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In December 2012, the government of the Philippines passed the Sin Tax Law (RA 10351) which restructured and raised tobacco and alcohol taxes, while earmarking 85 percent of the incremental revenues for health. Of this 85 percent, 80 percent was intended to be used to provide free health insurance for poor and near-poor families through the National Health Insurance Program managed by PhilHealth, programs intended to speed progress of the health Millennium Development Goals, and programs to promote health awareness. The remaining 20 percent augments the financing of the Medical Assistance Program of the Department of Health (DOH), which is a hospital-based fund (in the name of mayors, congressmen, and DOH officials) that can be used at the discretion of the facility to cover the medical costs of those who cannot afford to pay, and also the DOH's Health Facilities Enhancement Program which allows the DOH to supplement the local governments' investments in health facilities. This reform was important from a health financing perspective.In November 2014, free health insurance coverage was also extended to the elderly. This paper assesses the extent to which the automatic enrollment of a large number of poor and elderly people into health insurance programs, as a result of the Sin Tax Law, has been associated with an increase in self-reported health insurance coverage, especially among the poorest quintiles and households living below the poverty line.

Health Care Services Industry --- Health Economics & Finance --- Health Insurance --- Health, Nutrition and Population --- Industry --- Tobacco Use and Control

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A cluster randomized controlled trial was undertaken, testing two sets of interventions to encourage enrollment in the Philippines' Individual Payer Program. Of 243 municipalities, 179 were randomly assigned as intervention sites and 64 as controls. In early 2011, 2,950 families were interviewed; unenrolled Individual Payer Program-eligible families in intervention sites were given an information kit and a 50 percent premium subsidy until the end of 2011. In February 2012, the "non-compliers" had their voucher extended, were re-sent the enrollment kit, and received Short Message Service (SMS) reminders. Half were told that in the upcoming end-line interview the enumerator could help complete the enrollment form, deliver it to the insurer, and have identification cards mailed. The control and intervention sites were balanced at baseline. In the control sites, 9.9 percent (32/323) of eligible individuals had enrolled by January 2012, compared with 14.9 percent (119/801) in intervention sites. In the sub-experiment, enrollment was 3.4 percent (10/290) among eligible non-compliers and who did not receive assistance but 39.7 percent (124/312) among those who did. A premium subsidy combined with information can increase voluntary enrollment in a social health insurance program, but less than an intervention that reduces the enrollment burden; even that leaves enrollment below 50 percent.

Communities & Human Settlements --- Health Economics & Finance --- Health Law --- Health Monitoring & Evaluation --- Health Systems Development & Reform --- Health, Nutrition and Population --- Housing & Human Habitats --- Law and Development --- Social Health Insurance --- Voluntary Enrollment