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Social Protection: PhilHealth’s Policy on Partial Subsidy

Scheme for Microenterprisesand Inputs from the Ground in

PhilHealth Region VIII

Social Protection: PhilHealthSocial Protection: PhilHealth’’s s Policy on Partial Subsidy Policy on Partial Subsidy

Scheme for MicroenterprisesScheme for Microenterprises

and Inputs from the Ground in and Inputs from the Ground in PhilHealth Region VIIIPhilHealth Region VIII

WALTER R. BACAREZARegional Vice-PresidentPhilHealth Regional Office VIII

Conduct of FGDs and Survey for the Development of Enrollment Scheme for WMEs

Conduct of FGDs and Survey for the Development of Conduct of FGDs and Survey for the Development of Enrollment Scheme for WMEs Enrollment Scheme for WMEs

Background

1. Objectives

To identify possible problems in the implementation of the proposed partial subsidy schemethrough consultation with the target beneficiaries and come up with recommendations to address those problems.

2. Schedules

November 18-19, 2010 – Province of Quezon (Real, Infanta, Gen. Nakar)

November 23-24, 2010 – Province of Davao del Sur (Sta. Cruz, Bansalan, Matanao)

December 1-2, 2010 – Province of Leyte (Barugo, Baybay, Capoocan)

Conduct of FGDs and Survey for the Development of Enrollment Scheme for WMEs

Conduct of FGDs and Survey for the Development of Conduct of FGDs and Survey for the Development of Enrollment Scheme for WMEs Enrollment Scheme for WMEs

Background

3. Participants/ Respondents

3.1 Total of 151 participants/ respondents

3.2 Majority of the participants/ respondents:

3.2.1 Aged 41-45;

3.2.2 Married;

3.2.3 Have reached high school level;

3.2.4 Have approximately P2,000 – P5,000 monthly earnings.

3.2.5 Farming was the primary source of income

Super Elite

Working Elite

Poorest of the POOR

Findings on the Social Protection Coverage of Women Micro-Entrepreneurs (WMEs)

Findings on the Social Protection Coverage of Women Findings on the Social Protection Coverage of Women MicroMicro--Entrepreneurs (WMEs) Entrepreneurs (WMEs)

ON SOCIAL HEALTH INSURANCE

60% of the respondents are covered by PhilHealth;

78% of which are primary members;

45% are not legally married.

REGIONAL ADVISORY: Enrollment of Women as PRIMARY MEMBER




89% of those who have availed of PhilHealth benefits are satisfied;

IMPROVED SWS SURVEY

2009 – 53%

2011 – 66%

Reasons of those who are not satisfied with PhilHealth benefits and services:

65% Do not know how to use PhilHealth;

22% have mentioned that PhilHealth services are not yet available in their community

What is your What is your illness? illness?

11 22

AdmitAdmit

33

No MedsNo Meds

Buy OutsideBuy Outside

44

ooDo you have Do you have any money?any money?ooDo you have Do you have

PhilHealth?PhilHealth?••ID?ID?••MDR?MDR?••Birth Cert?Birth Cert?

•• Go to Governor Go to Governor for donationfor donation

•• Go to DSWDGo to DSWD•• Budget BleedBudget Bleed

55

22 33

••What is your illness?What is your illness?••PhilHealth?PhilHealth?••Name and Birthday:Name and Birthday:

••PatientPatient••SpouseSpouse••ParentParent••ChildrenChildren

11

PhilHealthLink PhilHealthLink Agent Agent --

CoordinatorCoordinator

AdmitAdmit

••Full MedsFull Meds••Zero out of pocket Zero out of pocket expenseexpense••Zero coZero co--paypay••No balance billingNo balance billing

[Thru drug [Thru drug consignmentconsignment]]

BeforeBefore

With PhilHealthLINK and Drug ConsignmentWith PhilHealthLINK and Drug Consignment

Coordinators Agents

25% have mentioned that PhilHealth services are not yet available in the country

75% of Women said: we give birth at home (where it is risky) because there is no facility in the first place

36% of Women said: I prefer giving birth at home because we dont have enough money to go to the facility

* USAID STUDIES

Rapid Accreditation (cy 2010)More Accredited Facility = Easier Access

Rank 2 on Rural Health UnitsRank 3 on TB-DOTS Clinics

Rank 1 on Maternity Clinics

Access to Health Facility is not the only KEY

69 of 73 Accredited Collection Partner is from PhilHealth Region VIII

3.2.5 Farming was the primary source of income




98% of those that are not enrolled to PhilHealth would like to become members;

90% of which are willing to pay a portion of the premium contributions;

78% can only afford to pay P 300 out of P 1,200 annual premium contribution.

On the Importance of Social Health Insurance

Participants recognized the following:

1.With SHI, one’s need not have to worry on where to get the money to cover for their hospitalization and other medical expenses in case a family member or one’s self suddenly gets ill;

2.It is a protection against loss of income because the funds collected can be used for needed health services. A member confronted by unexpected circumstances of the sort can keep the personal savings and income intact;

3. It makes quality health care affordable especially for those who have very limited income.

FGD Findings on the Social Protection Coverage of Women Micro-Entrepreneurs (WMEs)

FGD Findings on the Social Protection Coverage of Women FGD Findings on the Social Protection Coverage of Women MicroMicro--Entrepreneurs (WMEs) Entrepreneurs (WMEs)

Despite recognition of the importance of SHI, it only ranks secondary to basic necessities

in terms of spending priorities



I Want to Pay

I Can Afford to Pay

But it is so difficult to Pay

I Want to Pay

I Can Afford to Pay

But it is so difficult to Pay

Convenience is the KEY

Accreditation of Bayad CentersMall PresenceAccreditation of LGUs as Collecting Partners Text to Health/Remittance by Air Cell phone based payment Scheme

Convenience is the KEY

Accreditation of Bayad CentersMall PresenceAccreditation of LGUs as Collecting Partners Text to Health/Remittance by Air Cell phone based payment Scheme

On the Proposed Enrollment Scheme for WMEs under the NHIP

1. Issues and Concerns

1.1 Sustainability of coverage of WMEs, who are existing PhilHealth members under the Sponsored Program but are not included in the NHTS-PR list;

1.2 Limited knowledge about PhilHealth, specifically on how and where to register, benefits and availment process, and whom to approach in the area on other related concerns;

1.3 Difficulty in the registration due to lack of documentary requirements.




1.4 Due to irregular and limited income, most of the participants would not be able to afford to pay P 1,200 annual premium contribution;

1.5 While those who have the capability to pay, can only do so in a staggered monthly or quarterly basis;

1.6 Difficulty paying for the excess fee during confinement;

1.7 The processing of claims reimbursement was very slow. Checks were released more than 60 days or the prescribed period




2. Recommendations

2.1 Existing members under the Sponsored Program that are not included in the NHTS-PR list may still be renewed until Dec. 2011 (LGU counterpart only);

2.2 The Partial Subsidy Scheme may serve as an option for the enrollment of those WMEs who are not yet existing members under the NHIP and those current members who shall no longer be renewed for the succeeding years under the full subsidy scheme of the Sponsored Program due to non inclusion in the NHTS-PR;

2.3 Intensify the information dissemination among members through the implementation of the PhilHealth “AKO”.



Efforts Undertaken for the Approval of the Partial Subsidy Scheme Efforts Undertaken for the Approval of the Partial Subsidy SchemEfforts Undertaken for the Approval of the Partial Subsidy Scheme e

Approval of the Implementing Guidelines

•On June 25, 2011, Office Order No. 51, s. 2011 or Implementing Guidelines on the Partnership with the LGU for the Coverage of Women Micro-Entrepreneurs (WMEs), Small Self-Employed, and Underground Economy Workers of the Informal Sector has been approved.

Implementation FrameworkImplementation FrameworkImplementation Framework

LGU Identified Families (with monthly family

income of below Php25,000);

Premium-sharing options between the LGUs and Members:

Members’ counterpart should not exceed 50% of the prescribed annual premium.

Annual Premium Contribution shall be remitted in full;

• Hospitalization

• Outpatient Consultation and Diagnostics Packages (OPB)

Additional:

• 22 Case Rates Payments

• “No Balance Billing Policy”

• Increased Benefits on the Maternity and Newborn Packages

LGU (%) Member (%)

100% 0%

75% 25%

50% 50%

BENEFITS

Process FlowProcess FlowProcess Flow

Features of the Partial Subsidy SchemeFeatures of the Partial Subsidy SchemeFeatures of the Partial Subsidy Scheme

1. Convenience for Registration and Payment

Simplified registration process Easy payment procedure; remittance of premium contributions through the

LGUs/ premium donors

2. Cheaper/ Affordable Premium Contributions

Sharing of premium contributions with the LGUs/ premium donors Premium counterpart of members shall be based on their capability

to pay

3. Expanded Benefits

Includes Unified Hospitalization Benefits , Outpatient Consultation and Diagnostics Packages (OPB), 22 case rate payments, and “No Balance Billing”

1. Ifugao - Lagawe, Kiangan, Banawe, Hingyon, Hungduan and Lamut2. Quezon - Real, Infanta and Nakar3. Iloilo - Badiangan, Miag-ao and Pavia4. Bohol - Balilihan, Jagna and Buenavista5. Leyte - Capoocan, Barugo, Baybay and Tanauan6. Davao del Sur - Bansalan, Sta. Cruz and Matanao7. Metro Naga - one city in Camarines Sur and a cluster of municipalities (Naga City and its adjacent municipalities of Bula, Bonbon, Camaligan, Gainza, Magarao, Milaor, Pili, and San Fernando)8. PALMA Alliance, an alliance of six municipalities in North Cotabato (Pigcawayan, Pikit, Aleosan, Libungan, Midsayap and Alamada)

PROJECT SITES

Next Steps Next Steps Next Steps

1. Orientation cum Planning Workshop for the Implementation of the Partial Subsidy Scheme – (2nd Week of September 2011)

2. Development of Gender Sensitive Negotiation Tools, IEC Materials , and Monitoring Tools – ( August - September 2011)

3. Reproduction and distribution of materials for negotiation and IEC activities – (4th Qtr 2011)

4. Negotiation with the LGUs and other potential premium donors for the enrollment of WMEs (October 2011 - onwards);

5. Enrollment of at least 2000 WMEs for the initial implementation (October 2011 – September 2012) ;

6. Provision of Services to covered WMEs (October 2011 – September 2012)7. Monitoring and Evaluation of Program Implementation (October 2011 –

November 2012) 6. Presentation of the Results of Program Implementation to the PhilHealth

Board and ExeCom and partners (December 2012).

Benefit Payment for Drugs & Medicines – CY 2010

Thank You !

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