Social Insurance

• Data Sources

Most of the required data were taken from the 1992-1997 Annual Reports of the GSIS and SSS. Starting 1998, expenditures from Medicare program were obtained from PhilHealth’s Statement of Revenues and Applications.

Expenditures of PMCC (1992 to 1995) and PhilHealth (1996-1997) were obtained from COA’s Annual Financial Report of National Government and DBM’s General Appropriations Act and National Expenditure Program (NEP) files.

For OFWs’ Medicare program, expenditures were obtained from the 1995-2002 Annual Statement of Income and Expenses and Fund Balance of OWWA-Medicare Assistance Unit.

Data on EC benefit payments by type (to be able to segregate medical benefits) were obtained from reports of the ECC's Policy, Programs and Systems Management Division. For the 1995 to 2002 EC-SSS data, information were obtained directly from SSS.

Tabulations for the 1992 and 1993 Medicare claims by type of hospital paid were generated by PMCC (Health Data Systems). Tabulations for the later years were generated directly by GSIS/SSS/PhilHealth.

• Coverage and Estimation

Included are benefit payments from the Medicare Fund (SSS and GSIS for 1992 to 1997; PhilHealth for 1998 to 2002; OWWA-Medicare for OFWs from 1995 to 2002), EC Fund of SSS and GSIS (medical components only) plus operating expenses of these institutions attributable to the management of the said fund.

Included also are the entire expenditure of PMCC, the forerunner of PhilHealth, from 1992 to 1995.

General administration cost for the medical component of EC are estimated by applying the proportion accounted for by EC-medical benefit payments (out of the total benefit payments for EC) to the total general administration cost of EC.

Insurance expenditures of the GSIS were excluded to avoid double counting. Payments by re-insurers are accounted for in the "private insurance" column of the PNHA.

The first release of the PNHA (i.e., 1991-97 PNHA) included net income and additions to reserves among the “others” use of fund. These two items were later excluded from the PNHA concept of health expenditure as these do not represent actual expenditure. Instead, information regarding these are placed as memo items under the PNHA annual matrices. For the medicare, “net revenue” (of SSS and PhilHealth), “net income before increase in reserves” (of GSIS) and “excess of receipts over expenses” (of OWWA-Medicare) refers to total revenue of the medicare fund net of benefit payments, administrative and operating and other expenses. For the EC-medical component, net revenue (for SSS) and net income before increase in reserves (for GSIS) were estimated by applying the proportion accounted for by EC-medical benefit payments (out of the total benefit payments for EC) to the total net revenue/net income before increase in reserves of EC.

Breakdown of GSIS and SSS Medicare benefit payments by type of hospital was available only for selected years. Information on the breakdown was obtained from special tabulations made by PMCC, GSIS and SSS. For the years for which no tabulations were obtained, the breakdown was estimated based on data from the nearest year(s).

No breakdown by type of hospital was derived for the 1998 Medicare benefit payments since PhilHealth’s computer system was still in the process of enhancement and was not yet capable of extracting such data at that time. Starting 1999, however, PhilHealth was able to provide such breakdown in terms of percentage shares.

In the same manner, no breakdown by type of hospital was derived for OWWA-Medicare benefit payments due to lack of data.

• Classification by PNHA Use

For Medicare, benefit payments cover only hospitalization cost and are therefore classified under PNHA use category personal (hospital) care.

EC medical benefits cover hospitalization as well as rehabilitative care and should therefore be classified under four subcategories of personal care, i.e. government hospital, private hospital, non-hospital medical clinics and other professional care, if data were available.