Bawat Mahirap, Protektado
During my road trip to Bicol and CARAGA regions in the last two weeks, I
noticed that Medicare was still used to refer to anything PhilHealth-related.
A disconcerted me would then request that PhilHealth be used; to which I
will consistently be asked what the difference is between Medicare and
PhilHealth and why the need to change terms... A lot of difference!
Medicare, admittedly the parent of PhilHealth, was born way back in 1969
and focused on the formal sector with emphasis on covering hospital
services in both government and private medical facilities.
In 1995, after more than 25 years of Medicare and several studies showing
its inadequacies, PhilHealth was established to address the limited
population coverage, lack of primary care and continuity of care benefits,
and non-empowering policies and rules.
PhilHealth was designed to go beyond what Medicare offers. Not only was
it expected to fulfill the constitutional mandate to prioritize the
underprivileged and the vulnerable, it was expected to intensify efforts to
bring about universal coverage and financial access to health services.
PhilHealth explicitly calls for equity, wherein access to health care services
is a function of one’s health needs rather than his/her ability to pay.
PhilHealth overtly aspires for continuity of health care, so that the health
care needs of Filipinos are responded to throughout the various stages of
their lives. PhilHealth is fueled by social solidarity and community spirit
with the well off, healthy, young, and single are one with the poor, sick,
elderly, and married with children.
And PhilHealth empowers by making itsbenefits and processes simple and understandable to its members, and by doing so embodies informed choice and maximizes the participation of the
people.
To achieve universality, avoid adverse selection and address social inequity,
PhilHealth is legally bound to require mandatory membership and
compulsory coverage.
To sustain universality and the preferential bias for the poor, the government was made responsible for subsidizing the premium payments of poor/indigent families. In 2008, the national government, through the Department of Social Welfare and Development (DSWD), started a comprehensive determination
of the poor through the National Household Targeting System for Poverty Reduction (NHTS-PR). The tools and processes were rigorously designed and implemented, with over 10 million households surveyed and just over 5 million of these households determined to be poor.
Unfortunately, when PhilHealth cross-‐matched its Sponsored Program database with the NHTS-PR list of poor households, a mere 20% of the NHTS-PR had a match. Efforts therefore had to be scaled up to ensure enrollment of NHTS-poor households into PhilHealth.
Now, we are happy to say that the health insurance coverage of the NHTS‐poor has been provided for by the national government. 4.9 million household heads and their dependents are enrolled in the sponsored
program, and the remaining 300,000 covered under other membership categories. In addition, beneficiaries of the conditional cash transfer (CCT) program or the Pantawid Pamilya Pilipino Program are assured of PhilHealth coverage.
All this translates to at least 26 million poor Filipinos enrolled into PhilHealth. Our database has now undergone a fourth pass validation, and we are exerting effort to remove duplicates, correct inaccurate spellings, and complete missing data.
To support their use of benefits, polyvinyl chloride (PVC) ID cards are now being procured and distribution is expected by August 2012. In the interim, yellow member data records (MDRs) had been distributed to them. This will facilitate access to health facilities, as it addresses the difficulty in producing documentary requirements such as birth certificates and marriage contracts by the poor. We have also made available the master list of NHTS-poor households in the PhilHealth website; copies have also been provided to health facilities and LGUs. The PhilHealth CARES nurses deployed in 530 hospitals all over the country facilitate the determination of eligibility status and ease availment. Finally, to make things simpler for the Pantawid beneficiaries, their Pantawid identification cards are deemed adequate for benefit availment.
PhilHealth is strikingly different from Medicare because it pursues universality and equity, as embodied in its preferential treatment of the poor. More importantly though, we at PhilHealth constantly strive to be
there for any Filipino family who needs us the most.
noticed that Medicare was still used to refer to anything PhilHealth-related.
A disconcerted me would then request that PhilHealth be used; to which I
will consistently be asked what the difference is between Medicare and
PhilHealth and why the need to change terms... A lot of difference!
Medicare, admittedly the parent of PhilHealth, was born way back in 1969
and focused on the formal sector with emphasis on covering hospital
services in both government and private medical facilities.
In 1995, after more than 25 years of Medicare and several studies showing
its inadequacies, PhilHealth was established to address the limited
population coverage, lack of primary care and continuity of care benefits,
and non-empowering policies and rules.
PhilHealth was designed to go beyond what Medicare offers. Not only was
it expected to fulfill the constitutional mandate to prioritize the
underprivileged and the vulnerable, it was expected to intensify efforts to
bring about universal coverage and financial access to health services.
PhilHealth explicitly calls for equity, wherein access to health care services
is a function of one’s health needs rather than his/her ability to pay.
PhilHealth overtly aspires for continuity of health care, so that the health
care needs of Filipinos are responded to throughout the various stages of
their lives. PhilHealth is fueled by social solidarity and community spirit
with the well off, healthy, young, and single are one with the poor, sick,
elderly, and married with children.
And PhilHealth empowers by making itsbenefits and processes simple and understandable to its members, and by doing so embodies informed choice and maximizes the participation of the
people.
To achieve universality, avoid adverse selection and address social inequity,
PhilHealth is legally bound to require mandatory membership and
compulsory coverage.
To sustain universality and the preferential bias for the poor, the government was made responsible for subsidizing the premium payments of poor/indigent families. In 2008, the national government, through the Department of Social Welfare and Development (DSWD), started a comprehensive determination
of the poor through the National Household Targeting System for Poverty Reduction (NHTS-PR). The tools and processes were rigorously designed and implemented, with over 10 million households surveyed and just over 5 million of these households determined to be poor.
Unfortunately, when PhilHealth cross-‐matched its Sponsored Program database with the NHTS-PR list of poor households, a mere 20% of the NHTS-PR had a match. Efforts therefore had to be scaled up to ensure enrollment of NHTS-poor households into PhilHealth.
Now, we are happy to say that the health insurance coverage of the NHTS‐poor has been provided for by the national government. 4.9 million household heads and their dependents are enrolled in the sponsored
program, and the remaining 300,000 covered under other membership categories. In addition, beneficiaries of the conditional cash transfer (CCT) program or the Pantawid Pamilya Pilipino Program are assured of PhilHealth coverage.
All this translates to at least 26 million poor Filipinos enrolled into PhilHealth. Our database has now undergone a fourth pass validation, and we are exerting effort to remove duplicates, correct inaccurate spellings, and complete missing data.
To support their use of benefits, polyvinyl chloride (PVC) ID cards are now being procured and distribution is expected by August 2012. In the interim, yellow member data records (MDRs) had been distributed to them. This will facilitate access to health facilities, as it addresses the difficulty in producing documentary requirements such as birth certificates and marriage contracts by the poor. We have also made available the master list of NHTS-poor households in the PhilHealth website; copies have also been provided to health facilities and LGUs. The PhilHealth CARES nurses deployed in 530 hospitals all over the country facilitate the determination of eligibility status and ease availment. Finally, to make things simpler for the Pantawid beneficiaries, their Pantawid identification cards are deemed adequate for benefit availment.
PhilHealth is strikingly different from Medicare because it pursues universality and equity, as embodied in its preferential treatment of the poor. More importantly though, we at PhilHealth constantly strive to be
there for any Filipino family who needs us the most.
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