PhilHealth Engagement Follow-through meeting 30 October 2013 Philippine Rural Reconstruction Movement Building, Dr. Lazcano corner Mother Ignacia Avenue, Quezon City

Agreements reached at our September 27 Forum on PhilHealth Agreements/ Resolutions: 1) Civil Society volunteers to help out in information dissemination After realizing that the members’ lack of knowledge and information about the PhilHealth is a huge contributing factor to why there is low utilization, the participants in the forum have accepted a role of helping PhilHealth in helping in information dissemination. They volunteered to translate relevant PhilHealth materials, which are always written in English, to the language which is more convenient to use by the general public. Aside from that, the group also asked for other materials such as those that could empower patients. (October 2013 meeting) 2) The Civil Society is welcomed to attend the monthly ManCom Dr. Shirley Domingo emphasized that what everyone wants is to improve the country’s health care system. And while she reiterated that doing so could not be done by PhilHealth alone, she recognized that the CSOs can play a role in a lot of ways. She, in the end of the event, accepted the suggestion of the participants which is to let CSOs attend the monthly ManCom (meetings attended by PhilHealth officers) to be able to further help especially in discussing policies.

PHILHEALTH REGIONAL OFFICE NCR and RIZAL (PRO NCR and RIZAL) Office of the Vice President – Dr. Shirley Domingo Public Relations Unit – Henry Ramos Health Care Delivery Management Division – Dr. Nenita Valbuena Information and Technology Quezon City – 52 hospitals PRO NCR AND RIZAL THREE BRANCHES: PRO NCR South: Henry Almanon Las Pinas, Makati, Muntinlupa, Pasay, Pasig, Pateros, Taguig, Parañaque PRO NCR Central: Gilda Salvacion Diaz QC, Marikina, San Juan PRO NCR North: Dr. Elizabeth Fernandez Caloocan, Mandaluyong, Manila, Navotas, Malabon Valenzuala PRO RIZAL Angono, Antipolo, Baras, Binangonan, Cainta, Cardona, Jala-Jala, Morong, Pililla, Rodriguez, San Mateo, Tanay, Taytay, Teresa,

Local Health Insurance Office (Local Government) Business Processes: 1. Membership 2. Collection 3. Claims 4. Accreditation (hospitals, center, professionals) 5. Marketing (LHIO) 6. Legal 7. Public relations unit 8.. IT

PhilHealth Thrust: Financial Risk Protection 1. Satisfied and empowered beneficiaries and stakeholders 2. Excellent business processes 3. Viable, social health insurance fund 4. Adequate organizational capability

No Balance Billing Considerations: Sponsored program Government hospital 25 case payments only

PhilHealth NCR IEC Planning Workshop November, 2013

Membership Satisfaction. Increase awareness. Ensure access to healthcare service providers and professionals. increase collection. accurate -- operational excellence, strengthen relationship with stakeholders, cultivate shared understanding of philhealths corporate values. boost social marrketinga nd social satisfaction. ensure data quality of philhelaht data base. Point of Service enrollment former member just need to pay past 3 months premium, for indigent members - enrollment at point of service (pilot hospitals - Quirino, East Avenue Medical Centers) -- entitled to benefits into 3 mos - as needed On Complaints: can request for motion for reconsideration for disapproved reimbursment == that overt act (statement) is already a request for motion for reconsideration (c/o Diaz, branch manager) opening for advocacy -- the mere resubmission is an act of reconsideration --- magkaconchaba yung ospital at doctor na di accreditated - dapat ba sasabihin na senior citizen kahit obvious na - should they ask? what do we want? policy dapat pagpasok tatanungin agad yung patients Benefit payment notice – we can ask what they charged – halimbawa doble ang sinigil na professional fee

Dapat bantayan yung charging ng providers - kasi they can overcharge - - we should request for benefit payment notice mula sa office ng PhilHealth Public relations unit nandiyan lahat ng reklamo - gusto nila ngayong tingnan ang trends of complaints - complaints of members, hospitals, professionals - for policy implications Benefit administrative Section is in charge of claims - sana may monitoring of complaints of members - we can complain if the serivce provider did not give us true benefits we can also ask from their collection unit if our employer did not remit to PhilHealth

Pateros and Navotas do not have hospitals yet Monitoring is our entry point - to see if the accredited service providers are providing the right payment Can also monitor sponsored programs -- No Balance Billing Primary care benefit/package - PhilHealth will provide capitation - for indigents and organized groups - covered Families are -- annual health profiling - primary care doctors visit at least once a year - not just during sickness Monitor accredited hospitals: Post-monitoring scheme Automatic accreditation of PhilHealth for DOH licensed government hospitals – ibig sabihin di na kailangan dumaan sa stringent process of PhilHealth accreditation for government hospitals basta licensed ng DOH

PCB - Primary Care Benefit package -- advance benefit na yan - PhilHealth has already given capitation to the service providers For now 25 case rates, baka later on lahat na --- Statement of CHAT, KAMP, AER, ABI and WomanHealth Philippines during the Mancom PhilHealth is not just Financial risk protection. It is an equity tool and poverty tool. Delivery of basic services such as education, health and housing (commons) is a strategy to address poverty. Palagi niyong iniinterchange ang clients-customers- --- language is important – we are not clients or customers, we are members – We also push for financing – wag niyong ihihiwalay ang corporation sa members Bawat pilipino miyembre, kalusugan natin sigurado … sana ang bawat miyembro sasabihin – amin, atin – hindi lang sa inyo ang PhilHealth, amin yun, atin iyon- dahil atin ito gusto naming protektahan ito

Point of Service Enrolment Pregnant women Covered for the fiscal year (i.e. until December of the same year) Point of Service: Labas ng 2,400, kubra pabalik ay 8000 Indigency evaluation through DSWD for continued membership Initially, PhilHealth accredited government hospitals Higher rate for lying-in centers Normal delivery

Next steps Pagkikita ng DSWD, PhilHealth at DOH

DATA Unacceptable high OUT OF POCKET Low level of public spending % THE26-27% of THE % % In terms of equity, it it the worst picture. It is the opposite of what we want to happen.

Poverty incidence: no significant improvement, despite favourable economic growth, 40 richest families No inclusive growth; increasing informal/contractual workers

Frog leap investment poor & near poor 14.7 million families; 50M individuals 2011:3.5BP 31.9 GAA 2012:12BP 42.2B 2013:12.6BP 53.1B 2014:35.3P 80.1 NEP (P30B increase, P23B goes to PhilHealth) NHIP – p35.3B :35.3P :35.3P 89.5

Innovative Financing Sin Tax legislated in Earmarked for health 2013: P 28.8B 2014:P 36.4B 2015:P B 2016:P B 2017:P 54B

Challenges: Financial risk protection No Balance Billing (NBB): only 7% compliance to NBB policy (DOH hosp 11%, LGU hosp 6%). 93% continued practicing BB Not ready to apply NBB: lack of medicine, laboratory and supplies Case rate payment not reflecting full cost Expansion case payment from 23 to all conditions: Payment rate based on formula which do not reflect full cost May repeat mistake f noncompliance to NBB

Fundamental problems: not addressed adequately 1. Two decades stagnation: hospital bed population ratio 2.Overstretched bed, inadequate essential, auxiliary services 3.Supply bottlenecks restrict people seeking care; one of the Reasons for not accessing health care 4.Decentralization: large regional gaps in Shelled Birth Attendant (SBA) Level 1-4clinical laboratory X-ray Pharmarcy Dental service

FLAGSHIP STRATEGY I Strategic Vision: Advancing population coverage with a PCB++ for all and gradually expand package to IP. 1. Rolling out a package of primary care service including curative, preventive, promotion services PCB1 and 2, to all PhilHealth members (not only the poor). 2. Rolling out a publically funded package of PCB1 and 2 ++ (++ aims to reduce OOP and gaining health, quite a comprehensive package) to all Filipinos who are PhilHealth members and the remaining uninsured. 3. NBB applied throughout to reduce OOP. 4. Assessment and declare UHC for a package of primary care for all Filipino.

FLAGSHIP STRATEGY II Strategic Vision: Supply side strengthening (HRH, Facilities) 1. Heavy investment in a strong district health system (close to client services): RHU + DH to provide quality continuity of primary care services (Family Care, do not spend on tertiary care) 2. A decade of District Health Systems strengthening. 3. A five year plan for upgrading provincial, regional hospitals serving referral backups. 4. Devise policies to scale up, expand scope and financial / nonfinancial incentives of “mandatory district health services” by ALL medical nursing, pharmaceutical, dental graduates. 5. Embedded “rural retention” in education strategies (CHED, medical schools), rural recruitment, hometown placement, back to their hometown. 6. SUPPLY SIDE BOTTLENECK.

ACTION POINTS: A.Mobilize more resources 1.Sin Tax 2.GAA on top 3.the ceiling of 35K for the payroll contribution be removed. B.Improve efficiency 1.Seek greater allocative efficiency, shifting resource to primary care, increasing spending on preventive and health promoting interventions 2.Set right provider payment incentives - costing of service leading to care-based reimbursements of in patient care - gradual reduction of the DOH subsidies to the hospitals and shifting resources from DOH budget to PhilHealth C.Monitoring and Feedback 1.Accredited Facilities and Professionals (PhilHealth) 2.Sponsored Program is with DSWD – LGU identifies and distributes cards

Principles of Civil Society Engagement