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Pulling its Weight

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PhilhealthThe Philippine Health Insurance Corporation is not quite Obama care but it’s getting there

It would be easy to dismiss the Philippine Health Insurance Corporation, PhilHealth, as just a government gimmick if they weren’t so earnest about it.

Thousands of PhilHealth insurance cards were distributed to voters free the 2004 elections to help President Gloria Macapagal-Arroyo’s reelection bid. But beyond its value as a political tool is its value as a social tool. PhilHealth released 24.3 million pesos last year for the medicine and hospitalization of some 3.3 million Filipinos.

That number is expected to rise as PhilHealth tries for universal coverage in a Philippine health insurance system that will be paid for with funds from national and local governments as much as member contributions. The plan to provide each Filipino, including the unemployed and the elderly, with a basic care package is ambitious, but it’s getting there.

In the 15 years since the program was launched, PhilHealth now covers 86% of the population. That means around 77.4 million Filipinos are now eligible for government subsidies on hospital confinement, treatment, tests, and medicines. While subsidies may seem paltry—a mere 300–1,100 pesos a day for hospital confinement and 2,700–40,000 pesos for medicine— this could spell the difference between life and death for someone who can’t afford to see a doctor.

Although prohibited by law, some hospitals refuse to admit emergency room patients who cannot post a bond of as much as 15,000 pesos. The average amount that PhilHealth pays on each claim is 8,000–10,000 pesos, but this is often enough of a guarantee for hospitals to admit patients without asking them for a deposit says Ruben Basa, PhilHealth VP for corporate affairs.

Critics of the government health system, particularly Make Health Count, a coalition of students, professors, and doctors at UP Manila, says that PhilHealth’s coverage of only 10.7% of the total bill is not enough. Basa does not deny this, adding that it is still advisable to get a private HMO if you can afford it. “Just make sure that you are also covered by PhilHealth,” he says. Private HMOs factor in PhilHealth coverage when they price products offered to corporate accounts. If a patient fails to process their PhilHealth claim, private HMOs will not pay for the confinement.

Standardized Costs
There are plans underway to increase member benefits by 35% while driving down the cost of premiums even lower than the 1,200 pesos a year that they collect in monthly salary deductions. One of the proposals being studied is contracted payment, where government will pay up to 90% of a patient’s hospital bill.

This will require standardizing the costs of hospital treatments and procedures, a process that PhilHealth has already started. If the standard cost of cataractremoval surgery is, say, 16,000 pesos, Basa explains, and a patient has the procedure done at a hospital that charges 20,000 pesos, they will only have to pay the extra 4,000 pesos.

Contracted payment is already being tested in five pilot hospitals. Baguio General Hospital, a governmentrun facility is one of them, but Basa says two to three of the pilot hospitals are run privately. With standardized prices, Basa says, hospitals will find it easier to attract patients. Many Filipinos avoid going to the hospital because of the cost, which is often an unplanned expense. Raising government coverage will make it easier to put healthcare in the family budget.

Even as PhilHealth tries to cover the remaining 14% of the population without government health insurance, it has also been extending services to migrant workers and their families.

It is set to open its first satellite office in the Middle East this month. The PhilHealth office at the Philippine Embassy in Riyadh will promote the National Health Insurance Program, and will act as a clearing house for membership applications, premium payments, and benefit claims. There are more than one million OFWs in Riyadh, says Dr Rey Aquino, president and CEO of PhilHealth, and bringing government health insurance to them is a priority.

OFWs in other countries will not be left to fend for themselves either. Service desks at Philippine embassies in Malaysia and Singapore will be set up within the year. Meanwhile, PhilHealth has a roving ‘mobile official’ to coordinate with members among the more than 140,000 OFWs in Hong Kong and Macau.

PhilHealth coverage can mean a lot for OFWs, many of whom work as domestic helpers or menial laborers without employee benefits. PhilHealth will reimburse a portion of their hospital bill. Perhaps more important to OFWs with families back home, PhilHealth coverage extends to their wives, children, and parents.

Road Blocks
Universal health care is not without its challenges, however. Being a governmentrun company, it has been involved in allegations of corruption, as in the 2004 elections. It has also been the victim of alleged corruption: it was reportedly on the brink of bankruptcy because government agencies had not been remitting employee premiums. These were soon laid to rest by then Budget Secretary Rolando Andaya and PhilHealth officials. The Commission on Audit team assigned to check PhilHealth’s books found ‘no major findings’ of corruption either, Basa points out.

Surprisingly, the creative accounting sometimes comes from the hospitals themselves. PhilHealth benefits are supposed to be deducted from the final bill before the patient checks out, and some hospitals deduct less from the total than they should. Other hospitals charge just a bit more than PhilHealth covers or keep the patient confined longer than necessary. While these practices are not the norm in the Philippine hospital industry, PhilHealth still audits each claim before paying.

The greatest hurdle that the PhilHealth faces, though, is infrastructure and the lack of it. Poor road systems make giving health insurance to the remaining 14% of the population similar to the ‘last mile’ in telecommunications, and that last step is always the hardest.

There is also a lack of adequate healthcare facilities in the country, especially in rural areas. If the nearest government health center is two hours away by dirt road, a health card is about as useful as a rock.

During the presidential campaign early this year, Senator Benigno Aquino III said that universal health care should mean more than just giving people health cards, “but more important, are the essential health services, basic medicines, and appropriate quality healthcare.”

Aquino promised to increase spending on health by 5% and build 2,000 community health stations, 3,000 outpatient rural health units, and at least 150 district hospitals. Now President-elect, Aquino has a chance to make universal healthcare happen. He also has a chance to prove true to his Obama-like campaign and say “Yes, we can. And we did it first.”

Print ed: 06/10

 

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