phic case study
TRANSCRIPT
Healthcare Innovation: Philippine National Health Insurance
Teodoro J. Herbosa MD FPCS College of Medicine University of the Philippines, Manila Undersecretary (Deputy Minister) of Health (2010-2014)
PHILIPPINE HEALTHCARE
✤ Established by the Americans in 1900’s!
✤ Two systems in one: Public Health System for the poor and Private Health Care for those willing to pay!
✤ 1970s-1990s decline of public health funding and expenditure!
✤ 1991 Decentralization of Public Healthcare to Local government units!
✤ 1994 National Health Insurance Act Universal Health Care coverage for all by 2010.
PHILIPPINE HEALTH INSURANCE CORPORATION
✤ Replaced the Medicare Commission of the GSIS/SSS!
✤ Premium based health care insurance!
✤ Initially covered employed persons - shared premium payments by employee & employer!
✤ Indigents’ premiums shared by National government and local government!
✤ Premiums were paid by Local Chief Executives only on an election year
PHILIPPINE HEALTH INSURANCE CORPORATION
✤ Premium was @ US$2/month with hospitalization benefits only!
✤ Only 50% of the population was covered by 2010!
✤ Support value of Reimbursements were about 30% for simple cases and about 10% for Catastrophic illnesses!
✤ There were cases of fraud!
✤ Health Inequity was further enhanced!
✤ private HMO’s filled a gap
THE PHILIPPINE HEALTH AGENDAUniversal Health Care or Kalusugan Pangkalahatan, has three
strategic thrusts:
Universal Health Care / Kalusugan Pangkalahatan
Improved Health especially for the
Poor and Vulnerable
Secure access to quality
care at facilities
Achieve the public health
MDGs
Provide financial risk
protection
INTERVENTIONS OF CARE
Prim
ary
Prev
entio
n an
d
Health
Pro
mot
ion Curative
Health Care
Secondary Prevention and Primary Care
Universal Health CareKalusugan Pangkalatan
Health Risk Financing and Payment schemes reforms
Access to quality and affordable health care - modernization
Improved Public Health Outcomes focused on Maternal and Child Health
eHealth National eHealth Strategic Plan and Framework
Health FinancingPremium payments of the poor shouldered by National government
Targetting the poorest
Using Sin Tax revenues for sustainable financing
Increased Health expenditure by government
Catastrophic Illness packages
Primary Care Benefit
Case Payment scheme/Capitation payments
Improved Benefits packages
In patient benefits
Outpatient benefits
Z Benefits
MDG related benefits