To balance financial sustainability with rapid package growth, the Philippine Health Insurance Corp. (PhilHealth) is shifting toward prevention by expanding the primary care system with the Department of Health (DOH) and securing adequate premium funding from both the government and contributors.
In her first news briefing last Thursday, newly-assigned PhilHealth President and CEO Beverly Lorraine C. Ho said a working primary care system will sustain the insurer’s sustainability, as better health promotion and prevention could reduce the number of patients requiring costly therapies.
To do this, the PhilHealth and DOH will scale up the health insurer’s primary care program it dubs ‘Yakap’ (embrace), which aims to provide members with preventive and outpatient services, Ho said. She added the program will be brought to schools and workplaces instead of relying on patients to visit clinics, as well as integrating other government health programs for a more unified health system.
This is part of PhilHealth’s new shared roadmap with the health department anchored on five pillars, such as bringing services close to people, strengthening primary care, expanding access to affordable care, cutting red tape and strengthening PhilHealth’s organization.
The PhilHealth will also crack down on fraudulent claims to ensure that funds are not wasted and that quality services are paid for, and will seek continued support from Congress to ensure adequate funding for premiums, particularly for indirect contributors.
‘[This is] also an appeal to the formal sector and the direct contributor that everyone has to pay their premiums consistently,’ Ho added.
Aside from improving primary care, PhilHealth plans to increase the number of hospitals offering No Balance Billing, including private hospitals willing to provide services at NBB rates.
The PhilHealth and the DOH will likewise seek to cut red tape for healthcare providers by streamlining their licensing and accreditation processes.
Ho said the agencies could eventually allow providers to submit requirements through a single platform instead of separately dealing with the DOH and the PhilHealth, although stronger information technology system would be critical to making the reforms work.
The insurer will also proceed with organizational reforms mandated by the Governance Commission for GOCCs, while seeking to give its employees greater responsibility and fair compensation.
Further, a ‘task-shifting’ mechanism is being studied to allow certain services traditionally performed by doctors or specialists to be handled by nurses or general practitioners where appropriate, Ho added.
The new PhilHealth chief she would not abandon reforms initiated under Edwin Mercado, who was recently appointed as health secretary.
‘We’re just going to build on the gains,’ Ho said. ‘We will actually just focus on better execution moving forward.’
‘Our main goal is to address challenges systematically in the fastest possible ways so that we reduce friction,’ she added.