PHILIPPINE HEALTH INSURANCE

CORPORATION
 Comparative Statement of Income
CY 2010 – July 31, 2016 (in millions)

* *

Note: *Recognition of Incurred But Not Yet Received (IBNR)

Detailed Comparative Statement of Income
CY 2010 – July 31, 2016 (in millions)
 Comparative Benefit Expense vs. Premium
Income (CY 2010 – July 31, 2016)
TOTAL
125
Income
99,624.8
97,034.5
100 Expense
86,566.8
77,306.7
Thousands

75
57,054.3 60,358.0
58,904.9
55,463.8
47,928.4
47,440.4
50
33,949.8 36,770.0
34,971.6
30,014.2
25

2010 2011 2012 2013 2014 2015 2016

Ben. Exp.
Over Prem. 88.4% 95.1% 101.0% 97.2% 89.3% 97.4% 97.6%
Ratio
 Comparative Benefit Expense vs.
Premium Income (CY 2010 – July 31, 2016)
Private
38
Income
29,996.2 Collection
30 28,563.0 Efficiency
25,871.6 65%
66% 61%
22,428.8 67% 22,942.2
Thousands

23 20,654.3
19,001.6 67%
18,014.3 17,114.3
71% 68%
14,436.9 14,206.9
15 12,225.9 Expense
10,823.8
9,654.4
8

2010 2011 2012 2013 2014 2015 2016

Ben. Exp.
Over Prem. 57.0% 59.2% 64.4% 54.9% 63.1% 57.1% 42.1%
Ratio
 Comparative Benefit Expense vs.
Premium Income (CY 2010 – July 31, 2016)
Government
14 Income

91% 94% Collection

11 10,429.7 10,548.1 Efficiency
9,669.6
88%
87%
8,625.1 8,628.1
8,036.0 7,835.2 Expense
89%
Thousands

8 7,452.5
86% 7,161.4
6,846.8
5,973.2 55%
5,341.3
6 4,685.7
4,597.4

2010 2011 2012 2013 2014 2015 2016

Ben. Exp.
Over Prem. 71.7% 74.3% 79.4% 74.1% 82.7% 74.3% 98.1%
Ratio
 Comparative Benefit Expense vs.
Premium Income (CY 2010 – July 31, 2016)
Informal Sector
25

20 19,274.7
18,504.0 Expense
Thousands

15
11,898.4
10,410.5
9,622.9
10
5,826.4 5,162.5
4,419.5 5,048.7
5 Income
2,467.6 3,139.2 2,623.1
1,662.2 2,060.9
42% 40%
Collection
83% Efficiency
2010 2011 2012 2013 2014 2015 2016
Ben. Exp.
Over Prem. 265.9% 282.7% 390.0% 331.6% 381.8% 358.4% 453.6%
Ratio
 Comparative Benefit Expense vs.
Premium Income (CY 2010 – July 31, 2016)
Migrant Workers
3.3

2,526.4
2.6

26% Expense
Thousands

2.0
1,662.7 1,669.1
1,640.4
1,578.9 Income
1,224.7 1,245.9 1,273.0 24%
1.3 1,099.0
920.3
839.5 832.7 831.1 53%
592.3 Collection
.7
Efficiency

.0
2010 2011 2012 2013 2014 2015 2016
Ben. Exp.
Over Prem. 109.6% 147.1% 143.7% 133.5% 50.4% 101.7% 71.3%
Ratio
 Comparative Benefit Expense vs.
Premium Income (CY 2010 – July 31, 2016)
50
Indigent & Sponsored Income
39,232.7
37,881.8
38
32,584.1 Expense
Thousands

24,504.7
25 21,666.3
17,877.5
17,128.0 17,320.4
12,819.9
11,753.2
13
6,540.8 7,409.5
4,994.0 5,186.1

2010 2011 2012 2013 2014 2015 2016

Ben. Exp.
Over Prem. 131.0% 142.9% 91.7% 104.4% 64.7% 83.1% 79.9%
Ratio
 Comparative Benefit Expense vs.
Premium Income (CY 2014 – July 31, 2016)
Senior Citizens
20
Expense

15 13,984.3
13,045.1 Income
Thousands

10 8,842.0
7,609.6

5
2,117.3
306.9

2014 2015 2016

Ben. Exp.
Over Prem. 14.5% 107.2% 116.2%
Ratio
 Premium Income Recognition
Actual Receipts, Accrued and Deferred Income
As of July 31, 2016 (in millions)
Member Type Receipts Accrued Deferred TOTAL
Private 18,859 4,083 22,942
Government 3,483 1,203 4,686
Migrant Workers 761 70 831
IS/SEI/OG/WATGB 2,534 89 2,623
Indigent 19,715 14,082 33,797
Special Govt.
Programs 17 17
Sponsored 1,772 151 11 1,934
Senior Citizens 7,610 7,610
TOTAL 47,123 13,064 14,253 74,440
 Benefit Expenses Recognition
Actual Payment, Accruals & IBNR
As of July 31, 2016 (in millions)
Member Type Payment Accrued IBNR TOTAL
Private 8,547 630 477 9,654
Government 3,757 498 342 4,597
Migrant Workers 330 262 592
Informal Sector/
Self-employed 9,752 1,419 727 11,898
Indigent 10,576 731 11,307
Sponsored 5,726 287 6,013
Lifetime / Senior
Citizens 11,880 1,781 1,181 14,842
TOTAL 50,569 5,609 2,727 58,905
 Benefit Expenses
As of July 31, 2016 (in millions)

Particulars Payment Accrued TOTAL

Case Rates 50,000 8,330 58,330

PCB 569 6 575

TOTAL 50,569 8,336 58,905

 Benefit Expenses vs. Premium Income
As of July 31, 2016 (in billions)
Benefit58.90 B
25.0
22.9 Premium
98
60.36 B
19.7
18.8
14.8

12.5 11.9 11.3

9.7
7
6.0
6.3 4.6 4.7
2.6 2.0
.6 .8
.0
Govt
Priv Govt
Govt MW IS/SEI Indigent Sponsored SC/LM
Ben. / Prem. 42% 98% 71% 454% 57% 308% 195% Ratio
Comparative Financial Position
(in millions)
Investment Portfolio
As of July 31, 2016 (in millions)
 CHALLENGES

1. Addressing COA Concerns

a. Management of Disallowances

Head Office as of June 30, 2016 P1,021,153,436.10

Regional Offices 2,738,760,082.94

Total P3,759,939,448.30

b. Compliance on the monitoring of the findings and

observations of the CY 2015 AAR
 CHALLENGES

2. Financial Recording and Reporting

• Sustain the Unqualified Opinion on the fairness of the presentation

of the Audited Financial Statements

• Compliance to the Philippine Financial Reporting Standards (PFRS)

and International Financial Reporting Standards (IFRS);

• International Benchmarking (active membership in ISSA)

• Procurement and Implementation of the Enterprise Resource

Management Information System (ERMIS)
 CHALLENGES

3. Sustain the Financial Growth of the National Health

Insurance Fund

• Sustain and expand NHIP membership:

Ensure strong customer service and attain 95% active

membership;

Develop and implement an integrated marketing and

communication plan
 CHALLENGES

4. Effective and efficient collections

• Effective collection strategies, i.e. PhilHealth Accounts Management

Strategy (95% performance level of the assigned P-AIMS)

• Raising the level of collection efficiency to 95% (i.e. strict

implementation of ePRS/eCRS)

• Additional windows of collections (more collecting agents)

• Maximize the use of Dashboards re: Collection and Benefit Payments

• Collection of Receivables (95% Accounts Receivable Turn-Over)

 CHALLENGES

5. Mitigate Financial Risks

• Revisit the case rates payments
• Institute fraud containment measures for erring employers and Health Care
Providers

6. Implementation of Austerity Measures

• Rationalize spending specially in the conduct of Fora, Travels, Marketing and
Promotions, Trainings etc.
• Improve business process (i.e. review and rationalize steps of processing due to
the improve IT services)

7. Maximize Investment Yields

• Arrest opportunity loss by setting settlement time of benefit payments
• Hiring of External Fund Managers
Current Issues

For Board decision:

PhilHealth to follow CoA

Recommendation
Current Issues
COA Findings:
Inadequate/ Incomplete/
Inaccurate information in
the database

Recommendation:
-Cleanse and update
membership data
regularly
-Incorporate validation
routine during the data
entry