History

THE call to serve the rural indigents echoed since the early '60s when the Philippine Medical Association introduced the MARIA Project which prioritized aid to communities in need of medical assistance. The Project would then be considered a valuable precursor to the Medicare program, from which a medical care plan for the entire Philippines was created. On August 4, 1969, Republic Act 6111 or the Philippine Medical Care Act of 1969 was signed by President Ferdinand E. Marcos which was eventually implemented in August 1971. The Philippine Medical Care Commission (PMCC) was tasked to oversee the implementation of the program which went for almost a quarter of a century. In the 1990s, a vision for a better, more responsive government health care program was prompted by the passage of several bills that had significant implications on health financing. The public's clamor for a health insurance that is more comprehensive in terms of covered population and benefits led to the development of House Bill 14225 and Senate Bill 01738 which became The National Health Insurance Act of 1995 or Republic Act 7875, signed by President Fidel V. Ramos on February 14, 1995. The law paved the way for the creation of the Philippine Health Insurance Corporation (PhilHealth), mandated to provide social health insurance coverage to all Filipinos in 15 years' time. PhilHealth assumed the responsibility of administering the former Medicare program for government and private sector

employees from the Government Service Insurance System in October 1997, from the Social Security System in April 1998, and from the Overseas Workers Welfare Administration in March 2005.

Agency's Mandate And Functions

Mandate
The National Health Insurance Program was established to provide health insurance coverage and ensure affordable, acceptable, available and accessible health care services for all citizens of the Philippines. It shall serve as the means for the healthy to help pay for the care of the sick and for those who can afford medical care to subsidize those who cannot. It shall initially consist of Programs I and II or Medicare and be expanded progressively to constitute one universal health insurance program for the entire population. The program shall include a sustainable system of funds constitution, collection, management and disbursement for financing the availment of a basic minimum package and other supplementary packages of health insurance benefits by a progressively expanding proportion of the population. The program shall be limited to paying for the utilization of health services by covered beneficiaries. It shall be prohibited from providing health care directly, from buying and dispensing drugs and pharmaceuticals, from employing physicians and other professionals for the purpose of directly rendering care, and from owning or investing in health care facilities. (Article III, Section 5 of RA 7875 as amended)

Powers And Functions

PhilHealth is a tax-exempt Government Corporation attached to the Department of Health for policy coordination and guidance. (Article IV, Section 15 of RA 7875 as amended). It shall have the following powers and functions (Article IV, Section 16 of RA 7875 as amended by RA 10606): a) To administer the National Health Insurance Program; b) To formulate and promulgate policies for the sound administration of the Program; c) To supervise the provision of health benefits and to set standards, rules and regulations necessary to ensure quality of care, appropriate utilization of services, fund viability, member satisfaction, and overall accomplishment of Program objectives; d) To formulate and implement guidelines on contributions and benefits; portability of benefits, cost containment and quality assurance; and health care provider arrangements, payment, methods, and referral systems; e) To establish branch offices as mandated in Article V of this Act; f) To receive and manage grants, donations, and other forms of assistance; g) To sue and be sued in court; h) To acquire property, real and personal, which may be necessary or expedient for the attainment of the purposes of this Act;

i) To collect, deposit, invest, administer, and disburse the National Health Insurance Fund in accordance with the provisions of this Act; j) To negotiate and enter into contracts with health care institutions, professionals, and other persons, juridical or natural, regarding the pricing, payment mechanisms, design and implementation of administrative and operating systems and procedures, financing, and delivery of health services in behalf of its members; k) To authorize Local Health Insurance Offices to negotiate and enter into contracts in the name and on behalf of the Corporation with any accredited government or private sector health provider organization, including but not limited to health maintenance organizations, cooperatives and medical foundations, for the provision of at least the minimum package of personal health services prescribed by the Corporation; l) To determine requirements and issue guidelines for the accreditation of health care providers for the Program in accordance with this Act; m) To visit, enter and inspect facilities of health care providers and employers during office hours, unless there is reason to believe that inspection has to be done beyond office hours, and where applicable, secure copies of their medical, financial, and other records and data pertinent to the claims, accreditation, premium contribution, and that of their patients or employees, who are members of the Program; n) To organize its office, fix the compensation of and appoint personnel as may be deemed necessary and upon the recommendation of the president of the Corporation;

o) To submit to the President of the Philippines and to both Houses of Congress its Annual Report which shall contain the status of the National Health Insurance Fund, its total disbursements, reserves, average costing to beneficiaries, any request for additional appropriation, and other data pertinent to the implementation of the Program and publish a synopsis of such report in two (2) newspapers of general circulation; p) To keep records of the operations of the Corporation and investments of the National Health Insurance Fund; q) To establish and maintain an electronic database of all its members and ensure its security to facilitate efficient and effective services; r) To invest in the acceleration of the Corporations information technology systems; s) To conduct information campaign on the principles of the NHIP to the public and to accredited health care providers. This campaign must include the current benefit packages provided by the Corporation, the mechanisms to avail of the current benefit packages, the list of accredited and disaccredited health care providers, and the list of offices/branches where members can pay or check the status of paid health premiums; t) To conduct post audit on the quality of services rendered by health care providers; u) To establish an office, or where it is not feasible, designate a focal person in every Philippine Consular Office in all countries where there are Filipino citizens. The office or the

focal person shall, among others, process, review and pay the claims of the overseas Filipino workers (OFWs); v) Notwithstanding the provisions of any law to the contrary, to impose interest and/or surcharges of not exceeding three percent (3%) per month, as may be fixed by the Corporation, in case of any delay in the remittance of contributions which are due within the prescribed period by an employer, whether public or private. Notwithstanding the provisions of any law to the contrary, the Corporation may also compromise, waive or release, in whole or in part, such interest or surcharges imposed upon employers regardless of the amount involved under such valid terms and conditions it may prescribe; w) To endeavour to support the use of technology in the delivery of health care services especially in farflung areas such as, but not limited to, telemedicine, electronic health record, and the establishment of a comprehensive health database; x) To monitor compliance by the regulatory agencies with the requirements of this Act and to carry out necessary actions to enforce compliance; y) To mandate the national agencies and LGUs to require proof of PhilHealth membership before doing business with a private individual or group; z) To accredit independent pharmacies and retail drug outlets; and aa) To perform such other acts as it may deem appropriate for the attainment of the objectives of the Corporation and for the proper enforcement of the provisions of this Act.

Affiliations

International Social Security Association ASEAN Social Security Association Philippine Social Security Association

Vision, Mission, Core Values

Vision
"Bawat Pilipino, Miyembro, Bawat Miyembro, Protektado, Kalusugan Natin, Segurado"

Mission
"Sulit na Benepisyo sa Bawat Miyembro, Dekalidad na Serbisyo para sa Lahat"

Core Values
Innovation Quality Service Utmost Integrity Equity Social Solidarity &

Total Care
ISSUES

Conservative and sluggish PhilHealth misses healthcare target

By Niel Lim, INCITEGov and VERA FilesApril 20, 2011 12:26pm
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Tags: Philhealth

The Philippine Health Insurance Corp. (PhilHealth) has missed the December 2010 target mandated by law for it to provide universal health coverage to Filipinos, as health experts say the agency is poorly managed and consequently unable to deliver quality health care to those who need it most. Former and current officials said the agency has been hobbled by a conservative mindset" as well as a sluggish executive committee, that the agency has fallen short of its mandate to provide all Filipinos with the mechanism to gain financial access to quality health care services within the first 15 years of its implementation." Dec. 31, 2010 was the milestone set by law that we should have universal health care," said former health secretary Jaime Galvez Tan. It has failed and (PhilHealth officials) even twisted the definition. They said that 85 percent is already universal when the law says all Filipinos." There is still some confusion as to what is meant by all Filipinos." Technically, it should mean the entire population of 94 million. But the implementing rules and regulations (IRR) of the law creating PhilHealth lists those who can be membersonly those of legal age or 18 years and older, employed, self-employed, overseas workers and retirees. Eligible for membership are those who can pay the P200 monthly contributions, in exchange for which they get hospitalization assistance such as subsidy for room and board, professional fees, medicines and select outpatient procedures. The IRR also allows members to declare spouses, disabled children, and parents as dependents or beneficiaries by association. This makes it even harder to determine the exact number of those

covered. Former health undersecretary Alex Padilla, who was appointed by President Aquino to be PhilHealth executive vice president and chief operating officer last year, conceded that the inaccurate number of members is a big problem for the agency. Were after universal health care, but if you look at the figures, we cant even tell how many are actually enrolled," he said. Confusing numbers In 2004, PhilHealth claimed 84 percent coverage. In February 2010, Tan said, it claimed having achieved universal coverage with 86 percent. As of 2009, PhilHealth reported having more than 20 million members. But PhilHealth figures dont match information on the ground. Results of the 2008 National Demographic Health Survey showed that only 38 percent of respondents were aware of at least one household member being enrolled in PhilHealth. A 2010 Social Weather Station survey on health care services and financing showed only 36 percent of respondents having PhilHealth coverage. To make matters worse, the national government gave out PhilHealth cards with short-term coverage or good only for one year in 2004, the year Gloria Macapagal Arroyo ran for president. This has added to the confusion on the exact number of members, since many of those who received the cards were not able to pay the insurance premium after the government subsidy expired. Local government officials have followed Arroyos lead and have taken to distributing PhilHealth cards to their constituents during election campaigns or special occasions. But the disputed figures are just one of PhilHealths many problems. PhilHealth is also suffering from an identity crisis, its critics said, with the board treating the agency like a private health insurance company stingy in giving out benefits, rather than as a government-run social health insurance upholding citizens right to health and health care. Last year, President Aquino gave PhilHealth a new three-year timetable to institute reforms, and set

another deadline2016 or five more yearsto ensure universal health coverage. Informal sector Padilla said PhilHealth is trying to increase enrollment in the program, but is reluctant to get more members from the informal sector. The informal sector refers to persons who are neither indigent nor employed by an agency that automatically deducts the premium from their income. They include a wide range of income earners from the fishball vendor to the practicing doctor or lawyer. Padilla laments that the agency considers the informal sector as the biggest bleeder" because, unlike the indigent, they know more about PhilHealth benefits and are inclined to take full advantage of it. Usually, the informal sector are your entrepreneurs, they are your professionals. In short, they are usually the ones in the upper levels of the social class who also know more about the benefits," he said. A former senior vice president of PhilHealth, who asked not to be named, validated Padillas observations. The source also said the PhilHealth board and president are afraid to spend the reserves, thats why it is often called an HMO (health maintenance organization) or commercial health insurance." The former PhilHealth official said board members conservatism prevents the agency from performing its functions as provided by law. Many officers do not understand the concept of social health insurance and financial protection," the source explained. PhilHealth currently has at least P110 billion in reserves. The fund increases by some P3 billion every year since the agencys premium collections are usually higher than its benefit spending. Padilla said, however, that last year our benefit payments were higher than our collection." But a conservative mindset is apparently not the only problem with the PhilHealth board. The execom (executive committee) is not functioning. Most of the decisions of management have

no real evidence, no consultation and are not transparent," said the former PhilHealth official, who also claimed that decisions were usually made by those close to the president or whoever has the loudest voice" in the meeting. One SVP is a loan shark charging three percent a month and the president would rather travel than stay in the office," the source added. Out-of-pocket burden A study on health financing conducted by Tan, Ramon Paterno and Chrysanthus Herrera of the National Institute of Health of the University of the Philippines, Manila, noted that Filipinos out-ofpocket expense for health care has increased from 45 percent in 1998 to 54 percent in 2007. PhilHealths share in the national health expenditure has increased at a very slow rate from about 4.5 percent in 1995 to 8.5 percent in 2007. This means that for every P1,000 spent on health care, families shoulder more than half or P540, PhilHealth contributes only P85, while the rest comes from subsidies to hospitals by the national and local governments. According to the 2010 World Health Statistics, the Philippines spends only about 3.3 percent of its gross domestic product or GDP on health, lower than the World Health Organization recommendation of at least 5 percent of GDP. Padilla said the increased out-of-pocket expense might have even been caused by PhilHealth policies. Whereas 15 years ago out-of-pocket payment was 41 percent, now its 54 percent. That shows that there has been more prejudice against the public despite the benefits being given by PhilHealth," he said. The conclusion then is that PhilHealth has been giving the wrong kinds of benefits. Its not hitting the people that it should hit. Its not helping," he said. Health providers benefit Padilla cited another study last year which showed that health-care providers have increased their

charges despite a 35-percent increase in PhilHealth benefits. It was therefore the providers that profited from the increase in benefits by adding these to their cost, he said, adding that the providers got a 35-percent premium for not doing anything else." PhilHealth statistics show that bulk of payments have remained constant over the years: Drugs and medicines take up a third of PhilHealth payments, followed by professional fees at 23 percent, x-ray, laboratory and other fees at 23 percent, room and board at 17 percent; operating room charges at 7 percent. Notwithstanding the reserves, PhilHealth is not in the pink of health. In 2009, PhilHealth vice president for actuary Nerissa Santiago said that unless the government pays its P19.2-billion debt to the agency or increases the contribution rate, PhilHealth will go bankrupt by 2016. Although PhilHealth premiums are supposed to be automatically withheld from the salaries of public employees, a number of government agencies failed to remit their collections to the agency. PhilHealth increased its premium payments last year from P300 to P600 every quarter for new members who are earning P25,000 annually. This, despite the agencys P110-billion reserve. According to Padilla, some PhilHealth officials who refuse to give up many of the reserves" only use the issue of bankruptcy to oppose proposals on increasing benefits. Thats really foolish," he said. PhilHealth is a very solid organization. It has good investments. In fact, it has too many good investments and it should really be spending more for benefits." Tan agrees. PhilHealth will not be bankrupt," he said, adding, No social health insurance has ever been bankrupt because eventually people will bail it out." A study by Tan showed that based on PhilHealths records, sponsored members or indigents have much lower utilization rates" compared with other member groups. Many members from the formal sector, or those whose premiums are automatically deducted from their monthly pay, are not aware of what they are entitled to.

This is in contrast to health care providers who enjoy PhilHealth benefits more than its members. Padilla said PhilHealth policies in the past 15 years have favored health care providers over its beneficiaries and this has led to abuse. One good example was when PhilHealth increased the benefits for caesarian birthsI think it was raised to P15,000 while normal deliveries were at a low P4,500there was a sudden spike in caesarian deliveries. It went up by 40 percent, which was astronomically more than the usual and also puts mothers in peril," he said. Citing the case as proof that PhilHealth benefits could influence the behavior of health care providers, Padilla said PhilHealth should use its money to change or mold the behavior patterns of doctors and of institutions," instead of letting them abuse the system. Padilla said the current fee-for-service policy, which pays the amount charged by the attending physician for services rendered, is biased in favor of specialists and does not really help PhilHealth achieve its goal of providing health care to the poorest of the poor. We have a bias towards specialists. But given the Philippine setting, where 60 percent or more are poor and where most of them are in the rural areas without specialists, you should reimburse the general practitioners even more and you should do it on a premium basis when theyre in the province," he said. He said data shows that the current bias toward specialists is even more evident in highly urbanized centers where doctors are reimbursed for treating patients who can afford to pay them. Our focus should really be on the general family practitioners who are in the rural areas. You dont need a specialist in those areas because most of the ailments of the poor are really ordinary," he said. Based on 2009 data, PhilHealth has more accredited medical specialists (11,909) than accredited general practitioners (11042). Medical specialists charge higher fees than general practitioners. It has accredited nine out of 10 licensed hospitals, 59 percent of which are private and only 39 percent are public.

Professionals complaints Doctors and hospitals, however, have their own complaints against PhilHealth. Aside from late reimbursements, they say some of their claims are rejected outright by the agency and these could no longer be collected from their patients. PhilHealth reimburses medicines based on how much hospitals charge for these. While hospitals may not necessarily profit from the reimbursement of costlier medicines, Padilla said the premium given for branded medicines, which are often as effective as generic ones, unnecessarily increases the cost of health care. PhilHealth should look for the median price. If PhilHealth thinks that the price should only be P20, they should reimburse the same amount whether the hospital gives a branded or generic medicine," he said, adding, And thats what we need, because hospitals will then veer away from the branded and go into generic and lower costs for the poor." Its unfortunate, but the hard truth is money talks when it comes to medical or health terms. Literally, you can talk about doctors giving services for free for the poor or trying to cure everyone, but PhilHealth has shown that wherever you put your money, thats where they go, whether or not it is good or healthy for the public," he said. VERA Files (This story is the result of a collaboration between VERA Files and the nongovernment organization INCITEGov under a project supported by the British Embassy. VERA Files is put out by veteran journalists taking a deeper look at current issues.)

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Offer free health services, not PhilHealth coverage health groups

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The growing dependence of the DOH on the role of PhilHealth for healthcare delivery manifests a very myopic approach to decades-old problems besetting the Philippine healthcare system. Network Opposed to Privatization By ANNE MARXZE D. UMIL Bulatlat.com

MANILA No one shall be denied access to basic health care services. This is the promise of the new law expanding the coverage of the National Health Insurance or the RA 10606, An Act Amending the National Health Insurance Act of 1995. But for health groups, mandatory health insurance is not the solution to the problem of access to quality health care services for the poor majority. There is no need for a health insurance if the government is sincere in delivering health care services to the people. Funds for this program alone can be allocated to the improvement of deteriorating health care facilities and other equipment that are most needed by our government hospitals, Dr. Geneve Rivera-Reyes, secretary general of the Health Alliance for Democracy (HEAD) told Bulatlat.com. On June 21, President Benigno S. Aquino III signed RA 10606 or the National Health Insurance Act of 2013 which mandates the State to provide comprehensive health care services to all Filipinos through a socialized health insurance program that will prioritize the health care needs of the underprivileged, sick, elderly, persons with disabilities (PWDs), and women and children and provide health care services to indigents. Under the law, the government will also shoulder the premiums for the health insurance of the indigent and informal sectors. Before, members of PhilHealth are comprised of those who could pay the monthly premiums and sponsored members whose premiums are shouldered by the government. Sen. Pia Cayetano, author of the Senate version of the law said the National Health Insurance Act of 2013 also aims to ensure lower out-of-pocket expenses for the poor by shifting to a casebased payment from the current fee-for-service arrangement. The senators claim was countered by Reyes saying that even with PhilHealth, patients still shell out a big amount. The Network Opposed to Privatization, a network of health workers, patients, health professional and health advocates also said that World Bank data showed an increase in out-of-pocket share of patients, reaching as much as 83.5 percent. PhilHealth does not shoulder the entire bill of the patient. Paying members benefit more than the sponsored members. It specifies the type of illnesses to be covered by the benefits and the maximum amount for hospitalization. A member should have paid the premium for a minimum of nine months to be able to avail of the benefits. In far-flung areas where PhilHealth-accredited health facilities, necessary medicines and health professionals are absent, the insurance is certainly an ineffective and frustrating proposition, the NOP said in its website. PhilHealth, not the solution for the poors access to health services Reyes said health services for Filipinos should be free. She said the people should not be paying for health services because it is an obligation of the government to provide accessible and affordable health services.

But since the government has started modernization projects of government hospitals, the people who are mostly indigent patients are left with no other choice but to pay for the high cost of health services. Whats worse, said Reyes, is that patients who cannot afford choose not to seek treatment. Reyes said that instead of spending a big budget on health insurance, the government should provide government hospitals with budgets for capital outlay and maintenance and other operating expenses or purchase essential medicines. The budget should directly benefit the people, Reyes told Bulatlat.com. According to the NOP, in the 2013 budget, the government allotted P12.6 billion ($289 million) for PhilHealth. This is in line with the 2011-2015 Philippine Development Plan and Universal Health Care target to enroll five million poorest families by the year 2015. The growing dependence of the DOH on the role of PhilHealth for healthcare delivery manifests a very myopic approach to decades-old problems besetting the Philippine healthcare system, the NOP said. The NOP said PhilHealth cannot cover-up the continuing failure of the Aquino administration to provide long-term solutions. The group explained that for one, PhilHealth has its own problems. Its numbers regarding coverage, for instance, is highly suspect because PhilHealth has no reliable monitoring system. What PhilHealth projects as its percentage coverage are mainly estimates and because of this, many of the real poor will continue to be denied the health care they need. PhilHealth as a social health insurance has many limitations and restrictions. The group also stressed that for as long as the healthcare system remains neglected, the expanded coverage of PhilHealth is useless. The NOP explained that PhilHealths policy of No Balance Billing only applies to sponsored members who are confined in accredited state-run hospitals, and are suffering from 23 select medical & surgical conditions. http://www.philhealth.gov.ph/advisories/2011/adv09-01-2011.pdf However, the NOP said many provincial and district hospitals are not even equipped to provide services for these cases. Worse, the group said, PhilHealth cannot mitigate the effects of privatization. A recent study based on PhilHealths own projections shows that even if PhilHealth pays out all of its funds (P 103 billion or $2.3 billion) in 2015, this will account for only 20 percent of total health expenditure. And since the governments share in health expenditures will continue to decrease due to privatization, Filipinos will still pay for more than half of their health expenses.
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PhilHealth policy cannot cover medical expenses

By Kirstin C. Bernabe
Philippine Daily Inquirer

10:02 am | Tuesday, January 24th, 2012 7 2241 43

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(Second of two parts) A case-rate system to cover medical costs outlined by the Philippine Health Insurance Corp., or PhilHealth, did not help Aleta Manzanos aunt, Janet, a newspaper peddler who suffered a stroke. The family had to pay more than P30,000 a day, inclusive of med icines, room rate and doctors fees. We also had to pay P12,000 a day in cash on top of the total bill, said Aleta. Some hospitals drive to earn money takes its toll on the helpless, often penniless, patients. When Janet had to be placed immediately in the intensive care unit, the hospital told her family it couldnt admit her without a down payment of P25,000. At that moment, we really didnt have that amount of money. If were going to wait for remittances, that could take a while, Aleta said, referring to assistance from a relative working abroad. Fearing Janet would die without immediate attention, Aleta offered her car to the hospital as a collateral, but the hospital refused the key to the vehicle. After phone calls to friends and relatives, the family was able to give the required cash advance. It was all for naught. Janet died after four days in the hospital. I personally think that without the delays, my aunt could have survived, Aleta said. The grief-stricken family still had to worry about paying the total bill of around P200,000 to get Janet out of the morgue. Higher casualties The Manzanos werent able to get any help from PhilHealth. Although Janet was a member, earning roughly P100 a day from selling newspapers didnt allow her to pay h er premium regularly. Janet is but one of thousands of Filipinos who die of heart and vascular diseases every year, according to official statistics. These are the leading causes of deaths in the country, based on annual studies done by the Department of Health (DOH). We can expect higher mortality rates with the new scheme, said Dr. Rustico Jimenez, president of the Private Hospitals Association of the Philippines, referring to a major cause of deaths in an increasingly stressful world. They are scrimping on the patient. He also said that with the scheme, doctors would not be compensated well. What would happen is that specialists would not accept PhilHealth members anymore and would just let new doctors take over, he told the Philippine Daily Inquirer. I dont think this policy is going to last. Its just not viable. Its about time for PhilHealth to change its payment scheme from fee -for-service to case rates, said Dr. Ramon Paterno, a research faculty member at the University of the Philippines-National Institute of Health. In a fee-for-service scheme, doctors and hospitals tend to order unnecessary medical procedures to maximize PhilHealths benefits, he said. The private hospitals will only capture any increase in ceiling benefits based on PhilHealths experience. Reducing expenses Based on PhilHealths experience compiled in a study, when the agency increased its ceiling benefits in an attempt to reduce the out-of-pocket expenses of its members, hospitals responded by increasing prices and by maximizing the benefits. The publics cash-outs remained the same, according to the study, The impact of social health insurance in the Philippines. With the case-rate payment scheme, a doctors objective is to treat a patient within the fixed amount, Paterno said. PhilHealth intended to efficiently allocate its resources but were having problems with our doctors and hospitals. Theyre worried that their profits would suffer. In government hospitals, meanwhile, the new scheme is implemented with the no balance billing policy. According to this policy, PhilHealths sponsored members, the poorest of the poor, should not be charged any amount above the case rates. In essence, they are entitled to free medical treatment in its public health units. If an indigent, however, is forced to go to a private hospital, this person doesnt have a choice but to pay the amount beyond the fixed rates.

In this country, private hospitals outnumber government hospitals, Jimenez said. Besides, government hospitals can only accommodate so many with its ill-equipped facilities and scarce medical specialists. PhilHealth hopes to eventually implement the no balance billing policy in private hospitals. As we move forward, we know that we have to offer a rate that the private sector will be happy with, said Dr. Eduardo Banzon, PhilHealth president. We can give incentives like paying hospitals 50 percent if they are willing to do no balance billing, he told the Inquirer. More than payment schemes These are negotiations that PhilHealth cannot do with a fee-for-service system, according to Banzon. But the Universal Health Care (UHC) program is more than payment schemes and health insurance, Paterno said. We cannot even talk about universal health care if we only have P44.4 billion to spend, he said. Although the budget for health is about P11 billion higher than last years P33 billion, experts think it is not even half of UHCs cost. Based on the 2007 National Health Accounts, out of the P235-million total health expenditure, 54 percent came from the publics pockets while the governments share accounted for 26.6 percent. PhilHealths contribution was 8.5 percent. The health budget should be increased to at least P100 billion to significantly reduce the publics out -of-pocket medical expenses, said Paterno, who drafted a health financing reform proposal with colleague Dr. Chrysanthus Herrera. The proposal was published in a special issue of Acta Medica Philippina, the national health science journal of the University of the Phililppines-Manila. Political will needed The DOH budget for 2011 should have been at least P90 billion instead of P33 billion, with the LGU spending P36 billion for a total of P126-billion government share, according to the proposal. Starting with the P126-billion target, if the government would consistently increase its budget by 34 percent every two years, out-of-pocket expenses would significantly drop from almost 60 percent to 20 percent in the fourth year, it added. Paterno and Herrera also offered an alternative form of funding, a creation of a National Health Development Fund that would add P50 billion to the health department budget. This fund would provide for the PhilHealth premium of the poorest 60 percent of the population, health infrastructure improvement, wage hike for the governments health human resource sector, adequate supply of medicines and disaster preparedness, they added. Chronic under funding is just one of the problems that need to be addressed to give Filipinos a kind of health care that could help them survive an illnessor at least, give them hope. The current system is still far from the promise of universal health care, Paterno said. It can be done, it only takes political will, he said. Subsidizing premiums The case of Manzano, along with that of Joy Araneta, a house help who lost her daughter to ovarian cancer, has prompted proposals to make PhilHealth premiums for the poor noncontributory. Paterno said that the government could subsidize the premiums of t he poor, the near poor and those in the nonprofessional informal sector, like Araneta, pointing out that every Filipino, anyway, paid taxes through the value added tax, or VAT. He said: The past experience of PhilHealth, and reports from doctors in the field, have shown that targeting programs such as the National Household Targeting System for the Conditional Cash Transfer program, are again encountering the perennial problem of identification of the true poor, resulting in inclusion of the nonpoor and exclusion of the true poor. Secondly, even if Joy Araneta is able to scrimp and save for the P100 monthly PhilHealth premium, PhilHealth coverage will not guarantee that she will be able to get the health services she needs for two reasons: PhilHealth presently pays for only 30-50 percent of our hospitalization costs, and she might not even be able to get admitted into a public hospital, as was her experience with Philippine General Hospital. Increased national government spending for health is still a necessary first step to decrease out-of-pocket payments for health care and achieve Universal Health Care.

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PhilHealth-6 bats for more responsive, faster customer service

BY: ELSA S. SUBONG Monday 10th of June 2013
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ILOILO CITY, June 10 (PIA6) -- For PhilHealth in Western Visayas, there is no let-up in giving faster and better services to members and dependents. Among these services, according to PhilHealth Manager Dr. Dennis Mas, is reducing the length of processing for each transaction every day. For us, this translates to more responsive customer service, resulting to more happy and delighted clients, Mas said. Dr. Mas said that there was an increasing number of members from an average of 1,200 walk-in clients daily, PhilHealth aims to further reduce the processing time by 50 percent more. Members applying for initial registration and updating of their records will have their transactions completed in 10 minutes faster than the goal of 20 minutes, as stipulated in the Citizens Charter, Mas said. Mas also said that processing period for members paying for their premium contributions, requesting for any PhilHealth record, like the PIN card, MDR, Certificate of Premium Contributions and Certificate of Eligibility and release of benefit payment checks will also be reduced by half. He added that all their frontline officers have been undergoing

intensive training on Upholding ARTA and Excellent Public Service, conducted by the Civil Service Commission. With the hiring of additional 31 frontline officers this June, we hope to achieve our goal of giving only the best for our clients, Mas said. The office has also recently expanded its services closer to its members by putting up PhilHealth Express Offices in Robinsons Place in Iloilo City and Bacolod City as well as in the local government units of Guimbal, Iloilo and San Carlos City, in Negros Occidental. Dr. Mas said they have received positive feedbacks from members who have availed of services in these Express Offices. In terms of benefit delivery, claims filed in the regional office are processed the fastest, based on their routine report, which revealed that hospital and members claim is paid in less than one week only from actual receipt of documents. PhilHealth has automatically accredited private and government facilities with license from the Department of Health, while government health care doctors, midwives, dentists and other health personnel are deemed automatically accredited as professional providers for applicable PhilHealth benefits. Dr. Mas said that the office has already been cited for being among the top leading agencies which passed the CSCs Anti -Red Tape Report Card Survey. Capping it all was the +82 satisfaction rating in a nationwide survey of the Social Weather Station last year. We hope to receive the recognition of Citizens Satisfaction

Center Seal for Excellence, for all our local health offices, after our three offices were cited, Mas said. (JCM/ESS/PIA-Iloilo)
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