Corporation. Beginnings
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1 Philippine Health Insurance Corporation Beginnings Medicare Act GSIS SSS National Health Insurance Act
2 Legal Mandate Republic Act 7875 as amended by RA 9241 National Health Insurance Program (NHIP) shall provide health insurance coverage and ensure affordable, acceptable, available and accessible health care services for all citizens of the Philippines Enacted in 1995 amended in 2004 Legal Mandate Independent government agency to implement the NHIP Philippine Health Insurance Corporation (PhilHealth) One of the government-owned and controlled corporations (GOCCs) Substantial autonomy as to organizing its offices, y g g, and in the setting of premium rates, designing member benefits, and paying health care providers
3 Governance Structure Governance Commission for GOCCs (GCG) Supervises the board Compensation structure + compensation rates of senior management Department of Health (DOH) Attached agency to the DOH Secretary of Health is chairman of the board of directors Board Governance Structure Overall policy and strategic directions One year term for the 5 appointive members President/CEO Selected/elected among the board of directors Management and implementation of program
4 Philippine Health Insurance Corp. CHAIRMAN, Secretary of Department of Health BO OA ARD Department of Labor and Employment Department of Interior and Local Government Department of Social Welfare and Development VICE-CHAIRMAN, President/CEO of PhilHealth National Anti-Poverty Commission Civil Service Commission GSIS SSS Labor Sector Employers Overseas Filipinos Self-Employed Health Care Providers Governance Structure Board Investment Committee Committee on Appealed Cases Governance Committee Compensation Committee Nominations Committee Audit Committee Internal Audit Group reports directly to the board
5 Governance Structure Board Overall policy and strategic directions One year term for 5 appointive members President/CEO Selected/elected among the board of directors Management and implementation of program Governance Structure Congressional Oversight Validation studies to be lead by the national planning agency (National Economic Development Authority) Commission i of Audit
6 REGIONAL OFFICES Enrollment Collection Accreditation Claims Processing LOCAL OFFICES : Health as National Priority AQUINO HEALTH AGENDA: UNIVERSAL HEALTH CARE KALUSUGANG PANGKALAHATAN
7 PhilHealth races towards UHC Organizational Strengthening Enrolment and Collection Accreditation and Contracting Benefits Development Organizational Strengthening Immature Information System IT systems in silos, within and among gov t agencies Weak security controls y Research Agenda For Data Generation and Data Analysis types of Research Underutilized external funding sources Monitoring and Evaluation of Policies and Implementation Knowledge Management How recommendations feed into to policy changes Human Resource Development Limited plantilla positions, no dismissal of staff Customer-centered, process-oriented culture
8 Enrolment and Collection Philippines is an archipelago with ~100M Filipinos NO existing national ID system More unemployed/informal sector Who are the poor? Highly-devolved political system Insurance used as political leverage Reliability/consistency yof government payments Family-based Membership & Qualified Dependents Documentary requirements as hindrance Law: Mandatory for employed but voluntary for IPPs Accreditation and Contracting Moving towards contracting and incentives Private health sector is large and unregulated Increasing cost of care Public health care providers unable to deliver Human resources Drug availability - procurement Infrastructure & equipment Regulatory government agencies do not act in synchrony Bureau of Licensing Health Facilities, DOH National Program Offices (TB, Malaria, HIV/AIDS, etc.) Food & Drug Administration Professional Regulations Commission
9 Benefits Development Tackling Inertia SPEED in moving away from fee for service SOONEST and towards CASE PAYMENT SPEED in setting up primary care benefit + drug treatment packs $60/family/year premium limitation Zero-based costing analysis Top-down benefits package development Move towards evidence-based, demand-driven development Confusion with the DOH as to who pays for what services Stakeholders acceptance More effective means consultation and communication Leveraging purchasing power THANK YOU.
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