Philippine Health Insurance Corporation p
Beginnings 1995
1969
• Medicare
• National
Act
Health
• GSIS
I Insurance
• SSS
Act
Legal Mandate • Republic Act 7875 as amended by RA 9 9241 41 – National Health Insurance Program (NHIP) – shall provide health insurance coverage and p , available and ensure affordable,, acceptable, accessible health care services for all citizens of the Philippines – Enacted in 1995 • amended in 2004
Legal Mandate • Independent government agency to implement the NHIP – Philippine Health Insurance Corporation (PhilHealth)
• One of the g government-owned and controlled corporations (GOCCs) – Substantial autonomy y as to organizing g g its offices,, and in the setting of premium rates, designing member benefits, and paying health care providers
Governance Structure • Governance Commission for GOCCs (GCG) – Supervises the board – Compensation structure + compensation rates t off senior i managementt
• Department of Health (DOH) – Attached agency to the DOH – Secretary of Health is chairman of the b board d off directors di t
Governance Structure • Board – Overall policy and strategic directions – One O year term t for f the th 5 appointive i ti members
• President/CEO – Selected/elected among the board of directors – Management and implementation of program
Philippine Health Insurance Corp.
BO OA ARD D
CHAIRMAN, Secretaryy of Department p of Health VICE-CHAIRMAN, President/CEO of PhilHealth
Department of Labor and Employment
National Anti-Poverty Commission
Labor Sector Employers
Department of Interior and Local Government
Civil Service Commission
GSIS Department of Social Welfare and Development
SSS
Overseas Filipinos Self-Employed Health Care Providers
Governance Structure • Board – Investment Committee – Committee on Appealed Cases – Governance Committee – Compensation Committee – Nominations Committee – Audit Committee • Internal Audit Group reports directly to the board
Governance Structure • Board – Overall policy and strategic directions – One year term for 5 appointive members
• President/CEO – Selected/elected among the board of directors – Management and implementation of program
Governance Structure • Congressional Oversight • Validation studies to be lead by the national ti l planning l i agency (National (N ti l Economic Development Authority) • Commission C i i off A Audit dit
REGIONAL OFFICES Enrollment
Collection
Accreditation
Claims Processing
LOCAL OFFICES
2010-2016 2010 2016 : Health as National Priority
AQUINO HEALTH AGENDA: UNIVERSAL HEALTH CARE
KALUSUGANG PANGKALAHATAN
PhilHealth races towards UHC
Organizational Strengthening
Enrolment and Collection
Accreditation and Contracting
Benefits D Development l t
Organizational Strengthening Immature Information System • IT systems in silos, within and among gov’t agencies • Weak security y controls
Research Agenda • For Data Generation and Data Analysis types of Research • Underutilized external funding sources
Monitoring and Evaluation of Policies and Implementation Knowledge Management • How recommendations feed into to policy changes
Human Resource Development • Limited plantilla positions, no dismissal of staff • Customer-centered, Customer-centered process-oriented culture
Enrolment and Collection Philippines is an archipelago with ~100M Filipinos • NO existing national ID system • More unemployed/informal sector • Who are the poor?
Highly-devolved political system • Insurance used as political leverage
Reliability/consistency payments y y of government g p y Family-based Membership & Qualified Dependents • Documentary requirements as hindrance
Law: Mandatory for employed but voluntary for IPPs
Accreditation and Contracting Moving towards contracting and incentives Private health sector is large and unregulated • Increasing cost of care
Public health care providers unable to deliver • Human resources • Drug availability - procurement • Infrastructure & equipment
Regulatory government agencies do not act in synchrony • • • •
Bureau of Licensing Health Facilities, DOH National Program Offices (TB, Malaria, HIV/AIDS, etc.) Food & Drug Administration Professional Regulations Commission
Benefits Development T kli IInertia Tackling ti • SPEED in moving away from fee for service SOONEST and towards CASE PAYMENT • SPEED in setting up primary care benefit + drug treatment packs
$60/family/year premium limitation • Zero-based costing analysis
Top-down benefits package development • Move towards evidence-based, demand-driven development
Confusion with the DOH as to who pays for what services Stakeholders acceptance • More effective means consultation and communication
Leveraging purchasing power
THANK YOU.
