Expat guide to the Philippines: health care The organisation set up in 1995 to fulfil the idea is the Philippines Health Insurance Corporation - PhilHealth, as it is known. To date, about 86 per cent of the population is enrolled. The scheme is government-controlled and tax exempt. It is funded by employers, employees and subsidies from local and national government. All employees - irrespective of what other insurance cover they may have or who they work for - must joint PhilHealth. They pay a 2.5 per cent tax on their income. Their employer contributes the same sum - as with National Insurance in Britain, but with different ratios between employee and employer contributions. The poor are fully enrolled in the system without payment. The job of defining "poor" in individual cases is the responsibility of local government. Retirees also get "free" automatic enrolment, but only after a minimum 10 years" contributions. Anyone not fitting into these categories pays a subscription through an individual payment programme. Repayments PhilHealth is supposed to refund claims within 60 days. But this deadline has not always been met. Under a recently introduced change, claims are paid without delay (after a rapid initial assessment) to 75 per cent of the total. The rest follows later. Overall, 90 per cent of claims are met in full. Claims are made either by the individual patient or the service provider (for example, hospital, whether a private unit or state run.) How much care is government funded? PhilHealth may be a universal system with heavy state backing, but the government funds only 35 per cent of all health spending in the Philippines, according to World Bank data. That is a lower proportion than the US at 48 per cent. UK 84 per cent. And the actual proportion of money spent on health as a proportion of GDP is low - only 3.8 per cent. That is well less than half the West European average (UK 9.8 per cent.) Sixty per cent of some 1,700 hospitals are privately owned, the remainder state-run. The results The health of those living in the Philippines falls in to a middling category. The usual measure of a nation's health, those dying within a year, is 23 per 1,000 live births. In developed Western countries, infant mortality rates are four times better, but the Philippines are still an improvement on some other south-east Asian countries. The islands are continuing to improve (Philippine infant mortality was 25/1,000 in 2008). Life expectancy at birth - 68 years total both sexes - is 12 years short of that in Britain. The good and the bad Many countries have patchy health care but the Philippines appear to take this to an extreme. Hospitals in Manila and some other cities are up to Western standards, with US-trained personnel and equipment to match. Provision in rural areas is at the other end of the spectrum. Allianz, the international medical insurer that has a strong base in the business community, advises its policyholders: "Medical practitioners in the Philippines are graduates from the top universities in the country and most of them have studied in US medical schools. Additionally, there are doctors that have practised medicine in the US before sharing their expertise in the Philippines. Filipino nurses are also trained by nursing schools that have excellent standards. In fact, a large percentage of Filipino nurses go on to work in the US.  Allianz, a giant German insurer with a Dublin base for its international insurance, lists the following as among the top hospitals: the Medical Centre in Alabang; the Asian Hospital, Manila; the Makati Medical Centre, Manila; the Medical City in Ortigas; and St Luke's Medical Centre in Quezon City. Expats wanting a dentist or a doctor are advised "to seek the opinions of other expatriates that have been in the Philippines for a number of years." A more cautious view of quality is taken by another insurer, Medicare International. Its senior executive director, David Pryor, said: "What many fail to realise is the size of the country and with over 7,000 islands, medical facilities will vary in quality and quantity nationally. As well as sanitation, climate is a major factor, with mosquito-borne diseases a particular risk. Britain's Foreign and Commonwealth Office (FCO) describes hospitals as "sufficient" in cities but that "medical care is limited in more remote areas." Private insurance The FCO states: "You should get comprehensive travel and medical insurance before travelling. You should check any exclusions, and that your policy covers you for all the activities you want to undertake. In particular you should be aware that your insurance company might not extend cover to areas to which the FCO advises against travel. Certain areas of the Philippines are rated by the Office as at high risk of terrorism. It advises against travel to south-west Mindanao and the Sulu archipelago because of terrorist activity and clashes between the military and insurgent groups. We advise against all but essential travel to the remainder of Mindanao for the same reason. Reputable international medical insurers are unlikely to decline cover to a policyholder injured as a result of terrorism. Medical insurance adviser Stephen Walker said: "In strict policy terms most insurers exclude injuries resulting from terrorism but I doubt whether any insurer would risk the adverse publicity arising from refusing emergency evacuation or other treatment. To my knowledge that hasn't happened. Premiums Mr Walker, of Medical Insurance Services in Brighton, points to Axa PPP as one of the best deals for thirtysomethings in the Philippines. A couple 34 and 31 with Axa's Comprehensive plan and a £100 excess would pay £2,058 a year. Axa's budget plan, Standard, is £1,255 a year. InterGlobal's Ultra Comprehensive plan costs £2,908 for the same couple (budget £1,872). The UK subsidiary of US insurers IMG continues to give a 15 per cent "starter discount" on its plans, bringing the premium for the couple 34/31 down to £2,198 a year (budget £1,131). Aviva International Solutions charges £2,729 for its comprehensive plan with reduced out-patient cover (budget £2,456). Among the most expensive is ExpaCare Executivecare, a comprehensive plan with a £4,066 annual premium (budget £2,622). But no two plans are comparable because of different benefits, and the extent at which those benefits are capped. In addition, low initial premiums are no guarantee of continued value. A 25-year-old needing comprehensive cover would pay £1,477 a year for Bupa Classic (budget £804). Aviva International Solutions would charge £1,211 comprehensive with reduced out-patient cover (budget £1,090). InterGlobal, IMG and Axa PPP, with a £100 excess, are all under £1,100 annual premium for comprehensive cover. Health risks Mosquito-borne dengue is endemic in the Philippines. Malaria is a constant threat to the traveller. In both cases no vaccine is available. Standard anti-mosquito advice applies - cover up, use repellent and a mosquito net. Also endemic are water-borne diseases typhoid and cholera: drink or use only boiled or bottled water, avoid ice in drinks and ensure vegetables are washed appropriately. Anyone suffering from diarrhoea should seek immediate medical attention. Another hazard is the infection leptospirosis, also known as Weil's disease and transmitted in the urine of rats and some other animals. It can prove lethal although penicillin is effective against the organism and recovery is normally complete. An additional hazard is rabies. The prevalence of HIV/Aids is put at 0.1 per cent of the population, half that of Britain. Other hazards In 2010 the European Commission banned airlines certified in the Philippines from operating in Europe, following an inspection of safety procedures on the islands. This suggests that internal flights may contain an added risk element. The FCO rates risk of terrorism as "high" in the Philippines and emphasises that kidnapping is prevalent in the south of the country. Cultural variety The Philippines have a turbulent - often war-torn - history. Since the early part of the 16th century, the islands have been invaded and/or ruled by the Spanish, Dutch, British, Americans and Japanese. The result is a cultural goulash, with Spanish the overriding influence. To that is added Malayo-Polynesian, Chinese, Indian and Arab to aspects of life. For all that, English is the official language. It's a great help to expatriates and tourists using the health system. This piece was originally published in The Telegraph Weekly World Edition Return to the Expat country profiles index