Apostol, Joedhel R.

Legal Medicine

Health care system of the Philippines and Switzerland

Philippines
Health care in the Philippines has been defined by the WHO as "fragmented", meaning
there's a large gap between the quality and quantity of health services for the poor and the rich.
With different reasons such as low budget, low number of man power or general neglect for the
poor, the Philippines has always been unable to keep up with the high standards of healthcare
abroad. Efforts are being performed to bridge the gap. Last February 20, 2019, The Universal
Health Care (UHC) Bill was signed into all, aiming to provide proper healthcare services for all.
All citizens are entitled to free healthcare under the Philippine Health Insurance Corporation
(PhilHealth). The scheme is government-controlled and funded by local and national government
subsidies, as well as by contributions from employers and employees. All employees in the
Philippines, including foreigners, are eligible to the PhilHealth. Philhealth subsidises a variety of
treatments including inpatient care and non-emergency surgeries, although it does not cover all
medical treatments and costs. Enrolling with Philhealth is mandatory for expats who are employed
in the Philippines. Philhealth contributions are derived from employers, employee salaries and the
state. Expats can voluntarily enrol with Philhealth if they have residency status. Employers and
employees, as well as local and national government subsidies finance this insurance system. The
employee and employer will equally share the monthly contribution rate of 2.75% (as from January
2018). There are a salary floor and ceiling of Php10,000 and Php40,000, respectively. PhilHealth
generally makes refunds within 60 days following the request. However, according to the latest
regulations, it is required to refund 75% of the amount immediately and the rest once the
application is processed.
Providers are allowed to charge the patient the difference between the total cost of care
and what PhilHealth pay. Indigent and sponsored members, lifetime members, senior citizen
members and household members are entitled to avail the free hospitalization under the no-
balance billing scheme (NBB) when they are admitted in a non-private room of public or
government hospitals. NBB are not applicable under private rooms and private hospitals so
members have to pay the excess or balance after case rate amount has been deducted. The
benefits package is essentially the same for each membership category, PhilHealth deduction will
depend upon the final diagnosis.

Switzerland
In Switzerland, compulsory health insurance covers the costs of medical treatment and
hospitalization of the insured. The Swiss healthcare system is a combination of public, subsidized
private and totally private healthcare providers, where the insured person has full freedom of
choice among the providers in his region. Insurance companies independently set their price
points for different age groups, but are forbidden from setting prices based on health risk. There
are no free state-provided health services, but private health insurance is compulsory for all
persons residing in Switzerland (within three months of taking up residence or being born in the
country.)
The whole healthcare system is geared toward the general goals of keeping the system
competitive across cantonal lines, promoting general public health and reducing costs while
encouraging individual responsibility. Health insurance covers the costs of medical treatment and
hospitalisation of the insured. However, the insured person pays part of the cost of treatment. This
is done (a) by means of an annual deductible (called the franchise), which ranges from CHF 300
(PPP-adjusted US$ 184) to a maximum of CHF 2,500 (PPP-adjusted $1,534) for an adult as
chosen by the insured person (premiums are adjusted accordingly) and (b) by a charge of 10% of
the costs over and above the excess up to a stop-loss amount of CHF 700 (PPP-adjusted $429).
The compulsory insurance can be supplemented by private "complementary" insurance
policies that allow for coverage of some of the treatment categories not covered by the basic
insurance or to improve the standard of room and service in case of hospitalisation. This can
include complementary medicine, routine dental treatments, half-private or private ward
hospitalisation, and others, which are not covered by the compulsory insurance.
As far as the compulsory health insurance is concerned, the insurance companies cannot
set any conditions relating to age, sex or state of health for coverage. Although the level of
premium can vary from one company to another, they must be identical within the same company
for all insured persons of the same age group and region, regardless of sex or state of health. This
does not apply to complementary insurance, where premiums are risk-based.