Catastrophic illnesses can push a household into poverty by causing unmanageable, or catastrophic, expenditures for their treatment or management. Kalusugan Pangkalahatan aims to provide financial risk protection for the poor. Hence, insurance coverage for catastrophic illnesses need to be strengthened. However, the scope of the PhilHealth Z benefits, which was developed to protect Filipinos affected with certain medical conditions from financial catastrophe, is limited. This report provides an analysis of the feasibility of supplemental funds from the private sector, specifically from health maintenance organizations (HMOs) and self-insured companies, for the Z benefits program. Key informant interviews were conducted with representatives of PhilHealth, HMOs, and self-insured companies to determine the constraints, prospects, and requirements to implement a supplemental fund. Results were analyzed thematically.
Establishing a supplemental fund from the private sector for catastrophic illness financing is currently not feasible. The supplemental fund can be lodged in PhilHealth or outsourced to HMOs. However, managing a supplemental fund would require operational, institutional, and legal changes to be made by PhilHealth. On the other hand, better regulation of the HMO industry is also required. Regardless of how the supplemental fund will be managed and implemented, it is imperative to conduct studies on the incidence and costing of catastrophic illnesses first to make the supplemental fund viable.
