Professional Documents
Culture Documents
MANAGED CARE
ORGANIZATION
• Government Sector
• Social/Insurance
• Private Sector
Government Sector
• DOH
• RHU
• Government Hospitals
• Tertiary Care Medical
Centers
Social Insurance
• PhilHealth
Philippine Health Insurance
Commission
• ECC
Employees Compensation
Commission
Private Sector
1. Staff Model
2. Group Model
3. Combination
Classification of HMO’s as
Per Ownership
1. Investor–Based HMO’s
2. Community–Based
HMO’s
3. Cooperative–Based
HMO’s
HMO’s in the Philippines
(as of October 2003)
• PhilamCare
• Medicard
• Maxicare
• HMI
• SPCare
• Fortune Care
• StarCare
• Blue Cross
• Medserv
HMO’s in the Philippines
(as of October 2003)
• I.Care
• Ayala Care
• HPPI
• Pryce Care
• Caritas Health Shield
• Cocolife
• CAP Health
• IMS/Wealth Care
• MEDOCare
Generic Structure of an
HMO
1. It is not a Health
Insurance.
3. It is not a Pre-Need
Insurance.
Important Differences
Between an HMO and
Health Insurance
FEATURES HMO INSURANCE
Method of Payment Direct settlement Reimbursement
Scope of Services More Limited
comprehensive
Choice of Hospital Limited Freedom of
and Physicians choice
Membership Fee Higher Lower
Cost Effectiveness Present Not present
& Quality Assurance
Mechanisms
Supervising DOH OIC
Government
Agency
HMO Basic Health Care
Package
I. Out-Patient Benefits
II. In-Patients Benefits
III. Emergency Care Benefits
Benefits Package