2017 Stats & Charts

NHIP Dashboard Indicators

as of December 31, 2017

Coverage Accreditation Utilization Support

Covered 93% LGUs with

Beneficiaries PCB, MCP & 86%
DOTS
NBB 73%
Claims

Unique
Member
12%
Claims
Reimbursed
Total Population Total Covered NHTS/SP
Total LGUs
Members Claims
 Covered Members and Dependents
as of December 31, 2017
Sector Members Dependents Beneficiaries
Members in the 14,903,502 13,952,626 28,856,128
Formal Economy Private 12,646,606 10,361,739 23,008,345
Government 2,186,147 3,537,657 5,723,804
Household
Help/Kasambahay 69,621 51,687 121,308
Enterprise Owner &
Family Drivers
1,128 1,543 2,671
Members in the 11,077,951 11,821,151 22,899,102
Informal Economy Migrant Worker
Informal Sector
536,094
2,317,026
779,640
3,430,129
1,315,734
5,747,155 93%
Self-Earning Individual 435,824 599,814 1,035,638
Organized Group and
of 2017
Others
15,109 21,040 36,149 Projected
Informal Economy Population
Members w/o 3/6
contribution but Entitled
to Point of Service (POS)
7,773,898 6,990,528 14,764,426
excluding Foreign
Nationals
Indigents 14,329,442 17,700,855 32,030,297
Sponsored Members 1,127,692 1,452,057 2,579,749
Senior Citizens 6,899,207 1,574,258 8,473,465
Lifetime Members 1,245,993 888,947 2,134,940
TOTAL 49,583,787 47,389,894 96,973,681
Note:
- Indigent count of members and dependents was based on DSWD Listahan II database and are subject for further validation.
- 2017 Projected Population is 104,519,910 estimated from the August 2015 Census by PSA.
 Covered Members (by Sector)
as of December 31, 2017

Lifetime
3%

Sponsored Senior Citizens

2%
Formal
14%
Economy
30%
Indigents
29% Informal
Economy
22%
 Accreditation
as of December 31, 2017

Gov't
Private 35%
65%

100% of DOH-licensed hospitals are accredited by PhilHealth.

 Accreditation
Institutional Health Care Providers (IHCP)
as of December 31, 2017

Type of Ownership Government Private Total

Accredited Facilities 763 1,150 1,913

Note : Includes all accredited Hospitals and Infirmaries

Primary Care Maternity

DOTS Package
Benefit Package Care Package
Number of Accredited 2,455 3,243 1,996
Outpatient Clinics
No. of cities &
municipalities with 1,541 1,493 1,410
Accredited OP Clinics*
% to total cities &
municipalities 94% 91% 86%
A city or municipality may have more than one outpatient clinic accredited by PhilHealth to provide NHIP benefits and services.
There are 1,634 LGUs nationwide.
 Accreditation of Facilities
(by Category)
as of December 31, 2017

Category of Facilities Government Private Total % to Total

LEVEL 1 336 466 802 42%

LEVEL 2 45 279 324 17%

LEVEL 3 51 64 115 6%

Infirmary 331 341 672 35%

Total 763 1,150 1,913 100%

 Benefit Payment
January 1 to December 31, 2017
% Distribution of Total
Sector Total Amount of Claims Paid
Benefit Amount Paid
Formal Economy 26,709.45 23%
Private 19,248.42 17%
Government (including PCB1-DepEd)
7,461.03 7%

Informal Economy 24,460.49 21%

Migrant Worker including PCB 1,401.48 1%

Informal Sector/Self-Earning Individual 23,059.01 20%

Indigent-NHTS (including PCB1-NHTS) 21,282.93 19%

Sponsored 12,725.72 11%

NGAs 0.85 0%

LGUs (including PCB1-LGUs/PREVENTS) 9,168.48 8%

Others (Point of Care) 3,556.39 3%

Lifetime Member Program and Senior Citizens 29,481.53 26%

TOTAL 114,660.11 100%
Source: Financial Statements
 Claims Processing
(Number of Claims Paid Per Member Category)
January 1 to December 31, 2017

Total Amount of Claims Average Value Paid per % Distribution of Total No. of
Member Category Total No. of Claims Paid
Paid Claim Claims Paid

GOVERNMENT 6,353,763,508 619,533 10,256 6%

PRIVATE 16,914,834,765 1,655,484 10,217 16%
IPP 20,521,755,437 2,333,373 8,795 23%
OWP 1,694,522,822 152,994 11,076 2%
SPONSORED 11,351,960,037 1,159,796 9,788 12%
INDIGENT 18,443,759,854 1,990,791 9,265 20%
SENIOR CITIZEN 18,200,816,403 1,594,494 11,415 16%
LIFETIME 5,947,374,810 569,596 10,441 6%
Grand Total 99,428,787,636 10,076,061 9,868 100%

Number of claims paid were generated using Power BI Dashboard processed January 12, 2018 based on check date.
 Claims Processing
Number and Amount of Claims Paid Per Type of Facility
January 1 to December 31, 2017

Total Amount of Claims Total No. of Claims Average Value Paid per % Distribution of Total No. of
Type of Facility
Paid Paid Claim Claims Paid

Level 1 29,037,369,814 2,851,421 10,183 28%

Level 2 28,235,571,622 2,664,025 10,599 26%
Level 3 29,540,697,669 2,511,739 11,761 25%
INFIRMARY 4,170,918,375 644,032 6,476 6%
MCP 3,209,205,351 654,156 4,906 6%
Primary Health Clinic 2,722,000 939 2,899 0%
Animal Bite Package
3,014 1%
Provider 168,274,500 55,829
Ambulatory Surgical Clinic 1,456,633,094 111,377 13,078 1%
TB DOTS Provider 121,944,500 59,033 2,066 1%
Outpatient Malaria Provider 9,600 16 600 0%
Free Standing Dialysis Clinic 3,639,084,838 538,401 6,759 5%
Grand Total 99,582,431,362 10,090,968 9,868 100%
Number of claims paid were generated using Power BI Dashboard processed January 12, 2018 based on check date.
 Claims Processing
Top 10 Medical Case Rate
January 1 to December 31, 2017

Total Amount of Claims

ICD 10 Code DESCRIPTION Total No. of Claims Paid
Paid

COMMUNITY-ACQUIRED PNEUMONIA III, MODERATE

J18.92 RISK 10,248,698,481 707,113
A09.9 ACUTE GASTROENTERITIS 1,825,667,511 323,044
N39.0 URINARY TRACT INFECTION, SITE NOT SPECIFIED 1,579,961,608 227,931
K29.1 OTHER ACUTE GASTRITIS 804,899,924 140,857
J45.90 BRONCHIAL ASTHMA IN ACUTE EXACERBATION 1,077,236,822 128,685

I10.9 ESSENTIAL HYPERTENSION; MALIGNANT HYPERTENSION 969,992,224 112,194

I10.1 HYPERTENSION, STAGE II 951,592,313 110,886
A91.1 DENGUE WITH WARNING SIGNS 1,064,731,209 108,555
P36.9 BACTERIAL SEPSIS OF NEWBORN, UNSPECIFIED 1,090,670,203 85,476
A90 DENGUE WITHOUT WARNING SIGNS 724,488,143 75,474
Number of claims paid were generated using Power BI Dashboard processed January 12, 2018 based on check date.
 Claims Processing
Top 10 Case Rate Procedures
January 1 to December 31, 2017

Total Amount of Total No. of Claims

RVS Code Procedure
Claims Paid Paid

90935 HEMODIALYSIS PROCEDURE 8,375,307,755 1,653,491

99432 NORMAL NEWBORN CARE PACKAGE 1,322,801,660 818,078
NORMAL SPONTANEOUS DELIVERY PACKAGE
NSD01
FOR HOSPITALS
2,430,477,620 460,071
MCP01 MATERNITY CARE PACKAGE 2,727,008,500 343,503
59513 CAESARIAN SECTION, PRIMARY 3,281,981,429 167,859
59409 VAGINAL DELIVERY ONLY (W/ EPISIOTOMY) 1,394,529,594 142,162
96408 CHEMOTHERAPY ADMINISTRATION 972,496,040 132,677
59514 CESARIAN DELIVERY 2,276,769,700 113,650
EXTRACAPSULAR CATARACT REMOVAL W/
66987
INSERTION OF INTRAOCULAR LENS
1,699,033,290 105,989
RADIATION TREATMENT DELIVERY (COBALT OR
77401
LINEAR ACCELERATOR)
654,893,058 99,735
Number of claims paid were generated using Power BI Dashboard processed January 12, 2018 based on check date.
 Z-Benefit
Number and Amount of Claims Paid Per Package
January 1 to December 31, 2017
Total Amount of Claims Total No. of Claims
Z BENEFITS Paid Paid
BREAST CANCER 20,725,000 253
CABG 136,950,000 250
CERVICAL CANCER HD 1,900,000 12
FIRST TRANCHE, COLON CANCER STAGE II-III (HIGH RISK) 3,000,000 16
FIRST TRANCHE, RECTUM CANCER CLINICAL STAGE I BUT POST-OPERATIVE STAGE II-III 600,000 4
FIRST TRANCHE, RECTUM CANCER CLINICAL STAGE II-III BUT POST-OPERATIVE STAGE II-III USING
COBALT 5,460,000 33
FIRST TRANCHE, RECTUM CANCER CLINICAL STAGE II-III BUT POST-OPERATIVE STAGE II-III USING
LINEAR ACCELERATOR 250,000 1
KIDNEY TRANSPLANTATION 114,550,000 196
LEUKEMIA 7,875,000 45
PARTIAL HIP PROSTHESIS, BIPOLAR 73,180 1
PD FIRST 50,344,375 789
PROSTATE CANCER 1,000,000 10
TOF 33,550,000 105
TOTAL HIP PROSTHESIS, CEMENTED 413,600 4
TOTAL HIP PROSTHESIS, CEMENTLESS 4,065,600 24
VSD 38,400,000 154

ZMORPH FOR THE FITTING OF EXTERNAL LOWER LIMB PROSTHESIS BELOW THE KNEE (BOTH) 60,000 2

ZMORPH FOR THE FITTING OF EXTERNAL LOWER LIMB PROSTHESIS BELOW THE KNEE (LEFT) 660,000 44

ZMORPH FOR THE FITTING OF EXTERNAL LOWER LIMB PROSTHESIS BELOW THE KNEE (RIGHT) 555,000 37
Grand Total 420,431,755 1,980
Note : No. and amount of claims paid as reported by BDRD.
 Z-Benefit
Number and Amount of Claims Paid Per Facility
January 1 to December 31, 2017
Total Amount of Total No. of
Z BENEFITS Claims Paid Claims Paid
ANGELES UNIVERSITY FOUNDATION MEDICAL CENTER 2,975,000 6
BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER 3,928,180 45
BATANGAS MEDICAL CENTER 3,075,000 33
BICOL MEDICAL CENTER 800,000 10
BICOL REGIONAL TRAINING AND TEACHING HOSPITAL 665,000 8
CAGAYAN VALLEY MEDICAL CENTER 325,000 4
CHINESE GENERAL HOSPITAL & MEDICAL CENTER 3,850,000 7
CORAZON LOCSIN MONTELIBANO MEM. REG'L HOSP. 7,300,092 66
DAVAO REGIONAL MEDICAL CENTER 1,125,000 15
DE LOS SANTOS MEDICAL CENTER 2,850,000 5
EAST AVENUE MEDICAL CENTER 400,000 5
ILOCOS TRAINING AND REGIONAL MEDICAL CENTER 75,000 1
KAPAMPANGAN DEVELOPMENT FOUNDATION, INC. 1,170,000 76
KIDNEY SOLUTIONS INC. 934,614 38
LORMA MEDICAL CENTER 1,150,000 2
MAKATI MEDICAL CENTER 436,153 13
MANILA DOCTORS HOSPITAL 4,950,000 9
MARY MEDIATRIX MEDICAL CENTER 7,950,000 15
NATIONAL KIDNEY AND TRANSPLANT INSTITUTE 114,597,857 789
NORTHERN MINDANAO MEDICAL CENTER 10,761,000 40
NOTRE DAME DE CHARTRES HOSPITAL 1,000,000 2
PHILIPPINE CHILDREN'S MEDICAL CENTER 3,710,000 19
PHILIPPINE HEART CENTER 140,980,000 362
SOUTHERN PHILIPPINES MEDICAL CENTER 34,730,000 91
ST. FRANCES CABRINI MEDICAL CENTER, INC. 1,025,000 12
ST. LUKE'S MEDICAL CENTER - GLOBAL CITY 14,400,000 25
ST. PAUL'S HOSPITAL OF ILOILO, INC. 3,048,458 20
UNIVERSITY OF THE EAST RAMON MAGSAYSAY MEMORIAL MEDICAL CENTER, INC. 90,000 6
UP-PHILIPPINE GENERAL HOSPITAL 33,260,000 163
VICENTE SOTTO MEMORIAL MEDICAL CENTER 17,425,400 78
WESTERN VISAYAS MEDICAL CENTER 1,445,000 15
Grand Total 420,431,755 1,980
Note : No. and amount of claims paid as reported by BDRD.
Indigent-NHTS/ Sponsored Program
(Number of Claims Paid)
as of December 31, 2017

not NBB
26.71%
No Balance
Billing
73.29%

Note: Level of NBB Compliance per PROs based on Exit Survey Results from October to December 2017
 Support Value
January 1 to December 31, 2017

Preliminary estimates using Average Value Paid per Claim (AVPC ) for claims paid January 1 to December 31, 2017 P 9,870 over
P 17,801 the estimated average cost of In-patient care based from the 2013 NDHS by PSA with 3.2 inflation rate in 2017.