PhilHealth Holds SHInES for NEDA, DBM, COA and GCG

AT least 30 representatives from the National Economic Development Authority (NEDA), Department of Budget and Management (DBM), Commission on Audit (COA) and Governance Commission for GOCCs (GCG) gathered recently at the Legend Villas in Mandaluyong City to learn about the salient points of the National Health Insurance (NHI) Act of 2013 or Republic Act 10606.

Through the Social Health Insurance Education Series (SHInES) organized by the Philippine Health Insurance Corporation (PhilHealth), these government employees were thoroughly oriented on the various aspects of the NHIP to inculcate among them better appreciation of the NHIP. The SHInES was also aimed at providing comprehensive and relevant information as well as updates on new policies issued by PhilHealth.

Dr. Israel Francis A. Pargas, OIC-Vice President for Corporate Affairs Group welcomed the participants to the learning session. “You are now here wearing two hats. First, you are all members. As members, you should know what PhilHealth is. You should also know the different benefits, how to go about these benefits and its availment. Second, you’re wearing the hat of being in the policy-making /direction. So today, we are expecting a lot of participation from everyone from these two hats,” he said.

Alexander A. Padilla, PhilHealth President and Chief Executive Officer appealed to the participants to help support the program, stressing that the NHIP is one of the best programs of the administration. “Ang PhilHealth po ay isa sa pinakamagandang programa ng administrasyon na dapat tulungan at suportahan. Ginagawa namin ang lahat upang ito ay makatulong sa nangangailangan dahil ito ay obligasyon ng pamahalaan sa mga mamamayan.”

Esperanza S. Ocampo, President of the Philippine Government Employees Association, said that “in doing quality public service, the aspiration and motivation of government employees depend upon the government institution,”and that in PhilHealth “we tried our best to deliver output,” she added.

Arsenia B. Torres, Senior Manager of the Social Health Insurance Academy (SHIA) briefly tackled the health care financing module. She mentioned that with regard to resource mobilization, governments also have the option to solicit funds from international donor organizations such as the World Health Organization (WHO) or World Bank (WB) to fund their systems, and that this support can also take various forms such as technical assistance, logistical or infrastructure support.

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Lemuel T. Untalan, Senior Manager of the Corporate Planning Department presented the Universal Health Care and the NHI Program. He pointed out that the three (3) strategic thrusts to achieve Universal Health Care are financial risk protection through expansion of NHIP enrolment and benefit delivery, improved access to quality hospitals and health care facilities, and attainment of the health-related Millennium Development Goals (MDGs).

On the other hand, Dr. Francisco Z. Soria, Jr., OIC-Vice President for Quality Assurance Group discussed the details of the different benefit packages such as the Inpatient Care benefits being paid for through Case Rates, Primary Care, MDG benefits, Emerging Diseases. He also tackled the No Balance Billing (NBB) Policy, and reported that the implementation of the NBB in government hospitals had tremendously increased from 13 percent when it was first implemented in 2012, to 51 percent by 2015.

Alberto C. Manduriao, OIC-Vice President for Member Management Group shared with participants the details of the different membership categories, highlighting the 92 percent effective PhilHealth coverage as of December 2015. He also identified the different challenges and opportunities faced by PhilHealth such as the mandatory membership for all Filipinos, sustainability of the membership coverage and extending coverage to the uncovered informal economy members.

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Nerissa R. Santiago, Vice President and Deputy Chief Actuary talked about the actuarial process and valuation. She identified the corporation’s 5-year strategic plans such as the essential heath benefit package, fixed co-payment, expansion of Enhanced Primary Care Benefit (EPCB) to other sectors and PhilHealth Plus. She also mentioned the proposed increase of premium contribution by 2018 as one of the strategies to enable PhilHealth to attain the said plans.

Another resource speaker in the event was Jeannie T. Bernolia, Division Chief of ITMD who elaborated on the Enterprise Architecture as a critical instrument for organizational efficiency since it provides a strategic context for the evolution of the Information Technology (IT) system in response to the constantly changing needs of the business environment.

Gregorio C. Rulloda, OIC-Senior Vice President of the Fund Management Sector handled the financial position of PhilHealth. He clarified that the total annual costs for operations as mandated, shall not exceed the sum total of the following: 4 percent of the total premium contributions collected during the immediately preceding year; 2.4 percent of the total reimbursements or total cost of health services paid by PhilHealth in the immediately preceding year; and 3.5 percent of the investment earnings generated during the immediately preceding year.

Questions raised during the open forum included the NBB coverage for senior citizens, status of fund initially appropriated for benefit payments of indigents but later shouldered by the Department of Health, sustainability of senior citizens’ premium, PhilHealth’s preventive programs for the year, reasons why TSeKaP is only available to certain member categories, and the IT system, among others. PhilHealth officers thoroughly answered each of the questions.

The SHInES for this batch is the 23rd session since it started in 2012 and the second for this year. It was spearheaded by the Corporate Affairs Group, led by SHIA.