2014 Stats & Charts

NHIP Dashboard Indicators

41%

59%

Support

Total SPClaims

NBB SP Claims

11%

89%

Unique MemberClaims Reimbursed

Total Eligible Members

Utilization

95%

5%

AccreditationTotal LGUs

LGUs with PCB, MCP &

DOTS87%

13%Total Population

Eligible Beneficiaries

Coverage

as of December 31, 2014

Covered Members and Dependentsas of December 31, 2014

Members Dependents Beneficiaries

13,012,222 14,035,450 27,047,672

Private 11,003,394 10,222,297 21,225,691

Government 1,952,447 3,771,110 5,723,557

Household Help/Kasambahay 55,837 41,159 96,996

Enterprise Owner & Family Drivers 544 884 1,428

3,382,212 4,002,526 7,384,738

Migrant Worker 960,754 865,736 1,826,490

Informal Sector 2,023,696 2,662,266 4,685,962

Self-Earning Individual 382,069 456,433 838,502

Organized Group and Others 15,693 18,091 33,784

14,706,520 29,019,939 43,726,459

847,902 1,268,870 2,116,772

3,528,816 809,694 4,338,510

931,738 678,367 1,610,105

36,409,410 49,814,846 86,224,256 TOTAL

Lifetime Members

Sector

Indigents

Sponsored Members

Members in the

Formal Economy

Senior Citizens

Members in the

Informal Economy

87% of

2014 projected population

Note:

- Indigent count of members and dependents was based on DSWD Listahan database and are subject for further validation.

- 2014 Projected Population is 99,558,078 based on May 2010 Census by NSO.

Covered Members (by Sector)

Formal Economy

36%

Informal Economy

9%

Indigents40%

Sponsored2%

Senior Citizens10%

Lifetime3%

as of December 31, 2014

Accreditation as of December 31, 2014

Gov't

34%Private

66%

9 out of 10 DOH-licensed hospitals are accredited by PhilHealth

Accreditation Institutional Health Care Providers (IHCP)

Type of Ownership Government Private Total

Accredited Facilities 738 1,088 1,826

Primary Care Benefit Package

MaternityCare Package

DOTS Package

Number of Accredited Outpatient Clinics

2,438 2,645 1,654

No. of cities &municipalities with Accredited OP Clinics*

1,561 1,155 1,229

% to total cities &municipalities 96% 71% 75%

A city or municipality may have more than one outpatient clinic accredited by PhilHealth to provide NHIP benefits and services.

Note : Includes all accredited hospitals and infirmaries

There are 1,634 LGUs Nationwide.

as of December 31, 2014

Accreditation of Facilities(by Category)as of December 31, 2014

Private Government

Level 1 450 293 743

Level 2 235 46 281

Level 3 67 48 115

Infirmary 336 351 687

Total 1,088 738 1,826

% to Total 60% 40% 100%

SectorTotalCategory

Benefit Payment January 1 to December 31, 2014

Sector Benefit Payment

(in million pesos)

% to Total

Benefit

Payment

Government 8,494.05 11%

Private 18,015.57 23%

Informal Economy 19,245.64 25%

OFW 1,250.06 2%

NHTS/ Sponsored 25,558.16 33%

Lifetime Members 5,611.94 7%

Total 78,175.42 100%

Source: Financial Statements

-

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

2013 2014

Lifetime Member

Indigent

Informal

Formal

55.46

78.185

35%

42%

70%

25%

% INC/(DEC)

Source : Financial Statement

Benefit Payment (in Billion Pesos)

as of December 2014

(Number of Claims Paid Per Sector)January 1 to December 31, 2014

Sector Number Percent

Distribution

All Sectors 6,625,089 100%

Government 746,331 11%

Private 1,654,311 25%

IPP 1,742,285 26%

OWP 190,277 3%

NHTS/Sponsored 1,841,850 28%

Lifetime 450,035 7%

Claims Processing

Number of claims paid were extracted from Oracle Claims tables based on check date extracted on 1/09/2015.

.

Number and Amount of Claims Paid Per Type of FacilityJanuary 1 to December 31, 2014

Claims Processing

TYPE of FACILITYTotal Number of Claims Paid Total Amount of Claims Paid

LEVEL 1 HOSPITAL 1,817,519 18,256,236,051.00

LEVEL 2 HOSPITAL 1,812,995 20,229,629,748.00

LEVEL 3 HOSPITAL 1,731,815 22,106,849,577.00

AMBULATORY SURGICAL CLINIC 116,474 1,514,361,853.00

ANIMAL BITE PACKAGE PROVIDER 24,378 73,627,008.00

FREE STANDING DIALYSIS CLINIC 198,493 1,748,008,543.00

INFIRMARY/DISPENSARY 553,063 3,636,594,075.00

MCP PROVIDER 337,266 1,667,500,064.00

OUTPATIENT MALARIA PROVIDER 1,800 1,389,200.00

TB DOTS PACKAGE PROVIDER 28,602 62,616,525.00

Un-Classified 2,684 44,911,326.00

Total 6,625,089 69,341,723,970.01

Number and Amount of Claims Paid Per Packageas of December 31, 2014

Z-Benefit

Z Benefit PackageTotal Number

of Unique Claims Paid

Total Amount of Claims Paid

% Distribution to Total No. of Z Ben. Claims

Paid

BREAST CANCER 180 15,600,000 26%

CABG 162 89,100,000 23%

END STAGE RENAL DISEASE 128 76,150,000 18%

TETRALOGY OF FALLOT 116 37,070,000 16%

VENTRICULAR SEPTAL DEFECT 93 23,250,000 13%ACUTE LYMPHOCYTIC LEUKEMIA 24 3,640,000 3%

PROSTATE CANCER 2 200,000 0.3%

TOTAL 705 245,010,000 100%

Number of claims paid were based on unique member claims while total amount paid is the aggregate of tranche 1 and 2 claims payment.

.

Number and Amount of Claims Paid Per Institutionas of December 31, 2014

Z-Benefit

INSTITUTION NAME

Total Number of Unique Claims

Paid

Total Amount of

Claims Paid

PHILIPPINE HEART CENTER 364 146,330,000

NATIONAL KIDNEY AND TRANSPLANT INSTITUTE 115 65,750,000

VICENTE SOTTO MEMORIAL MEDICAL CENTER 47 5,600,000

BATANGAS MEDICAL CENTER 37 3,300,000

SOUTHERN PHILIPPINES MEDICAL CENTER 27 9,340,000

PHILIPPINE CHILDREN'S MEDICAL CENTER 23 3,360,000

DAVAO REGIONAL HOSPITAL 19 5,025,000

CORAZON LOCSIN MONTELIBANO MEM. REG'L HOSP. 16 1,225,000

NORTHERN MINDANAO MEDICAL CENTER 15 1,475,000

BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER 12 1,000,000

BICOL MEDICAL CENTER 10 825,000

BICOL REGIONAL TRAINING AND TEACHING HOSPITAL 9 725,000

EAST AVENUE MEDICAL CENTER 5 375,000

DR. PAULINO J. GARCIA MEM'L. RESEARCH & MED. CTR. 3 225,000

CAGAYAN VALLEY MEDICAL CENTER 1 100,000

QUIRINO MEMORIAL MEDICAL CENTER 1 75,000

ILOCOS TRAINING & REGIONAL MEDICAL CENTER 1 280,000

TOTAL 705 245,010,000

Number of claims paid were based on unique member claims while total amount paid is the aggregate of tranche 1 and 2 claims payment.

.

Top 10 Procedures January 1 to December 31, 2014

Claims

Processing

Number of claims paid were extracted from Oracle Claims tables based on check date extracted on 1/09/2015.

ProcedureTotal No. of Claims Paid

Total Amount of Claims Paid

Hemodialysis Procedure 691,489 4,666,806,642

Normal Spontaneous Delivery Package 263,486 1,347,576,658

Cesarian Delivery 217,754 4,212,308,808

Maternity Care Package 195,720 1,521,402,841

Cataract Removal 128,331 2,056,379,782

Radiation Treatment 118,467 626,454,521

Chemotherapy administration 74,400 553,551,034

Vaginal delivery only (w/ episiotomy) 59,747 558,109,645

Dilation and curettage 49,668 546,868,855

Endoscopy 27,809 297,874,684

Top 10 MedicalJanuary 1 to December 31, 2014

Claims Processing DESCRIPTION

Total No. of Claims Paid

Total Amount of Claims Paid

PNEUMONIA MODERATE RISK 533,594 7,619,776,074

ACUTE GASTROENTERITIS 243,424 1,389,119,710

URINARY TRACT INFECTION, SITE NOT SPECIFIED 216,317 1,503,118,230

DENGUE FEVER 134,548 1,307,333,050

BRONCHIAL ASTHMA IN ACUTE EXACERBATION 83,761 704,137,810

GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 76,012 596,543,422

ESSENTIAL HYPERTENSION 72,339 633,203,136

HYPERTENSION, STAGE II 71,085 624,357,442

OTHER ACUTE GASTRITIS 62,205 383,048,974

TYPHOID FEVER 50,863 476,740,512

Number of claims paid were extracted from Oracle Claims tables based on check date extracted on 1/09/2015.

(Number of Claims Paid)January 1 to December 31, 2014

NHTS/ Sponsored Program

Total SP Claims

Case Rates89%

Fee-for Service

11%

not NBB59%

No Balance Billing41%

Level of NBB Compliance by PROs based on Exit Survey Results

from July28 to October2014

as of December 31, 2014

Support Value

Preliminary estimates using AVPC as of December 2014 P 10,465 over P 17,697 the average cost of confinement

based from the 2013 NDHS by NSO with 5% inflation rate.