PHILHEALTH today continues to face challenges that prevent the effective and efficient implementation of the National Health Insurance Program. As of 2012, only 84% of the population were enrolled in Philhealth, of which, only 6% were able to successfully receive claim reimbursements. Of the few beneficiaries who received the claim payments, only 19% were poor (presumably, as they are enrolled under the Sponsored Program), while the greater majority are employees from either government or the private sector.

As discussed last week, several reforms are being undertaken in Philhealth, including: recent amendments in the National Health Insurance Act to address flaws in the policy governing Philhealth; strengthening of the implementation of the No Balance Billing (NBB); adoption of the Case Rate System; and expansion of Philhealth benefits. Also, the passage of the Sin Tax Law further expands the company’s financial resources by earmarking the bulk of the additional proceeds from alcohol and tobacco taxes to Philhealth.

While these reforms are steps in the right direction, the opportunities for improvements to give public the capacity to maximize Philhealth benefits remain ample. In this endeavor, the role of local government units (LGUs) cannot be overemphasized.

In the past, several LGUs adopted their respective innovations to maximize the use of Philhealth. Of the many notable practices, one worth discussing, is the health model applied in Leyte under the leadership of then-governor Jericho Petilla.

Also known as the Petilla Health Model, the innovations in Leyte enabled the province to hurdle several age-old challenges in its local health system by tapping previously underutilized resources from Philhealth. Among others, these included the enhancement of government-owned hospitals, retention of doctors in public health facilities, and increased access to health services (especially among the poor).

Access to Philhealth benefits first necessitates access to accredited facilities. This fact was recognized by Leyte’s LGU officials and authorities of Philhealth Region VIII. So to attain accreditation of more facilities, close coordination between the local officials from the provincial government and the regional Philhealth office was established. Together, they identified the needs and addressed the problems that hampered the development of the health facilities in the province.

Philhealth Region VIII aided the facilities to meet the minimum requirement for accreditation. Unnecessary stringency was lessened, and the procedures for accreditation were simplified. The paradigm shifted from facility enhancement as prerequisite to accreditation, into granting the accreditation first to enable the use of Philhealth capitation to afford the enhancement. This not only makes use of untapped Philhealth funds to improve the quality of health facilities but also increases the number of hospitals that will enable members to better access their entitled benefits.

In a country where the number of health professionals remains inadequate, keeping doctors in public hospitals means having to compete against the opportunities that the private sector has to offer. But doing this does not justify that other local basics suffer to finance the doctors’ competitive salaries. So how did the province of Leyte afford the salary increase of public doctors to an average of P180,000 monthly? The key was to use the underutilized funds from Philhealth.

As the number of accredited facilities increased in the province, more patients were able to avail themselves of the benefits from Philhealth. Subsequently, more resources from the company were channelled into government-owned hospitals, and a larger pool of income apportioned to government doctors.

Consequently, doctors were induced to stay in public facilities since working outside government-owned hospitals would result in higher foregone revenues. Better returns for rendering medical services also prompted the doctors to prioritize service provision over other options. Thus, by making service in public facilities an optimal choice for doctors, the availability of service providers expanded in the province.

Ultimately, the mechanism provided the public with better access to health services.
(To be continued)

(The author is a a member and researcher of the Sin Tax Team of Action for Economic Reforms.)