CHAPTER 1

INTRODUCTION

As medical care advances and treatments likewise increase, health care costs also

increase. The purpose of health insurance is to help pay for the expenses of care. It also

helps families to be protected financially in the event of an unexpected illness. However,

not all are given the chance to have a health insurance.

Today, having a health insurance is a must not only for an individual but for all the

members of the family. The most common reason for having a health insurance is simply

being insured in time of sickness. A health insurance can cover medical expenses,

hospitalization expenses and even calamities affecting one’s health.

The National Health Insurance Program was established to provide health insurance

coverage and ensure affordable, acceptable, available and accessible health care services

for all citizens of the Philippines. It shall serve as the means for the healthy to help pay for

the care of the sick and for those who can afford medical care to subsidize those who

cannot. It shall initially consist of Programs I and II or Medicare and be expanded

progressively to constitute one universal health insurance program for the entire

population. The program shall include a sustainable system of funds constitution,

collection, management and disbursement for financing the availment of a basic minimum

package and other supplementary packages of health insurance benefits by a progressively

expanding proportion of the population. The program shall be limited to paying for the

utilization of health services by covered beneficiaries. It shall be prohibited from providing

health care directly, from buying and dispensing drugs and pharmaceuticals, from
 2

employing physicians and other professionals for the purpose of directly rendering care,

and from owning or investing in health care facilities. (Article III, Section 5 of RA 7875 as

amended)

Over the years, the Philippine Health Insurance Corporation Regional Office VIII

has done its very best to provide services to its valued stakeholders; but through the years

in providing valuable services, it has also encountered different challenges particularly in

the Benefit Administration Section (BAS) who are in charge in the processing of benefit

payment for its clients. As our members and stakeholders increases, the demand to serve

all its clients have also increased. Thus, additional staff and manpower are needed to

accommodate such increase. In view of this, the researchers were encouraged to conduct a

study in order for the office to do away the idea of sacrificing the members and

stakeholders’ needs.

Objectives

This study aimed to:

1. Identify problems in the Philippine Health Insurance Corporation Regional

Office VIII – Benefit Administration Section.

2. Prioritize and select a problem based on the most pressing problems

encountered;

3. Generate and categorize possible cause of the problem;

4. Identify the major cause of the problem using the Ishikawa Diagram;

5. Make a decision through

a. Generating alternative courses of action

 3

b. Determining the best alternative course of action;

6. Make an action plan;

7. Analyze potential problems of the action plan and set up preventive and

contingent actions.

Significance of the Study

This re-entry plan will contribute to the achievement of the goal of PhilHealth in

providing quality health care services to its members through better health care financing.

PhilHealth’s role in the National Health Insurance Program is to influence accredited health

care providers in the provision of quality health care services. It is PhilHealth’s role to

subsidize part of the Health Care Institution’s bill (Hospitals, Rural/City Health Unit,

Ambulatory Surgical Clinics, Birthing/Maternity Care Clinics, and Free Standing Dialysis

Clinics). Health Care Institutions (HCIs) are being reimbursed of their PhilHealth claims.

Faster claims reimbursement of HCIs will allow them to improve financial status. Thus,

better allocation of their operating budget that will result into availability of drugs and

medicines, better medical equipment, and as a whole better procurement of goods and

services for improvement of health care services.

Health Care Institutions (HCIs) that provide better health services providing faster

claims reimbursement are best marketing strategy to increase PhilHealth Membership and

Premium Collection. HCIs will be more than willing to advocate for PhilHealth

membership knowing that more PhilHealth members will translate to better inflow of

finances. Moreover, HCIs will not be hesitant to accept patients with little or no capacity
 4

to pay due to the fact that PhilHealth will pay part of the hospital/clinic bill for and in behalf

of the patients in contrast to charity patients that are outright expense to hospital budget.

Definition of terms

The following terms are defined for clarification and understanding as used by the research

in the study.

Benefit Package. It refers to services that the program offers to members, subject

to the classification and qualifications provided for in these rules.

Board. This refers to the Board of Directors of the Philippine Health Insurance

Corporation.

Contribution. It is the amount paid by or in behalf of a member to the Program for

coverage, based on salaries or wages in the case of members in the formal economy and

on household earnings and assets, in the case of the informal economy, or on other criteria

as may be defined by the corporation in accordance with the guiding principles.

Corporation. It refers to the Philippine Health Insurance Corporation (PHIC or

PhilHealth), which is mandated by law to administer the Program.

Coverage. It is the entitlement of an individual, as a member or as dependent, to

the benefits of the Program.

 5

Health Care Institution. It refers to health facilities that are accredited with

PhilHealth which includes, among others, hospital, ambulatory surgical clinics, TB-DOTS,

freestanding dialysis clinics, primary care benefits facilities, and maternity care package

providers.

Health Insurance. This refers to as an insurance against the risk of

incurring medical expenses among individuals. By estimating the overall risk of health

care and health system expenses, among a targeted group, an insurer can develop a routine

finance structure, such as a monthly premium or payroll tax, to ensure that money is

available to pay for the health care benefits specified in the insurance agreement.

National Health Insurance Program (NHIP). This is a compulsory health

insurance program of the government as established in the Act, which shall provide

universal health insurance coverage and ensure affordable, acceptable, available and

accessible health care services for all citizens of the Philippines.

 6

CHAPTER II

METHODOLOGY

This part of the study comprises the methods and procedures used by the researcher

in gathering the needed data for the study. This includes the discussion of the Research

Design, Scope and Delimitation, and Data Collection and Research Instruments, and Data

Analysis of the study.

Research Design

The study used the descriptive type of research using a checklist. To get the needed

information for the study, data were obtained through a checklist of the different problems

encountered in the office. The respondents were solicited with the problem and were asked

to rank each problem. The proponent also asked permission from the Regional Vice

President of PhilHealth Regional Office VIII to conduct scheduled interviews.

Scope and Delimitation of the Study

The study was done by the researcher with the help of the respondents. Ten (10)

respondents gave their insights and concerns on the different problems experienced by the

Philippine Health Insurance Corporation Regional Office VIII – Benefit Administration

Section. The respondents comprise of five (5) regular employees from the Benefit

Administration Section and five (5) casual employees from the same section.
 7

Specifically, the study was conducted at the Philippine Health Insurance

Corporation Regional Office VIII – Benefit Administration Section located at PhilHealth

Building, P. Burgos Street, Tacloban City. This study was limited to the identification of

problems and their possible causes encountered especially by the staff of PhilHealth

Benefit Administration Section, the said problems and their causes, based on the

respondent’s opinions and the researcher’s observation.

Data Collection and Research Instruments

Data were gathered through interviews and brainstorming using an outline prepared

by the researchers. The interview focused on the different problems encountered by the

staff from the locale as well as tracing the cause of the problems and what they think would

be the best solution to the problems identified. In addition, questionnaires were used to

further process data obtained from the interviews.

To analyze the problem and its solution more clearly, management tools were used

such as the Pareto Chart and the Fish Bone Diagram.

The Ishikawa diagrams (also called fishbone diagrams, herringbone diagram,

cause-and-effect diagrams, or Ishikawa) are causal diagrams created by Kaoru

Ishikawa (1968) that show the causes of a specific event. Common uses of the Ishikawa

diagram are product designs and quality defect prevention to identify potential factors

causing an overall effect. Each cause or reason for imperfection is a source of variation.

(https://en.wikipedia.org/wiki/Ishikawa_diagram;5/11/17).
 8

A Pareto chart, named after Vilfredo Pareto, is a type of chart that contains

both bars and a line graph, where individual values are represented in descending order by

bars, and the cumulative total is represented by the line. The left vertical axis is

the frequency of occurrence, but it can alternatively represent cost or another

important unit of measure. The right vertical axis is the cumulative percentage of the total

number of occurrences, total cost, or total of the particular unit of measure. Since the

reasons are in decreasing order, the cumulative function is a concave function.

(https://en.wikipedia.org/wiki/Pareto_chart;5/11/17)

Data Analysis

In order to examine the data obtained, the researchers used the Frequency Table to

determine the rate of recurrence of perceived problems by the respondents using the

prepared questionnaires. Data were ranked from most frequent problems to problems with

sporadic occurrence.

After the problems were identified and ranked, alternative solutions were

determined by the researchers. A Criteria Score was utilized to decide which was the best

alternative solution out of the three (3) possible alternative solutions.

 9

CHAPTER 3

THE PHILIPPINE HEALTH INSURANCE CORPORATION

REGIONAL OFFICE VIII

A. Brief History

The call to serve the rural indigents echoed since the early 1960s when the

Philippine Medical Association introduced the MARIA Project which prioritized aid to

communities in need of medical assistance. The Project would then was considered a

valuable precursor to the Medicare program, from which a medical care plan for the entire

Philippines was created. On August 4, 1969, Republic Act 6111 or the Philippine Medical

Care Act of 1969 was signed by President Ferdinand E. Marcos which was eventually

implemented in August 1971.

The Philippine Medical Care Commission (PMCC) was tasked to oversee the

implementation of the program which went for almost a quarter of a century.

In the 1990s, a vision for a better, more responsive government health care program

was prompted by the passage of several bills that had significant implications on health

financing. The public's clamor for a health insurance that is more comprehensive in terms

of covered population and benefits led to the development of House Bill 14225 and Senate

Bill 01738 which became The National Health Insurance Act of 1995 or Republic Act

7875, signed by President Fidel V. Ramos on February 14, 1995. The law paved the way

for the creation of the Philippine Health Insurance Corporation (PhilHealth), mandated to

provide social health insurance coverage to all Filipinos in 15 years' time.

 10

PhilHealth assumed the responsibility of administering the former Medicare

program for government and private sector employees from the Government Service

Insurance System in October 1997, from the Social Security System in April 1998, and

from the Overseas Workers Welfare Administration in March 2005.

B. Corporate Profile

Vision

"Bawat Filipino, Miyembro, Bawat Miyembro, Protektado, Kalusugan Natin, Segurado"

Mission

"Sulit na Benepisyo sa Bawat Miyembro, Dekalidad na Serbisyo para sa Lahat"

Core Values

 Innovation

The Program shall adapt to changes in medical technology, health service organizations,

health care provider payment system, scopes of professional practice, and other trends in

the health sector. It must be cognizant of the appropriate roles and respective strengths of

the public and private sectors in health care, including people’s organizations and

community-based health care organizations.

 Quality Service
 11

The Program shall promote the improvement in the quality of health services provided

through the institutionalization of programs of quality assurance at all levels of the health

service delivery system. The satisfaction of the community, as well as individual

beneficiaries, shall be a determinant of the quality of service delivery.

 Utmost Integrity

The Program shall ensure that its officers and personnel adhere strictly to moral and ethical

principles as expected from civil servants; PhilHealth shall promote soundness of moral

character and honesty within the organization.

 Equity

The Program shall provide for uniform basic benefits. Access to care must be function of

a person’s health needs rather than ability to pay.

 Social Solidarity

The Program shall be guided by community spirit/ It must enhance risk sharing among

income groups, age groups, and persons of differing health status, and residing in different

geographic areas.

 Total Care

The Program shall focus on the provision of benefit packages spanning from preventive to

corrective (even catastrophic) health care services from birth up the beneficiary’s last

moments- such that beneficiaries would consider “health” the least of their worries.
 12

Business Profile

Nature of Organization

 Government Owned and Controlled Corporation (GOCC)

Type of Industry

 Health Care Financing

Affiliations

 International Social Security Association

 ASEAN Social Security Association

 Philippine Social Security Association

Funding Sources

 National and Local Government Units (for the annual premium of enrolled

sponsored members)

 Contribution of members into the Program

Key Program Partners

 Institutional and Professional Health Care Providers

 National Government Agencies

 Local Government Units

 Collecting Banks and Agents

 Private Organizations

C. Membership Categories

 Formal Economy
 13

This member category includes those with formal contracts and fixed terms of employment

including workers in the government and private sector, whose premium contribution

payments are equally shared by the employee and the employer.

 Informal Economy

This member category includes a wide range of individuals and sectors ranging from the

self-earning to migrant workers.

 Overseas Filipino Workers (OFW)

I. Sea-based Filipino workers or seafarers – any person who is

employed or engaged in any capacity on board a seagoing ship

navigating foreign seas other than a government ship used for military

or non-commercial purposes. The definition shall include fishermen,

cruise ship personnel and those serving foreign maritime mobile

offshore and drilling units. (same definition of seafarer per '38 Rule II

Part I of POEA Rules and Regulations Governing Recruitment and

Employment of Seafarers'; (ss) Section 1, Rule II of Omnibus Rules and

Regulations Implementing the Migrant Workers and Overseas Filipinos

Act of 1995, as amended by Republic Act No. 10022)

II. Land-based overseas Filipino workers – an Overseas Filipino Worker

who is other than a sea-based OFW

III. Filipinos with Dual Citizenship – Filipinos who are also citizens of

other countries.
 14

 Lifetime Members

This category is for members who have reached the age of retirement under the law and

have paid at least 120 monthly premium contributions.

 Senior Citizens

This category is for those who are 60 years old and above and are not currently covered by

any of the existing membership categories of PhilHealth.

 Indigent Members

To this category belong persons who have no visible means of income, or whose income

is insufficient for family subsistence, as identified by the Department of Social Welfare

and Development (DSWD), based on specific criteria.

 Sponsored Members

This category includes members whose contributions are being paid for by another

individual, government agencies, or private entities.

D. Benefits

The benefit package is uniform to all members. It includes the following personal health

services.

 Inpatient Coverage
 15

PhilHealth provides subsidy for room and board, drugs and medicines, laboratories,

operating room and professional fees for confinements of not less than 24 hours.

 Outpatient Coverage

Day surgeries, dialysis and cancer treatment procedures such as chemotherapy and

radiotherapy in accredited hospitals and free-standing clinics.

Special Benefit Packages

 Enhanced Outpatient Benefit Packages

 Newborn Care Package

 TB treatment through DOTS

 SARS and Avian Influenza Package

 Influenza A (H1N1) Package

E. Geographical Location

The Philippine Health Insurance Corporation in Region VIII is located at 167 P.

Burgos Street, Tacloban City, Leyte. PRO VIII has a total of seven (7) Local Health

Insurance Offices located at Tacloban City, Maasin City, Ormoc City, Biliran,

Catbalogan City, Catarman and Borongan.

 16

Figure 1 Presents the location map of the Philippine Health Insurance Corporation

Regional Office VIII.

 17

Figure 2 Shows the location map of the Philippine Health Insurance Corporation

Regional Office VIII – Local Health Insurance Offices.

 18

F. Organizational Structure

The Philippine Health Insurance Corporation Regional Office VIII is

headed by the Regional Vice President who is responsible for the overall operations

of the regional office. Directly reporting to the Regional Vice President are three

Division Chiefs who are responsible in monitoring their various sections and units

under each division. The Field Operations Division Chief has the responsibility for

the overall supervision, coordination, and performance management of the

Membership Section, Collection Section, and all the 7 Local Health Insurance

Office from the different provinces of Region 8. The Health Care Delivery

Management Division Chief supervises the Accreditation and Quality Assurance

Section as well as the Benefit Administration Section. The Accreditation and

Quality Assurance Section are in charge of the accreditation requirement and the

monitoring of all accredited Health Care Institutions of PhilHealth Regional Office

VIII.

The Benefit Administration Section is responsible for the processing of

claims or benefit payments which then serves as reimbursement to the accredited

Health Care Institutions. Before the claims are translated to benefit payments for

the Health Care Institutions they undergo numerous processes. First, they are

received by the office thru the manual receiving stage. Then it is proceeds to the

next stage which is claims encoding. After claims encoding it goes now to the

adjudication stage where the claims are reviewed and validate it they are good for

payment. Lastly, if the claims are good for payment they go to the voucher stage
 19

and eventually be generated with its corresponding check. The check then is given

to the facility as benefit payment.

20
 21

CHAPTER IV

WHOLISTIC-PROBLEM SOLVING ANALYSIS

PhilHealth is mandated to provide social health insurance to all Filipinos. Part of

its function, is to reimburse accredited health care providers with the health services they

provide to the PhilHealth members. The process of claiming reimbursement involves

submitting pertinent documents to PhilHealth. Under Implementing Rules and Regulations

of PhilHealth, the HCIs are provided with 60 days after the discharge of the patient to

submit complete and accurate documents to PhilHealth in order to for payment to made to

the HCIs. This study focuses on the section – Benefit Administration Section which is

tasked to receive documents, evaluate the same and forward the documents to Finance

Management Section for payment to HCIs.

Problems exist in the Benefit Administration Section and may be caused by man,

material, machine, money, method, measurement, and management of time. In this study,

the Wholistic Problem-Solving Analysis is used to ascertain the most persistent problems

in BAS. This study involves identifying and clarifying the problems. It also includes phases

in prioritizing, selecting, and analyzing problems. The last part, is deciding the best

solutions possible.
 22

A. Generating and Clarifying the Problem

1. Delayed Processing of claims documents

2. Absenteeism

3. Unskilled staff/encoder

4. Demotivated Staff

5. Involvement in marketing activities

6. Slow pace of procurement process

7. Slow System connectivity

8. Outmoded computers

The problems identified were further ranked according to the most pressing that currently

troubles BAS which enabled the researchers to arrive at a shortlist. The following problems

were:

1. Delayed Processing of Claims Documents

The Benefit Administration Section has 5 encoders. Each encoder has a quota

of 160 claims documents per day. BAS receives an average of 2,500 claims

documents every day. Taking into consideration that all 5 encoders reached

their quota, their output would only be 800 documents. There will still be a

backlog of 1,700 documents per day. In order to fast track payment BAS has to

finish encoding in order to move to the next stage of the process which in the

Finance Management Section.

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2. Slow pace of procurement process

The encoders’ output is the Validation Report. It has data on how much would

be the reimbursement to the health care provider alongside with other

information. It should be printed and attached to the claim document. There are

times that the process cannot move to the next stage because the printing of the

document is unsuccessful. There are times that ink of the printer is not

sufficient, thus, producing unreadable Validation Report. There are also

instances that there are no available ink cartridges. These occasions place the

process in a stand still.

3. Involvement in marketing activities

There are times that conferences, fora and marketing activities, are taken to a

bigger scale like the nationwide and simultaneous PhilHealth Run, Visayas

Area III Summit (which involved Region 6,7, and 8) and other conferences and

fora. Such marketing endeavors require a lot of personnel from preparation to

implementation. Most of the time, the personnel under BAS are enlisted to be

members of the different committees. These committees meet frequently during

the preparation until implementation. Such activities disrupt the output of the

encoders. In addition, the encoders are occasionally tapped to be speakers

and/or facilitators in the conduct of IEC and orientations. These require time to

organize like preparation of procurement documents for the venue and food,

preparation of presentation materials, preparation of invitations among many

 24

other related necessities. On cases such as these a lot of “encoding time” is lost

to these activities.

4. Demotivated staff

Absenteeism and tardiness are manifestations of unmotivated staff. A good

number of encoders manifest this kind of attitude. Both behaviors result to a

decrease in the number of working hours. It would be very difficult to catch up

with lost time. Its impact to the encoding output is negative.

5. Slow system connectivity

The module which is used in the encoding is “on-line”. It is dependent to the

connectivity of the system. In many cases encoders complain that the system

always lags, hang, or pause. These occasions directly lower the encoders’

output.

B. Prioritizing and Selecting a Problem

After identifying the problems that affect BAS, the researchers’ respondents were

requested to rank them to the degree of recurrence. The five (5) problems identified

with more pressing significance were ranked by the respondents from 1-5, where 1

represents the highest degree of recurrence and 5 with the least degree of

recurrence. Table 1 presents the frequency of the identified problems experienced

in BAS.
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Table 1. Frequency of the Identified Problems

Problems Frequency (F) Percentage Cumulative

1. Delayed 4 40% 40
Processing of
Claims
Documents
2. Slow pace of 3 30% 70
the
procurement
process
3. Involvement 1 10% 80
in marketing
activities
4. Slow system 1 10% 90
connectivity
5. Unmotivated 1 10% 100
Staff
TOTAL 10 100%

As presented in Table 1, four (4) respondents (40%) agreed that Delayed

Processing of Claims Documents is the most recurring problem in BAS. Three (3)

respondents (30%) viewed that the Slow Pace of Procurement Process as the second

most recurring problem. Lastly, 3 respondents have different views stating that (apart

from each other) Involvement in Marketing Activities, Slow System Connectivity,

and Unmotivated Staff are the most recurring problems.

 26

Table 2. Pareto Chart

10 100%

9 90%

8 80%

7 70%

6 60%

5 50%
Frequency
4 40%
Cumulative (%)
3 30%

2 20%

1 10%

0 0%
Delayed Slow pace of Involvement slow system Unmotivated
Processing of the in marketing connectivity staff
Claims procurement activities
Documents process

C. Analyzing the Problem

Analyzing the problem consists of Problem Statement, Desired State/Goal,

Generating Possible Causes of the Problem, Categorizing Possible Causes - using the

Fishbone Diagram, and Identifying the Root Cause.

c.1. Problem Statement

There is a delay of processing of claims documents in the Benefit Administration

Section in PhilHealth Regional Office VIII.

 27

c.2. Desired State/Goal

The Benefit Administration Section of PhilHealth Regional Office VIII should be

able to increase encoding output by 100% to cope with the increasing number of claims

documents filed for reimbursement.

c.3. Generating Possible Causes of the Problem

The following are the possible causes generated in the focused group discussion

between the researchers and the staff under BAS-PRO VIII, to wit:

1. No budget of additional staff

2. Increasing number of claims documents received

3. No formal training for BAS personnel

4. Transfer of personnel from BAS to other sections or divisions

5. Low number of skilled encoders

After a series of discussion between the respondents and the researchers, both agree

that the most probable causes are the following:

c.4. Categorizing Possible Causes

The Fishbone Diagram or the Ishikawa Diagram, Figure 1. , is one of the tools in

identifying the root cause of the problem. It provides a schematic diagram that shows

the relationship between the problem (effect) and the causes.

 28

Figure 4. Root Cause Analysis

 29

Table 3. Supplemental Analysis of Root Cause

POLICIES/IMPLEMENTATION

 Incomplete dissemination of procedures

 Lacking work instructions

ATTITUDE

 Force of habit
 Tolerance
 Abuse of authority
 Uncaring attitude of staff
 Passive attitude towards task at hand

ADMINISTRATIVE

 Absence of disciplinary procedures

 Negligence of accountable staff
 Subjective enforcement of policies
 Lack of necessary equipment
 Poor planning, organizing and control
 Ineffective supervisors

There are five (5) categories that comprise the diagram.

1. Manpower

 Less interest in encoding tasks

o Encoding is perceived as a boring task

 Failure to reach quota

o Absenteeism and Tardiness

 30

o Lack of motivation

o Senior staff are perceived as antagonistic

2. Material

 No available ink

o Untimely delivery of supplies

o Late procurement

o Late submission of purchase request

3. Machine

 Slow connectivity

o Internet provider problem

4. Measurement

 Quota is too difficult too difficult to achieve

o The number of documents is too many

o There is a need to increase the quota in order to

reimburse to the HCIs immediately

5. Method

 Encoding is confusing and tedious

o Encoding process is difficult to understand

o Lack or no formal training

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D. Deciding the Best Solution

The research presents a balanced way of coming up with a solution by stating its

Purpose, Setting of Criteria for Evaluating Alternative Courses of Action and, Determining

the Best Alternative using a Criteria in determining the best solution.

d.1. Purpose

The purpose of this re-entry plan is to be able to identify a solution to the

problem in the Benefit Administration Section of PRO VIII involving the

shortage of manpower complement specifically, encoders.

d.2 Identify the Possible Solutions

The researchers have identified some possible solutions to the problem

affecting BAS. The following are the suggested solutions:

1. To hire additional personnel and assign them in Benefit

Administration Section

2. To re-assign personnel from other divisions/sections to BAS

3. To provide formal training to encoders and potential encoders

4. To upgrade the module for encoding

5. To upgrade system connectivity

d.3. Determining the best alternative courses of action

 32

Considering the effectiveness and efficiency in solving the problem, the

researcher narrowed the list into three (3) possible solutions.

Alternative A: To hire additional personnel and assign them in Benefit

Administration Section.

One of the possible solutions to the problem is to hire additional staff for

BAS. There are a number of positions in the BAS which are currently vacant. The

additional workforce that will be hired will reinforce the number of encoders. Thus,

the additional encoders will contribute in the output and eventually decrease the

encoding backlog.

Alternative B: To reassign personnel from other Divisions/Sections.

It is a possible option that personnel from other Divisions/Sections can be

re-assigned in BAS. However, it would result to the same problems for the

Divisions/Sections from where the personnel are originally assigned. Proper

consultations with concerned supervisors and adjustments should be made in order

not to compromise their work output. The key indicators can be adjusted in order

not to overwhelm the remaining workforce. Deliverables can also be allocated to

other sections in order to distribute the work load.

Alternative C: To provide formal training to encoders and potential encoders

Encoding is a skill that can be taught and developed. There is a protocol in

encoding claims documents that if followed will ease the encoders from confusion.
 33

The errors will be prevented and the tedious task of re-encoding will be prevented.

There are techniques and short-cuts that are very essential for an efficient and

effective encoding. Unfortunately, these techniques are known to some who have

attended formal training in ICT. Some encoders are self-taught and have developed

their skill through experience. Sometimes some of the knowledge acquired through

the years are incorrect. Formal training should be mandatory to all encoders. The

trainees that would not pass the training standard should not be allowed to be a BAS

encoder.

Table 4. Defined Criteria with their Corresponding Weights

Criteria Defined as Weight

Ease of Implementation How easy would it be to implement 12%

the solution?

Probability of Success How likely is it that the solution itself 30%

could be successfully implemented?

Effectiveness of How effective would the solution be 50%

Solution in addressing the root causes and

solving the problem?

Relatively Low How much resistance might there be 8%

Resistance to implement this solution?

 34

The three alternative courses of action were evaluated using the Criteria Rating for

determining the best solution as shown in Table 4. Each alternative is given a score that

would establish which is best among them alternative solutions.

Table 5. Application of Criteria to Identified Alternative Solution

Criteria Weight A B C
(%) To hire To conduct staff To acquire
additional development/ state of the art
staff for BAS training computer
facilities
Ease of 12 7 5 6
Implementation (0.84) (0.6) (0.12)
(How easy
would it be to
implement the
solution?)
Probability of 30 8 7 6
Success (2.4) (2.1) (0.3)
(How likely is it
that the solution
could be
successfully
implemented?)
Effectiveness of 50 7 6 5
Solution (3.5) (3.0) (2.5)
(How effective
would the
solution be in
addressing the
root causes and
solve the
problem?)
Relatively low 8 9 4 7
resistance (0.72) (0.32) (0.56)
(How much
resistance these
might be in
implementing
this solution?)
Total Points 100% 7.46 6.02 3.48
 35

Table 6. Determining the Best Solution Using Impact and Probability as Criteria
ALTERNATIVE POSSIBLE ADVERSE CRITERIA INTER-
SOLUTIONS CONSEQUENCE IMPACT PROBABILITY PRETATION
(High, (High,
Medium, Medium, Low)
Low)

1. Hire  Budget
additional constraints
staff  Insensitive
recruits Low Low 1
 Implementatio
n is not
immediate

2. Training  Inefficient
despite
training
 High training
costs High Medium 3
 Resistance to
new and
advance
technology

3. Reassignm  Resistance to
ent of learning to
Personnel processes
 Feeling of Medium Low 2
Contempt
against
management
 36

The three (3) alternative solutions were rated by the respondents from 1 to 10,

where 10 was the highest and 1 was the lowest score. Table 4 shows the weight of each

criterion. The score of each alternative solution was multiplied by the weight assigned

to each criterion. The products of which were summed to get the total points. The

alternative solution that garnered the highest point is the best solution.

Alternative A, “To hire additional staff for BAS” is the best solution with 7.46

points. It is more feasible and has the highest possibility of success in implementation.

E. Action Plan

The action plan is a tool and a guide in accomplishing a solution to a problem. The

action plan includes a list of activities to be carried out at certain stages of the

implementation.

GOAL: To pay the health care institutions immediately after providing health care

services to PhilHealth members

OBJECTIVE: To decrease the backlog in encoding by 50% after 6 months from

hiring of new encoders and reach 0% backlog after 1 year from

hiring of new encoders

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BIBLIOGRAPHY
 38

A. Books

Chang, Richard Y and P. Keith Kelly, 1993. Step by Step Problem Solving
California: R. Chang Associated, Inc.

Chang, Richard Y and P. Keith Kelly, 1993. Team Decision Making

California: R. Chang Associated, Inc.

Schermerhorn, Jr., John R., 2008. Management Book 9th Edition: John Wiley and
Sons, Inc.

B. Government Document

Republic Act 10606 An Act Amending Republic Act No. 7875, Otherwise known
as The “National Health Insurance Act of 1995”

C. Internet Sources

https://en.wikipedia.org/wiki/Ishikawa_diagram

https://www.isixsigma.com/tools-templates/cause-effect/cause-and-effect-aka-
fishbone-diagram/

https://en.wikipedia.org/wiki/Pareto_chart

https://www.isixsigma.com/tools-templates/pareto/pareto-chart-bar-chart-
histogram-and-pareto-principle-8020-rule/

APPENDIX A
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Survey Form

Appendix B
 40

CURRICULUM VITAE

PERSONAL CHARACTERISITCS
Name: EARL ALDWIN S. YOUNG
Age: 26
Birthdate: AUGUST 14, 1991
Address: 127 Esperas Avenue, Tacloban City
Mobile No.: +639178198055
E-mail Address: earlaldwinyoung@gmail.com

EDUCATIONAL ATTAINMENT
Elementary: Sacred Heart School
1998-2004
Highschool: Sacred Heart School
2004 - 2008
College: Dona Remedios Trinidad Romualdez Medical
Foundation (College of Nursing)

WORK EXPERIENCE
April 2014 – present Philippine Health Insurance Corporation
ReachOut Coordinator
January 2014 – April 2016 Expert Global Solutions -RMH
Customer Care Representative

CURRICULUM VITAE
 41

PERSONAL CHARACTERISITCS
Name: FLOYD R. PATUAL
Age: 40
Birthdate: September 2, 1977
Address: Barreda Compund, Brgy. 79, Marasbaras, Tacloban City
Mobile No.: +639173040902
E-mail Address: floydpatual@gmail.com

EDUCATIONAL ATTAINMENT

Elementary: University of San Carlos – South Grade School

1984 - 1990
Highschool: University of San Carlos – Boys School
1990 - 1994
College: Velez College

WORK EXPERIENCE
May 2002 – present Philippine Health Insurance Corporation
Social Health Insurance Officer II