SAYO, Henry Louis V.
Periodic Assessment 1: The Oregon Health Experiment
There are estimations stating that Philippines will increase healthcare expense to grow at
an average of 8% every year. Thus, these increases have negative impacts on the overall
well-being of the people. Total healthcare expenditure in the country was approximated
at around Php 684 billion with 56% uninsured or out-of-pocket expenses. 20% was
shouldered by the national/local government, 17% came from social health insurance
agencies (i.e. Philhealth and Employee Compensation Commission), 5% came from
Health Maintenance Organizations (HMO), 2% private health insurance, 2% for others
and 56% for the uninsured.
Expanding the healthcare to the poor, as referenced from Oregon Health Insurance
Experiment (OHIE), will provide a net benefit to the society. The recipients or insured will
enjoy a better financial well-being. Thus, their savings will better stimulate the economy
and lead to development. Finkelstein et al. (2012) mentioned that there is a statistical
significance of healthcare utilization among the adults insured by the OHIE. Furthermore,
it decreases the out-of-pocket expenses by the recipients and better physical and mental
health. Heintzman et al. also mentioned in their 2014 study that there is evidence that the
said experiment is a success. Baicker et al. (2018) also noted that experiment decrease
the cases of undiagnosed depression by 50%.
The OHIE also contributed how policymakers should draw the line of illnesses to be
covered by the insurance. Hence, the coverage is based on cost-effectiveness, clinical
effectiveness, and value to the society. Comestics and light illnesses (i.e. sore throat)
and diseases that aggressive treatment is usually ineffective (i.e. advanced cancer) are
the least priority in the utilization for the insured.
Based on the study by Obermann et al. (2006), PhilHealth and the overall social health
insurance in the country has been a success although it has a major room for
improvement. Among the recommendations are the need to actively invest for greater
healthcare quality and access, especially for the unemployed. However, in a recent study
again by Obermann et al. (2018) states that financial protection among Philhealth
members remains low and the share of Philhealth in total health expenditure is only at
14%. They further recommended that the Universal Health Coverage will massively boost
the capabilities of the Philhealth in providing better healthcare and access.
With all that said, Philippines must adopt the UHC to increase the social well-being of the
poor. In a politically volatile environment, social health insurance will face delays,
resistance, and other challenges. With the landmark achievement of utilizing the revenues
from Sin Tax and other sources, UHC will provide a net benefit to the society.
References
Baicker et al. (2018). The effect of Medicaid on management of depression: Evidence
from the Oregon Health Insurance Experiment. The Milbank Quarterly, 96(1), 2956.
Finkelstein et al. (2012). The Oregon Health Insurance Experiment: Evidence from the
first year. The Quarterly Journal of Economics, 127(3), 1057-1106.
Heintzman et al. (2014) The Oregon experiment re-examined: the need to bolster primary
care. BMJ: British Medical Journal, 349.
Obermann et al. (2006). Social health insurance in a developing country: The case of the
Philippines. Social Science & Medicine, 62(12), 3177-3185.
Obermann et al. (2018). The role of national health insurance for achieving UHC in the
Philippines: a mixed methods analysis. Global Health Action, 11(1).