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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

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Universal Health Care

Financial

RiskProtection

Improving

Access to

Quality

Health

Facilities

Attainment of

MDGmax

Better health

outcomes

Responsive health

system

Equitable &

sustainable healthfinancing

Health

Financing

Service

Delivery

Policy,

Standards and

Regulation

Health

Human

Resource

Health

Information

Governance

for Health

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In the Philippines

Source: NSCB, MDG watch

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PhilHealth

Engagement for

Participation

Payment

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History Maternity Care

2001

Low RiskMaternity CarePackage

1st twodeliveries

2003

MaternityCare Package

Case

paymentscheme 4.5 k

2006

MCPexpanded to3rd delivery

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History Maternity Care

2008

Expanded to4th delivery

2009

Revisedstandards

Increasedpackagerate to 6.5k

2011Increasedpackagerate to 8k

No balancebillingpolicy

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History Newborn Care

2006

Newborn Care Package

Case rate P1000

Newborn care, screening, Hepa Bvaccine

2007

BCG added

2011

Rate increased toP1750

Newborn HearingScreening Test

included

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Members and Qualified Dependents Up to 4th delivery onlyWho can avail

Non-hospital facilities

Engaged Maternity and Lying-in Clinics Engaged physicians and midwivesWho provides

Prenatal care

Delivery

Post natal care

Health education and counselling

What services

P 1,500 pre-natal care fee

P 6,500 facility fee including professional fee

No balance billingRemarks

Maternity Care Package

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Qualified dependents (newborn) of members No limit as to number of birthsWho can avail

Non-hospital facilities

Maternity and Lying-in Clinics

HospitalsWho provides

Newborn care

Screening tests newborn screening and hearing

Vaccination

hepatitis B and BCG

EINC protocolWhat services

P 1,750

No balance billing

Important

Features

Newborn Care Package

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WHAT ARE WE DOING:

Provide financial access to health care

services for mother and child

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34 74105

180269

333

627

742

1020

1201

0

200

400600

800

1000

1200

1400

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Maternity Clinics

Increase in access with increase in providers

Num

berofAccreditedProviders

Year

PhilHealth MCP/NCP providers per year

Source: AD

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Utilization of MCP, NSD and NCP increase

22022

38073 38990

70043

106509

131561

164797

196806

216955

274390

7 1327

33009

68333

91457

133718

224842

0

50000

100000

150000

200000

250000

300000

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

MCP/NSD

NCP

Source; TFI, date of admissions, extracted 5.24.2013

Number of Claims for MCP/NSD and NCP

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Number of MCP/NSD Claims per Member Type

0

50000

100000

150000

200000

250000

300000

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Life Member

OWP

Sponsored

IPP

Employed

Source; TFI, date of admissions, extracted 5.24.2013

Number of poor (SP) accessing the benefits

increases

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WHAT ARE WE DOING:

Engaged private sector providers

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Private sector engagement increased over

the years

Number of Engaged MCP ProvidersSource: AD

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WHAT ARE WE DOING:

Ensuring quality of care through qualityassurance program

Accreditation

Alignment with the initiatives of the DOH

Automatic accreditation

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WHAT NEEDS TO BE DONE

Increase MCP/NCP provider permunicipalities/cities

H lf f ll i i liti d iti i th

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Half of all municipalities and cities in the

country do not have an engaged MCP

provider

Source: AD

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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 the next few months

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In summary

What we want is !!!

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