Achieving MDGs 4 and 5 through Kalusugang Pangkalahatan: Social Health Insurance and Maternal and Child Benefits

Dr. Francisco Z. Soria, Jr. OIC-VP, Quality Assurance Group PhilHealth

Universal Health Care
Better health outcomes Responsive health system Equitable & sustainable health financing

Financial Risk Protection Improving Access to Attainment of Quality MDGmax Health Facilities

Health Financing

Service Delivery

Policy, Standards and Regulation

Health Human Resource

Health Information

Governance for Health

In the Philippines

Source: NSCB, MDG watch

PhilHealth
Engagement for Participation Payment

History – Maternity Care

2006 2003

Maternity Care Package

MCP expanded to 3rd delivery

2001

Case payment Low Risk Maternity Care scheme 4.5 k
Package
1st two deliveries

History – Maternity Care

2011 2009
Revised standards Increased package rate to 8k

2008

Increased Expanded to package 4th delivery rate to 6.5k

No balance billing policy

History Newborn Care

2011 2007 BCG added 2006
Newborn Care Package
Case rate P1000
Newborn care, screening, Hepa B vaccine

Rate increased to P1750 Newborn Hearing Screening Test included

Maternity Care Package
Who can avail Who provides What services Remarks
• Members and Qualified Dependents • Up to 4th delivery only

• Non-hospital facilities • Engaged Maternity and Lying-in Clinics • Engaged physicians and midwives • Prenatal care • Delivery • Post natal care • Health education and counselling

• P 1,500 pre-natal care fee • P 6,500 facility fee including professional fee • No balance billing

Newborn Care Package
Who can avail Who provides What services Important Features
• Qualified dependents (newborn) of members • No limit as to number of births

• Non-hospital facilities • Maternity and Lying-in Clinics • Hospitals • Newborn care • Screening tests – newborn screening and hearing • Vaccination – hepatitis B and BCG • EINC protocol

• P 1,750 • No balance billing

WHAT ARE WE DOING:

Provide financial access to health care services for mother and child

Increase in access with increase in providers
Number of Accredited Providers
1400 1200 1000 800 600 400 200 0
Maternity Clinics

1201

1020
627 180

742

269

333

34

74

105

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Year

PhilHealth MCP/NCP providers per year
Source: AD

Utilization of MCP, NSD and NCP increase
300000 274390 250000 216955 200000 164797 150000 131561 100000 70043 50000 38073 22022 0 2003 2004 2005 7 2006 38990 33009 106509 133718 MCP/NSD NCP 196806 224842

91457
68333

1327 2007 2008

2009

2010

2011

2012

Number of Claims for MCP/NSD and NCP
Source; TFI, date of admissions, extracted 5.24.2013

Number of poor (SP) accessing the benefits increases
300000 250000

200000

150000

Life Member OWP Sponsored

100000

IPP Employed

50000

0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Number of MCP/NSD Claims per Member Type
Source; TFI, date of admissions, extracted 5.24.2013

WHAT ARE WE DOING:

Engaged private sector providers

Private sector engagement increased over the years

Number of Engaged MCP Providers
Source: AD

WHAT ARE WE DOING:
•Ensuring quality of care through quality assurance program
•Accreditation

•Alignment with the initiatives of the DOH
•Automatic accreditation

WHAT NEEDS TO BE DONE
Increase MCP/NCP provider per municipalities/cities

Half of all municipalities and cities in the country do not have an engaged MCP provider

Source: AD

In the next few months
• Local advocacies to provinces/municipalities with no or low number of accredited facilities • Further dissemination of information re: engagement process, claims filing among others • Work closer with different stakeholders to accomplish this goal

In summary

• What we want is

!!!