• published on 8/3/2022
  • 10min

Healthcare and Medical Insurance in the Philippines

If you’re new to the Philippines and plan to stay for the long term, then it’s worth digging deeper into the healthcare system. First, you need to know that healthcare in the Philippines is affordable for Western expats since it comes at a fraction of what you would pay at home. Second, you won’t have any issues accessing state-of-the-art facilities and modern equipment in major cities. And third, health insurance is often required to access hospital care.

Healthcare and Medical Insurance in the Philippines

The Philippines' healthcare system is improving

The quality of healthcare in the Philippines is considered on par with Indonesia and Vietnam but lower than in Thailand and Malaysia. However, their health system is under a lot of strain due to low staffing levels, a result of emigration by medical staff and other workers looking for better job opportunities.

A combination of brain drain and economic stagnation has seen many skilled workers emigrate to countries such as Canada and the United States, meaning there are insufficient numbers in some hospitals.

Public vs. private healthcare in the Philippines

There are around 1,800 hospitals in the Philippines, and 40% of them are run by the government. Public healthcare is government-funded and provides comprehensive, preventive, curative, rehabilitative, and palliative healthcare to qualified and underprivileged Filipinos regardless of their ability to pay.

However, public hospitals have limited capacities due to insufficient funding, lack of equipment, and human resources. As a result, patients wait longer for treatment, and sometimes doctors can only spend a short time with patients. Many patients opt for private facilities or choose to pay for additional services at public facilities (e.g., specialised surgery).

Meanwhile, in private hospitals, you'll find that many of them have ICU units and high-end equipment like MRIs and CT scans available on-site or nearby. Asian Hospital, St. Luke's Medical Center, Makati Medical Center, and Medical City are examples of high-end private hospitals in the Philippines, which are often referred to as "five-star" hospitals because of their excellent patient care.

The quality of healthcare between cities vs rural locations

The Philippines is an archipelago that is composed of 7,641 islands. It has a population of 110 million people, making it the 7th most populous country in Asia. The majority of its population is concentrated in urban areas where there are better opportunities for employment, education, and social services. Rural areas are often more isolated and have fewer resources available to residents who do not work outside of their communities.

The biggest difference between cities and rural locations is that fewer doctors and nurses are working in rural areas than in cities. This means that there are more patients per doctor and nurse on average in rural areas than in urban ones. Additionally, there are fewer specialists available in rural areas to treat specific conditions like cancer or heart disease.

Another factor affecting healthcare quality is access to transportation between cities where public transportation systems may be limited or nonexistent altogether due to a lack of funding from government sources.

Comparing local vs. international health insurance plans in the Philippines

To cover the expense of medical care at private hospitals and clinics, expatriates in the Philippines may consider getting private medical insurance. Since local and foreign health insurance plans differ, it is crucial to comprehend the benefits and drawbacks of each.

Benefit levels

Benefits given by international plans typically outweigh those of local plans. Higher annual benefit limits and specific coverage, including cancer, HIV/AIDS, or pregnancy complications, are some of them.

Local insurance policies sometimes feature restrictions, such as a daily or per-visit benefit limit. Comparatively, international medical plans tend to be more generous and less restrictive in their coverage. If you're seeking to reduce your out-of-pocket payments, you might want to keep in mind that a lower annual limit or more specific limitations on your plan's benefits could raise them.

Ability to offer direct billing

One area where local insurance providers excel is that they usually have extensive direct billing networks for inpatient and outpatient healthcare providers.

For international medical insurance plans, the scope of direct billing networks in the Philippines for outpatient treatments depends on the company you choose.

Coverage outside of the Philippines

You may need to fly outside of the Philippines for some extensive planned surgeries, either because the level of care is greater abroad, such as in Singapore and Hong Kong, or because the treatment is still not accessible in the Philippines, even in private hospitals or clinics. Buying an international plan will ensure that you are also covered abroad.

For APRIL members, they must send their request for pre-authorisation at least five working days in advance for non-emergency hospitalisation or treatment. Once approved, APRIL will issue a Letter of Guarantee (LOG) to the chosen medical facility and settle the cost of treatment directly. Today, we can place LOGs in most hospitals around the world.

However, if you have a local health insurance plan and need treatment outside of the Philippines, your expenses will not be covered. Additionally, local insurance companies cannot issue a Letter of Guarantee to a hospital outside of the Philippines.

Several international insurers also offer the possibility to take your health insurance plan with you if you move outside the Philippines. This makes it easier to keep continuous coverage and avoid needing to go through the underwriting process again, which may exclude pre-existing conditions from coverage.

Calculating renewal premiums

Insurers utilise either the community rating method or experience rating to determine how much premiums need to increase at renewal. When renewing policies, insurers also take into account medical inflation, aging populations, and benefit changes that may have an impact on your premium.

Under the experience rating method, when determining how much to increase the premium at renewal, the insurer considers your claim history for the prior year. Therefore, if you have a year with few claims, your premium won't increase much. However, if you have a year with many claims, your premium will probably increase significantly at renewal.

There are further issues, such as if you have a history of large claims or a chronic ailment that needs ongoing care. After a few renewals, this could raise your premium so high that it is no longer bearable. A major pre-existing condition may force you to look for health insurance, in which case your insurer may impose limits, co-insurance, or deductibles on some benefits or simply decide not to renew your policy.

The other method used by insurers to determine renewal premiums is community rating, which involves looking at the performance of everyone covered by a product rather than individual cases, and then applying a fixed premium increase to everyone based on that performance. This safeguards your ability to receive care as well as your money if you have a string of unlucky events, but it also implies that your premium will increase even if you have been healthy that year.

Whether you choose local or international plan, it’s best to know if your health insurance plan is community or experienced-rated because this will determine whether you pay stable amounts each year or if your premium will increase based on your claims history. APRIL uses community rating to calculate renewal premiums, which is one of the key selling points of MyHEALTH in the Philippines.

Insurance for Expatriates in the Philippines

In the Philippines, MyHEALTH gives you the best of both worlds: a local insurance company's direct billing network and easy access to the excellent advantages of an international medical insurance plan.

You can create your own plan that works for your specific needs, whether you only need coverage for yourself or you also need to cover your family. You can add outpatient, maternity, dental, and optical benefits modules to our inpatient plan, which covers major treatments like kidney dialysis, cancer treatments, and even organ transplants, and you can select one of three levels of coverage for each module.

You can choose a customisable coverage package through MyHEALTH that will cover you in hospitals all around the world, not just in the Philippines. Additionally, your MyHEALTH plan is worldwide portable, so if you ever leave the Philippines, you may take it with you to your new country with no coverage gaps at all.