National Health Insurance, the Informal Sector, and Elements of a New Social Contract in the 2019 UHC Act of the Philippines

Abstract

This chapter explores the governance issues in the implementation of insurance coverage for the informal labour sector in the context of universal health coverage (UHC). The COVID-19 pandemic highlights the vulnerabilities of the informal sector that remain overlooked by employer health insurance and are not targeted by the government’s cash transfer programmes for the poor. While universal health coverage may, on paper, assure every one of the basic minimum health care packages, issues of capturing subsidies for and availing of similar no user charges for the poor may be a Gordian knot before universal coverage is achieved. The chapter interrogates this issue as follows—firstly, we present key health financing features of the Philippine efforts to cover the informal sector in the national health insurance programme; and secondly, based on a concept approach, we analyse the elements of a social contract that may enhance or break down relationships in informal sector health insurance—with the market, bureaucratic and networks in health systems. Implications are drawn on the design of institutional arrangements to capture subsidies, contributions, and provider payments as part of a post-pandemic new normal of greater health security through the financing of health in the context of a social contract.