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Finding the Missing Poor

A Presentation to the Philhealth Board. Workers in the Informal Sector, National Anti-poverty Commission (NAPC).
by

James Matthew Miraflor

on 27 February 2013

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Transcript of Finding the Missing Poor

National Anti-Poverty Commission (NAPC)
Workers in the Informal Sector Finding the Missing and Near Poor PhilHealth's & Financing Kalusugang Pangkalahatan (KP) How about the Missing Poor? NAPC's Solution: Including the Missing and Near Poor and
Increasing PhilHealth's Coverage Rate A Presentation to the PhilHealth Board PhilHealth, KAYA MO! Increasing PhilHealth's Premium:
UHC "ensures that they [the poor] are given financial risk protection through enrollment to PhilHealth and they are able to access affordable and quality health care and services in times of need.”
This is in recognition that for the longest time, the primary source of health financing is Out of Pocket (OOP) expenditure of households. PhilHealth's role is crucial in fulfilling Universal Healthcare (UHC) Increasing Coverage, Affordable PhilHealth Pegged at P1,200, PhilHealth attempts to make its premium as affordable as possible to ensure as large a coverage as possible (85%). - PhilHealth has long been pushing for premium increases from P1,200 to P2,400. Initially scheduled to take effect by July 2012, it was postponed to October of the same year, then to Jan. 2013.
Partial deferment (premium = P1,800) until end of 2013, announced by PhilHealth Eastern Visayas VP Walter Bacareza (Board Resolution No. 1677, series of 2012). - The increases would supposedly help finance expanded members benefits. - "NHTS Poor" Households remain to be exempted, with the government's full subsidy on their premium. Premium Increase Plan Who are the poor? 10.9 million HH out of 19 million surveyed
5.2 million are poor, based on Proxy Means Test - alternative measure of poverty
3.2 million are CCT beneficiaries
National Household Targeting System (NHTS) already covers the poorest areas. Who are the poor (according to NHTS)? How about the 5.7 million categorized as non-poor? Are they really not poor? The Transient Poor The NHTS's PMT methodology of identifying the poor may have excluded a set of poor.
These are the transient poor*
They may be non-poor during the conduct of NHTS in 2009 but were poor in 2008 or in 2010. They move in and out of poverty. *Reyes, Celia et. al. (2011, December). Dynamic of Poverty in the Philippines: Distinguishing the Chronic from the Transient Poor. PIDS, DP Series No. 2011-31. Insuring the Missing and Near Poor Government must subsidize the missing and near poor, on top of the poor identified by NHTS-PR.
Expected revenues from Sin Tax can cover NHTS "Non-Poor"
5.7 Million Households The Near Poor NO YES Do they belong to the 6th decile (3rd quintile) & below AND not HS graduates? There is a need to determine the "near poor" - the transient poor in Dr. Celia Reyes' paper. The Missing Poor Not all poor individuals/households can be captured by PMT. These individuals must be empowered to identify themselves. Is the individual / household in NHTS? YES NO Subquestion:
Was PMT able to capture poverty effectively in all areas and sectors? Ask DSWD to survey individual / household (PMT) and be included in the NHTS. DSWD have a periodic review of the NHTS-PR list. Add as PhilHealth Member with a new KAYA MO! payment scheme PhilHealth for Near &
Missing Poor A Schematic KAYA MO! PhilHealth strategy to make PhilHealth affordable and increase social health insurance coverage Compare this with the expected incremental revenues from the Sin Tax: Universal Healthcare for all Filipinos - Full coverage of social protection
- Addresses the gap of inequity in the health system
- Quality of health care
Accessible & efficient
Equitably distributed
Equip with the state of the art medical machines & tools
Informed public PhilHealth's Race to Universal Healthcare Underemployed Households with heads that are informally employed i.e. neither employed regularly by the government or the private sector* : Home-Based Personal Care Workers
Motorcycle Drivers
Market & Sidewalk Stall Vendors
Street Ambulant Vendors
Farmhands & Laborers
Fishery Laborers & Helpers
Construction & Maintenance Laborers
Hand or Pedal Vehicle Drivers   The Health Care Fund for the Poor (HCFP) is free and has no co-payment
Prior to this, the rural and informal sector rely on Community-based Health Insurance (CBHI) and other micro-insurance schemes* Vietnam-model: Healthcare Insurance for the Informal Sector *World Health Organization (2003, December). Recent Advances in Social Health Insurance in Vietnam: A Comprehensive Review of Recent Health Insurance Regulations. Health Financing Master Plan Technical Paper Series-I. Based on NAPC's criteria, Sectoral Councils shall submit names of individuals and household members
(missing poor) Persons with disabilities without work
Disadvantaged IPs
Victims of calamities
Teenage single mothers
Those who cannot afford a house More criteria These names will later be verified in the NHTS list If they can't afford housing how can they even afford health insurance? Education of the Transient Poor Transient poor is concentrated among households headed by those with highest educational attainment of “elementary undergraduate” (Reyes*, 2011: 7-10) *Reyes, Celia et. al. (2011, December). Dynamic of Poverty in the Philippines: Distinguishing the Chronic from the Transient Poor. PIDS, DP Series No. 2011-31. Add as PhilHealth member with full subsidy for premium just like the NHTS poor. Up to 70% of the population (7th decile) is unable to access even the cheapest formal financial housing package of Php 150,000.00* Housing Problems:
7th Decile and below *The Implications of the Family Income and Expenditure Survey on Housing Demand and Affordability: a Research Paper of the Home Guaranty Corporation (September 26, 2005) Transient Poor &
Underemployment Transient poor is high among those employed in the informal sector (Reyes), in which there is high underemployment . Occupations with high
underemployment*: 1st quintile (roughly the poor)
workers in agriculture, laborers and unskilled workers, and special occupations
top 3 industries: farming, mining and quarrying, employed in the private households
2nd-3rd quintiles (could not afford to buy a house)
clerks, trades and related workers, and plant and machine operators
(top 3 sectors: fishing, public utilities and construction) *"Hunger: Key Challenges, Policy Issues and Recommendations" by Dr. Dennis Mapa and Nikkin Beronilla Non-stable income may incapacitate informally employed household heads/individuals from diligently paying PhilHealth premiums. with up to 80% of the population unable to afford a finished socialized housing unit *Occupations categories from the Annual Poverty Indicator Survey (APIS) HCFP is also referred as Decision 139/October 2002. Phase I: Top 20 poorest provinces, and municipalities with 60% and above poverty incidence and highly urbanized cities (HUCs) with large pockets of poverty
Phase II: Municipalities with 50-60% poverty incidence
Phase III: Municipalities with below 50% poverty incidence as Phase III targets. The "transient poor" is usually in the "near poor" category, or missing. This applies to all citizens not considered as poor,
near poor, or missing poor. For those already covered by LGUs, LGUs will be asked to cover instead others who are not covered by national government.
Increases overall coverage in the process Mandaue and Lapu-Lapu cities recently renewed the health insurance sponsorship of around 31,000 families for two-years ending December 31, 2013. P33.96 billion in 2013
P42.86 billion in 2014
P50.86 billion in 2016 11.62 million households in the 6th decile below (FIES, 2009)
Logically, this includes 5.2 m poor households in the NHTS
11.62 - 5.2 m = 6.4 m households left. For feasibility, get the half = 3.2 m households. billion/year (2013-2016) P17.64 Full Coverage Cost
vs. Sin Tax How many beneficiaries? 20.9 million HH National Statistics
Office 10.9 million National
Household
Targeting
System 5.2 million
poor Households 6th decile and below 11.62
million Near Poor (3.2 m) + NHTS Poor (5.2 m) (suggested number of hh to be fully subsidized) 8.4 million poor households How much would this cost? Addressing Supply-side Constraints Part of the Sin Tax will cover improvement of health facilities;
Need to address personnel backlog
Require 1st-4th class LGUs to increase Barangay Health Workers (BHW) employed for every 10/20 more people insured by NGA in the area LGU Counterpart Average of Even under Scenario 1, where there is no LGU counterpart:
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