Point-of-Care Enrolment: Providing Coverage Right Where It Matters


  • Point-of-Care Enrolment: Providing Coverage Right Where It Matters
    • The author interviews Melinda as Nomer listens
    "Nilalagnat, masakit ang tiyan at manas noong dinala namin si Nomer sa ospital. Sabi ng doktor, kailangang i-confine na, i-ICU at lagyan ng tubo. Ayokong pumayag, wala talaga kaming kapera-pera", narrates Melinda Garduce, mother of Nomer G. Baldera, a beneficiary of PhilHealth’s Point-of-Care enrolment scheme.

    Nomer is her second child and was diagnosed with Congestive Heart Failure, a condition in which the heart's function as a pump is inadequate to deliver oxygen-rich blood to the body. With a brood of seven and relying only on his husband’s meager income as a seasonal construction worker, she doesn’t have enough money to spend for Nomer’s hospitalization.


    Since Nomer turned 21 years old in November 2013, he was no longer qualified as a dependent of his father Norberto, a member of the PhilHealth Indigent Program.    Point-of-Care Enrolment: Providing Coverage Right Where It Matters
    Thanks to the Point-of-Care system (POC), Nomer was given the needed health insurance coverage from PhilHealth.
    "Salamat sa PhilHealth, dalawang linggo sa ospital ang anak ko, wala kaming binayaran sa ospital. May kaunti man kaming nagastos pero lumapit ako sa lahat ng pwedeng mahingan ng tulong", Melinda added.
    Under the POC, the patient should pass the medical social worker’s assessment to become a Sponsored member, with the hospital shouldering the annual premium contribution of P2,400 to PhilHealth. The hospital-sponsored member (HSM) is automatically granted PhilHealth coverage starting on the first day of admission up to the end of the calendar year.

    Aside from inpatient benefits, the HSM may also avail himself of outpatient benefits except those in the Tamang Serbisyo para sa Kalusugan ng Pamilya or TSeKaP. He is also entitled to the No Balance Billing policy wherein he will no longer pay anything on top of his PhilHealth coverage when confined in ward accommodation in government hospitals.

    Launched last November 2013, POC was initially implemented in 85 retained hospitals of the Department of Health nationwide. The scheme became an effective mechanism to cover those from the C3 to D segments of the population who are confined in the government or LGU-owned hospitals but are either non-members or existing members but lacking qualifying contributions.

    In less than a year of implementation, PhilHealth has already enrolled over 73,107 beneficiaries nationwide through the said system.

    To ensure continuity of health insurance coverage, PhilHealth shall provide a list of HSMs to Department of Social Welfare and Development for validation and possible inclusion in the National Household Targeting System (NHTS-PR ) or Listahanan.

    Those in the Listahanan are automatically given PhilHealth coverage under the Indigent Program, with their annual premium contribution being paid for by the National Government.

    To date, there are 161 hospitals participating in the POC, including LGU-owned and other government-run hospitals. Based on latest records, the Southern Philippines Medical Center in Davao City had the highest number of enrolees with 6,548, while total benefit payments for those enlisted under the system nationwide already reached Php214M as of April 2014.

    "We are very thankful for the support of the hospitals and LGUs in the successful implementation of the POC. With this, we believe that poor Filipinos will no longer be afraid to seek medical attention knowing that their Government and the hospitals are working together to give them the financial help that they need,"Alexander A. Padilla, PhilHealth President and CEO said. (Pinky Gemeniano- Aragones)

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