Republic Act No. 7875 (National Health Insurance Act of 1995)
Also known as: National Health Insurance Act of 1995 · NHIP · PhilHealth Law
Definition
Republic Act No. 7875, the National Health Insurance Act of 1995, is the law that established the Philippine Health Insurance Corporation (PhilHealth) and created the National Health Insurance Program, the country’s social health insurance system. Signed on 14 February 1995, it mandated coverage of all Filipino citizens through employed, self-paying, and sponsored members, pooling premiums to finance hospitalization and other health benefits, with the stated goal of universal coverage.
Identities
| Database | Identifier |
|---|---|
| Wikipedia | Philippine Health Insurance Corporation |
| Wikidata | Q7185056 |
| DBpedia | http://dbpedia.org/resource/Philippine_Health_Insurance_Corporation |
Also Known As
- National Health Insurance Act of 1995
- NHIP
- PhilHealth Law
Examples and Analogies
The Act set up a social insurance model akin to national health insurance systems in Taiwan and South Korea, where pooled contributions pay for defined benefits rather than individual out-of-pocket payment. A factory worker whose employer-remitted premiums cover a hospital confinement’s case-rate benefit, or a sponsored indigent family enrolled by a local government, illustrates the program at work.
Usage Scenarios
The law operates when employees and employers remit premium contributions, when members claim benefits for confinement, dialysis, chemotherapy, or maternity care, when local and national governments sponsor indigent enrollment, and when overseas Filipino workers are covered through mandatory contributions.
Strategies
Coverage expansion strategy moved from employment-based enrollment to sponsored programs for the poor, then to automatic enrollment of all Filipinos under the 2019 Universal Health Care Act. Benefit design has shifted from fee-for-service to case rates and packages for chronic conditions to control cost and standardize payments.
Security and Safety Measures
The statute penalizes contribution evasion, fraudulent claims, and collusion of providers with claimants, and it guarantees portability of benefits nationwide. Safeguards include member data systems, accreditation standards for hospitals and clinics, and audits of claims processing.
Historical Context
Before 1995, government financing centered on the Philippine Medical Care Commission and Medicare programs for formal-sector workers. RA 7875 consolidated these into a single corporation, which was later re-chartered by the National Health Insurance Act of 2013 (RA 10606) and superseded in policy by RA 11223, making PhilHealth the national purchaser of health services.
Challenges and Controversies
PhilHealth has faced recurrent controversies over alleged fraud syndicates and padded claims, benefit adequacy versus rising hospital costs, and a 2020 corruption scandal over interim reimbursements and executive allowances that forced leadership changes and criminal charges. Universal coverage targets contend with large informal-sector populations and contribution compliance gaps.