Feature: Closing in on universal health insurance coverage
Davao City (10 March) -- 1995. The year opened with a major breakthrough in the global economic arena when the World Trade Organization replaced the Global Agreement on Tariffs and Trades, a development that economic analysts at that time perceived to be the gateway for more trading activities across all continents.
It was also during this year when Yahoo, Java programming and the DVD were formally launched into the global market, and the same year when Finland won the ice hockey world championships and South Africa, the Rugby World Cup. In the field of medicine, workers from the National Institutes of Health announced the success of clinical trials testing the first preventive treatment for sickle cell anaemia. Indeed, a lot of things took place in 1995 that have helped shape what we now enjoy in this century.
On local shores, a landmark legislation was passed, further expanding the government's efforts to provide an intangible yet very important social protection benefit for its fast-growing population.
Fast forward to 2009.
Fourteen years after Republic Act 7875, or the National Health Insurance Act of 1995 was passed, has PhilHealth proven its worth to the Filipino family? Let's take a quick look at some of the strides it has made.
As the government corporation tasked to provide all Filipinos with health insurance coverage, PhilHealth has posted significant achievements that redound to the benefit of its 69 million-strong membership base. "To date, we have covered about 76 percent of the entire RP population, with the employed sector comprising the biggest chunk with 8.2 million active members," PhilHealth President and CEO Dr. Rey B. Aquino said. "Our coverage of the less privileged sector of society follows closely at 24 percent or 3.26 million members, while our Individually Paying Program, which consists of self-earning professionals and daily wage earners, comprise about 18 percent or 2.72 million paying members."
Two other programs, namely, the Lifetime Member Program and the Overseas Workers Program, posted noteworthy membership figures as of end-December, with one (1) percent and 12 percent, respectively. "We aim to further boost these figures with our aggressive marketing efforts, as we inch closer to our goal of universal coverage," the PhilHealth Chief said.
Aside from expanding its coverage, PhilHealth has also expanded the benefit packages that it provides its members with. Just recently, it announced the coverage of the 4th Normal Spontaneous Delivery in accredited facilities nationwide. The new package took effect January 1 this year, at a case rate of P4,500.00 inclusive of hospital and doctor's fees.
Earlier, PhilHealth also introduced the Outpatient Malaria Package worth P600.00 as part of the country's response to the global aim of combating malaria as called for in the Millennium Development Goals of the United Nations. The PhilHealth also introduced the Voluntary Surgical Contraception Package and the Tiered Payment of the Professional Fees of accredited physicians to ensure that the medical care services that they provide are of the highest quality that PhilHealth members deserve.
Just recently, the PhilHealth Board of Directors approved important amendments to how certain procedures are classified and the corresponding relative value units of particular surgical procedures in light of rapid developments in the field of medicine. These include the Amendments in the Relative Value Scale 2001 which was earlier based on the 1997 edition of the physician's current procedural terminologies (CPT) of the American Medical Association. After consultations and workshops with specialty societies, PhilHealth recognized that more procedures and services need to be included in the list to correctly report them during claims reimbursements and revise some of the Relative Value Units (RVUs) attached to selected surgical procedures in the Scale.
In particular, 14 new procedures have been added, the RVU of about 60 procedures were decreased, and the RVU of about 1,042 procedures were increased.
The Board also approved the revised Case Type Classification to update the benefits by providing a more appropriate case type classification with corresponding ICD-10 codes. During the previous implementation of case type classification, cancer cases receiving chemotherapy and/or radiotherapy as well as chronic renal failures undergoing dialysis were previously classified as Case Type "A". These have been upgraded to Case Type "C".
"We continue to review our benefit packages to ensure that these remain truly relevant, especially in light of emerging and re-emerging diseases and other health situations in the country," Aquino stressed.
Financially, PhilHealth is very stable and sound and it is ready to provide the health insurance cover that its members might need. Investments are growing steadily, and actuarial reserves are reaching levels that give Top Management peace of mind, knowing that the corporation can readily address the hospitalization needs of its members, anytime.
Structurally, the organization has just undergone a re-engineering and the revitalized organization is now getting used to new internal branches and offices designed to enable it to better serve its members and stakeholders.
As far as awareness is concerned, about 96 percent of the entire RP population are already aware of PhilHealth, up from only about 79 percent not too long ago. The organization is working harder towards sustaining this awareness level to usher in member empowerment, especially where benefits availment and membership responsibilities are concerned.
As it pushes 15, PhilHealth takes on calculated steps to make sure that it delivers on its promise of universal coverage when 2010 comes. Just as Dr. Bernard A. Harris, Jr. and Michael Foale took their careful steps to become the first African-American and Briton, respectively, to walk in space in February 1995, PhilHealth looks forward to making history next year when it fulfills its mandate of providing at least 85 percent of the growing Filipino population with the health insurance protection that they all deserve. (PhilHealth/PIA XI) [top]