since income does not appear to be a barrier in obtaining health insurance for the nonpoor segment of the population, it denotes that something else is. Silfverberg noted there is an impression that if the coverage offered by health insurance will not account for the majority of their health expenditures, the individual will see no need to avail of health insurance. She recommended that a study should be conducted on out-of-pocket (OOP) expenditures incurred by outpatient services. If high OOPs are established, this would be a basis, she explained, for expanding the current outpatient benefit package of PhilHealth to include those who are part of the voluntary program as well.

Lastly, it was observed that the size of certain sectors has a significant effect on the IPP coverage levels of a province. Thus, PhilHealth should target certain employment sectors such as the agricultural sector and those employed in manual labor where workers are more likely to have lower coverage rates. According to the PIDS study, identifying sectors that employ individuals who are less likely to avail of health insurance will allow for a targeted approach to achieving universal coverage.

The study also recommended the creation of programs similar to the Kalusugang Sigurado at Abot-Kaya sa PhilHealth Insurance, which partners with local nongovernment organizations and rural banks, as a way to expand into certain employment sectors that tend to have low coverage levels. ###

(For more details, you may download the PIDS Policy Notes)

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Gauging the efficacy of enrollment in PhilHealth's employed program will help policymakers in the health sector determine a more effective approach in achieving the goal of universal coverage.

Last year, PhilHealth officials iterated their commitment to achieving universal coverage by 2016. President Benigno Aquino III signed an amendment of the National Health Insurance Act highlighting the responsibility of the national government to cover the health insurance premiums of Filipinos in the informal sector.

However, full coverage in the formal sector also needs due attention and improvement. Thirty percent of PhilHealth's members come from the formal economy where enrollment is mandatory. But based on a study by state think tank Philippine Institute for Development Studies (PIDS), "full coverage" is "yet to be achieved".

The private sector currently sits at 95-percent coverage, while the government employed sector sits at 75 percent. Denise Valerie Silverberg, author of the study, argues that examining the level of PhilHealth coverage and enrollment in the formal sector will help policymakers bridge that gap.

Silfverberg surmised that the gap in coverage can be explained by looking at how some agencies comply with labor policy. For example, the low coverage rates may be attributed to the significant number of contractual employees in government who do not enjoy the benefits of being enrolled in PhilHealth.

The perpetuation of contractual employees--something the private sector is just as guilty-- allows firms and agencies to stall enrollment of employees into PhilHealth's employed program and withhold "appropriate benefits".

But companies deliberately shortchanging employees are not just the only flaws. Variations of enrollment rate can also be produced by characteristics that set the private and government sector apart, and other factors like establishment size and area.

For the private sector, sectoral employment, nature of employment, union coverage, union-employees ration, and number of employees all influence variations of coverage rate. But in the provinces, it is the size of the firm that matters.

"More employees hired by medium-sized establishments lead to a higher likelihood for the province to have lower coverage," Silfverberg pointed out, "On the contrary, the greater the number of employees in large-sized enterprises, the more likely it is for the province to have higher coverage levels."


Silfverberg concluded that before the country can work toward full coverage, policymakers must find a way to address the problems that impede effective implementation of the national health insurance program. Enrollment should be more targeted, depending on the sectors where undercoverage occurs the most.

Monitoring by PhilHealth should also be strengthened. Medium-sized establishments, surmised by Silfverberg, are more likely to short change employees when it comes to health insurance enrollment if they are not closely monitored.

Employers have to be held accountable to follow the labor code provision on employee regularization. The rules are often undermined by resorting to a six-month cycle to prevent employees from being regularized, and to refrain from giving them their due benefits.

Employers--both public and private--should enroll their employees into the program, whether they are regular or casual. Compliance at the local government level should be also closely monitored. After all, it would be harder to close the gap if government units themselves do not implement the health insurance program in their own offices. ###

If you wish to know more about this study, you may download the Policy Note here.