The Philippines’ long and arduous journey toward achieving Universal Health Care or UHC reached a significant milestone when Republic Act No. 11223, otherwise known as the Universal Health Care Act of 2019, was signed into law by President Rodrigo Roa Duterte on February 20, 2019. The UHC’s overarching objective is to provide all Filipinos with equitable access to quality and cost-effective health care services without causing financial hardship.
The UHC Act by far provides the most comprehensive policy as well as the enabling environment for such a vision to happen in a progressive manner. The last 50 years had been marked by various attempts to achieve such a profound and collective aspiration for the health of the Filipino especially of the underprivileged and the marginalized.
It all started in the 1960s when a group of doctors introduced the MARIA (Medical Aid to Rural Indigents Areas) Project, considered the precursor of the Medical Care Plan that was created through RA No. 6111 in 1969. A quarter of a century hence, the National Health Insurance Program under the administration of the Philippine Health Insurance Corporation (PhilHealth) was created through RA No. 7875 on February 14, 1995.
The NHIP signaled an era that upheld financial protection for all Filipinos so that everyone can access needed health care services that are available, accessible, adequate and acceptable.
The rest is history.
As we mark PhilHealth’s 25 years of enduring service to the Filipino, we invite the nation of 108 million to look back, reflect and celebrate important milestones in the last 25 years that nurtured PhilHealth to what it is today… Pinatatag na Segurong Pangkalusugan sa Bawat Filipino!
Come together: Consolidation of the Medicare programs
A couple of years after PhilHealth took the reins from the former Philippine Medical Care Commission, it assumed administration from and started with the consolidation of separate health insurance programs of the Government Service Insurance System in 1997, Social Security System in 1999, and the Overseas Workers Welfare Administration in 2005 into one National Health Insurance Program. The historic integration led to the unification and subsequent increase in benefit levels as well.
The First Amendment: Republic Act 9241
Signed on February 10, 2004, this law revises pertinent provisions of RA No.7875 which resulted to the merging of OWWA Medicare with the NHIP, enhancement of members’ benefits, and strengthening enrollment of indigent members into the program through sponsorship.
More power to you: The Second Amendment
RA No. 10606 amended RA No. 7875 to better the member experience through simplified registration process, and to ensure full coverage of the poor and the marginalized. This also enhanced the powers of PhilHealth in implementing the program by strengthening its quasi-judicial functions.
Small step, big leap for the health of the people: Introducing the primary care benefit
Launched in 2012, the Primary Care Benefit 1 (PCB1) provides primary preventive services, diagnostics and medicines to specified diseases to select members. It was further expanded in 2017 through the Expanded Primary Care Benefits (ePCB) and extended coverage to members in the Formal Economy, Lifetime Members and Senior Citizens.
The shift towards efficiency: The All Case Rates
In 2013, PhilHealth shifted to case-based payment to make benefit payments predictable and equitable based on patients’ medical condition – a complete departure from the Fee-for-Service that is known to encourage wastage. Initially introduced in 2011 for selected cases, the system has set benefit amounts for more than 4,000 medical conditions and surgical procedures, making it easy for members to know exactly their PhilHealth entitlements.
Covered from A-Z: The Z Benefits
First introduced in 2012, this new set of benefits covers certain cases that are catastrophic and financially draining for afflicted members especially the underprivileged. Among the packages created are kidney transplantation worth P600,000, coronary artery bypass graft at P550,000, acute lymphocytic/lymphoblastic leukemia at P500,000, and surgery for tetralogy of fallot for children at P320,000. In 2018, the packages were expanded to include cases of children with disabilities.
“Peace of mind during sickness”: The No Balance Billing Policy
This policy provides that no other fees or expense shall be charged against the patients above and beyond the case rates for the entire confinement. This was initially introduced to indigent and sponsored patients, and was later extended to Kasambahays, Senior Citizens and Lifetime Members in 2017.
No coverage? No worries: Point-of-Care and Point-of-Service
First introduced in 2013, the POC ensures that the poor and near poor confined in government hospitals are given coverage after having been assessed as financially incapable. Subsequently in 2017, the POS was introduced to strengthen the POC, which include patients who are financially capable by permitting them to pay a year’s worth of contribution to be able to avail of social health insurance.
Because we care: The arrival of the P-CARES
In 2012, a roster of competent registered nurses called Customer Assistance Relations and Empowerment Staff (CARES) were deployed to accredited facilities to assist members in benefit availment. In 2015, the PhilHealth CARES won in the Philippine Government Best Practice Competition by the Development Academy of the Philippines; and was given the Customer Service and Transformation Excellence Award during the 33rd ASEAN Social Security Association (ASSA) Board Meeting in Pasay City, Philippines.
Remembering the needy and marginalized
To further extend reach to the marginalized sectors, PhilHealth partnered with Department of Social Welfare and Development to ensure that orphans, abandoned and abused children and other minors are provided with social health insurance. The Kasambahays and senior citizens followed suit by virtue of special laws, while dual citizens and foreign nationals living in the country were also granted access to health insurance.
No papers, no lines… just keep online
Web-based application Electronic Premium Remittance System (EPRS) was first introduced to employers in 2010 to replace the manual reporting system that they are required to do on a monthly basis. In 2015, the EPRS included an online payment facility which contributed to greater ease in doing business in the country in terms of easier payment of taxes. The feat was noted by no less than the World Bank in its Doing Business Report 2017 and duly cited by the National Competitiveness Council.
Efficient benefit entitlement
The HCI Portal established a linkage between PhilHealth and its accredited facilities through online connection, simplifying and making benefit eligibility checking a breeze and real time – effectively cutting down time as well as eliminating the need to submit paper requirements. This electronic gateway took off in 2014.
In just a few clicks: Member Inquiry Facility
This facility allows members to verify online information contained in their membership profile and the summary of their contributions through an online platform linked to the PhilHealth website which was launched during PhilHealth’s 20th anniversary in 2015.
We want to make it fast: Electronic claims
This aims to provide the health care institutions to submit claims electronically and track the status of their claim reimbursements with the help of technology providers or in-house developed software solutions duly certified by PhilHealth. The new system has enabled hospitals to transmit claims with ease, and be reimbursed faster.
We have an App: All Case Rates Search Engine and Mobile Application
Found in the homepage of PhilHealth’s website, this facility assists members and even providers in determining the amount that PhilHealth pays for medical conditions and procedures. This online platform was created in 2015 and can be downloaded and used by Android mobile phone users even offline.
PhilHealth Action Center
The PhilHealth Call Center was established in 2011 to efficiently manage the volume of members’ requests for timely information about their entitlements. To be more relevant, it expanded to a round-the-clock Action Center which administers customer queries on multiple channels which include e-mails, SMS, and the social media as well.
We are certified!
PhilHealth also takes pride being duly ISO 9001:2008 certified, the initial certification of which was awarded to selected offices in 2014, and subsequently granted to all its regional offices nationwide in 2015. In July 2018, PhilHealth leveled up to ISO 9001:2015 following the recommendation of third party auditor Anglo Japanese American (AJA) Registrars Inc.
Investing on the youth
PhilHealth has initiated a full scale partnership with the Department of Education in order to integrate its social health insurance module using the PhilHealth Learner’s Manual in the basic to tertiary education curriculum. The program was pilot tested with tertiary level students of Sultan Kudarat Educational Institution in Tacurong, Sultan Kudarat in 2015.
Quality matters
The enhanced Benchbook for use of accredited health care providers aims to ensure that only quality service is provided to the members. First adopted in 2005 and fully implemented in 2010, the Benchbook is an innovative approach where PhilHealth shifted from a purely accountable framework to that of continuous quality improvement.
We are now everywhere
Launched in 2012, the PhilHealth Express are frontline desks conveniently located in malls and other high-traffic areas aimed at providing timely and quality frontline services to members who maximize their time fulfilling their health insurance concerns even while shopping, dining and bonding with families and friends, or in between errands.
Reaching you: The Alaga Ka Campaign
Alaga Ka (“Alamin at Gamitin”) is an integrated information campaign which aims to empower PhilHealth members to know their rights and privileges. Launched in March 2014, Alaga Ka is being conducted through roadshows in various barangays and local communities where members at the grassroots level can easily converge to avail of information and other services.
Hall of Famer: ARTA Frontline Service Champion
In 2018, the Civil Service Commission (CSC) has conferred the Seal of Excellence Award (SEA) Hall of Famer to PhilHealth for earning the most number of SEAs from 2010 to 2016 – a testament to PhilHealth’s abiding commitment to excellence in customer relations and service.
Most Trusted Government Agency
PhilHealth was named most trusted social protection agency based on the 2017 and 5th Philippine Trust Index conducted by communications agency EON Group. PhilHealth garnered a total of 95 percent trust rating among various government agencies that include social protection entities.
Increasing Social Media presence
With increasing digital access among Filipinos, PhilHealth deemed it appropriate to go where most of its members are, enabling it to reach millions of members locally and overseas to inform them of new developments about the program. To date, its official Facebook page (PhilHealth Official) has more than 1.2 million followers who benefit from constant stream of information either from art card posts or through livestreaming facility “Facebook Live” which discusses specific topics at length.
Our ultimate vision: Universal Health Care
As PhilHealth welcomes the new era of reforms, it shifted its gears to the challenges of UHC. Real and profound changes will be felt by Filipinos in a progressive fashion starting with the automatic inclusion of all Filipinos into the NHIP, implementation of immediate eligibility to the benefits, introduction of a strengthened primary care package that entitles everyone regardless of their health status, among others.
More reforms are on their way, and PhilHealth fully commits to take on every challenge as the nation endeavors to progressively realize Universal Health Care for the generations of today and of tomorrow.