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The Philippine Health Insurance Corporation (PhilHealth) was created in 1995 to create a universal health coverage for the Philippines. It is a tax-exempt, government-owned and government-controlled corporation (GOCC) of the Philippines, and is attached to the Department of Health. It states its goal as insuring a sustainable national health insurance program for all.〔(【引用サイトリンク】title=R.A. 7875 AN ACT INSTITUTING A NATIONAL HEALTH INSURANCE PROGRAM FOR ALL FILIPINOS AND ESTABLISHING THE PHILIPPINE HEALTH INSURANCE CORPORATION FOR THE PURPOSE )〕 In 2010, it claimed to have achieved "universal" coverage with 86% of the population, although the 2008 National Demographic Health Survey showed that only 38 percent of respondents were aware of at least one household member being enrolled in PhilHealth. Nevertheless, this social insurance program provides a means for the healthy to pay for the care of the sick and for those who can afford medical care to subsidize those who cannot. Both local and national government allocate funds to subsidize the indigent.〔(【引用サイトリンク】title=PREMIUM SUBSIDY FOR INDIGENTS UNDER THE NATIONAL HEALTH INSURANCE PROGRAM )〕 ==Mandate and Functions== In 2010 and 2015, reform efforts were outlined to make decentralization and health insurance work more effectively, including an expanded government subsidy for the enrollment of the poor, the creation of local health service delivery/planning units to reduce fragmentation, and a stronger DOH role in regulation. PhilHealth and SSS has four categories of enrollees encompassing nearly the entire population. The "informal" sector is for workers employed by companies and other institutions. Indigents have no means of support. Retirees (non-paying members) have already paid premiums for 120 months of membership and are 60 or older. The individual paying program (IPP) is for those not eligible for the other three categories. Although treated separately, the Overseas Filipino Workers (OFW) program can be considered as part of the IPP category. Since 1996, the benefits package and delivery system have improved. For example, PhilHealth now has an Outpatient and Diagnostic Package limited to indigent enrollees. This addition creates nearly comprehensive coverage for indigents. All other beneficiaries have access to nearly comprehensive services, excluding some outpatient care. PhilHealth introduced an accreditation program for private hospitals. Some key reform indicators to date include: *Estimated coverage is 100% *Average period for payment of providers is estimated at 70 to 75 days. The law requires PhilHealth to reimburse providers and/or members within 60 days. A recent move , implemented a “simplified reimbursement scheme” wherein 95% of the claims amount is reimbursed after a rapid assessment of member and provider eligibility and the remaining 25% follows after detailed review of the claims. On average, 90 out of every 100 claims are paid, 3 to 4 are denied, and 6 to 7 are returned to health care providers for more information. 28% of claims were submitted by public providers and 72% by private providers. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Philippine Health Insurance Corporation」の詳細全文を読む スポンサード リンク
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