PHILHEALTH UPDATES2nd Semi-Annual Hospital Managers Meeting

OUTLINE OF PRESENTATION

PhilHealth Directions in Relation to KP Including Status of PhilHealth Membership, Collection and EngagementImplementing Rules and Regulations of RA 10606New PhilHealth ProgramsBenefits Payment and AvailmentOpen Forum

Atty. Jerry F. IbayRegional Vice PresidentPhilHealth-CAR

Synergy for Universal Health Care

KP Vision Financial Risk Protection

Access to Improved Health Facilities

Attainment of Health-related MDG Bawat Pilipino Miyembro

Bawat Miyembro Protektado

Kalusugan Natin Segurado

Outcomes and Strategies of UHC

Outcome 2: Financial Risk Protection* Depends on NHTS list of DSWD

Strategy 1: Expand PhilHealth CoverageActionStatusTARGETS201420152016Enroll NHTS poor & near-poor families5.2 M14.7 M*14.7 M14.7 M

Increase hospitals with point of care enrollmentLGU

DOH100

72200

72300

72

Enroll the remaining informal sector80%3.1M not enrolled but can pay premium858890

84%76%86%

Chart1

17007375428079023451445152

24285369379108594177793

117746304475588186328

341775161473189421350894

429173132540229027361567

20093048076104978153054

21069858234120315178549

1584824265894129136787

85%

73%

73%

103%

85%

Population

No. of Members

No. of Dependents

Total

Number of PhilHealth Members and Dependents As of September 2013 By Province, CAR

Sheet1

PopulationNo. of MembersNo. of DependentsTotal

CAR1,700,737542,807902,3451,445,152

Abra242,85369,379108,594177,793

Apayao117,74630,44755,88186,328

Baguio City341,775161,473189,421350,894

Benguet429,173132,540229,027361,567

Ifugao200,93048,076104,978153,054

Kalinga210,69858,234120,315178,549

Mt. Province158,48242,65894,129136,787

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Number and Percentage Distribution of Members and Dependents as of September 2013, CAR

Chart1

1891830.13

2278240.16

5546680.38

3118060.22

1301030.09

315680.02

Total = 1,445,152

Number

Percentage

Sheet1

CategoryNumberPercentage

Government189,18313%

Private227,82416%

Sponsored554,66838%

Individually Paying311,80622%

OFW130,1039%

Lifetime31,5682%

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Summary of Licensed vs Accredited/Engaged Hospitals per province per year:

201120122013LICENSEDENGAGEDLICENSEDENGAGEDLICENSED ENGAGEDABRA10999109APAYAO777777BAGUIO CITY868686BENGUET999999IFUGAO888888KALINGA987788MT. PROVINCE777777TOTAL585455535754

Chart1

9769887

9769877

9769887

Abra

Apayao

Baguio City

Benguet

Ifugao

Kalinga

Mt. Province

Summary of the Number Hospitals Engaged/Accredited in CAR from 2011 - 2013

Sheet1

AbraApayaoBaguio CityBenguetIfugaoKalingaMt. Province

20119769887

20129769877

20139769887

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Hospitals With Out-Patient Benefit Package Services

OPB ServicesProvince/CityHospitalTBDOTSBenguetBaguio CityBenguet Gen. Hospital (BeGH) Baguio Gen. Hospital & Medical Center (BGHMC)St. Louis Hospital of the Sacred Heart (SLUHSH)Notre Dame de Chartres HospitalHemodialysisBenguetBaguio CityBeGHBGHMCSLUHSHNotre Dame de Chartres Hospital Pines City Doctors HospitalAnimal BiteAbraKalinga

Mt. ProvinceAbra Provincial HospitalKalinga Provincial HospitalWestern Kalinga District HospitalBontoc General HospitalLuis Hora Memorial Regional Hospital

Hospitals With Out-Patient Benefit Package Services

OPB ServicesProvince/CityHospitalPCBAbra

Apayao

Baguio CityAbra Provincial Hospital

Bucay MunicipalHospitalDolores Medicare and Community HospitalLa Paz District HospitalVillaviciosa Medicare and Community Hospital

Amma Jadsac District HospitalFlora District HospitalSta. Marcela Med. and Community HospitalFar North Luzon Gen. Hosp. & Trng. Center

Baguio Gen. Hospital and Medical Center

Hospitals With Out-Patient Benefit Package Services * Above Packages to expire on December 31, 2013.

Province/CityHospitalPCBKalinga

Mt. Province

Kalinga Provincial HospitalJuan M. Duyan District HospitalKalinga District HospitalPinukpuk District HospitalWestern Kalinga District Hospital

Bontoc General HospitalBarlig District HospitalBesao District HospitalParacelis District HospitalLuis Hora Memorial Regional HospitalNatonin Community Hospitals

Premium Collection vs Benefit Availment, Jan. September 2013CollectionBenefit Payment P412,899,000 or 68% of the annual collection target

P875,362,714.18 or 71%% of the annual budget for benefit payment2013 Annual Premium Target CollectionP603,084,000.002013 Annual Budget for Benefit PaymentP603,084,000.00

PFPR Paid to Different Hospitals as November 19, 2013

Province/HospitalAmount ReleasedAbra1. Bucay Municipal HospitalP16,400.002. Dolores Medicare and Community HospitalP41,600.003. La Paz District HospitalP65,459.86Apayao1. Far North Luzon Gen. Hospital & Training CenterP123,000.00Kalinga1. Kalinga Provincial HospitalP258,500.002. Juan M. Duyan District HospitalP181,500.03. Kalinga District HospitalP172,000.004. Pinukpuk District HospitalP222,500.005. Western Kalinga District HospitalP176,250.00

PFPR Paid to Different Hospitals as November 19, 2013

Province/HospitalAmount ReleasedMt. Province1. Bontoc General HospitalP958,760.002. Barlig District HospitalP115,784.513. Besao District HospitalP351,636.674. Paracelis District HospitalP14,250.005. Luis Hora Memorial Regional HospitalP9,250.00Grand TotalP2,706,891.31

*Funding Requirements to Cover the Poor and Near Poor

No. of FamiliesPremium @ P2,400DSWD Poor(Submitted for 2014 GAA)Principal Families5.48 millionPhP 13.15 billionOther families in the list4.74 millionPhP 11.38 billionTOTAL10.22 millionPhP 24.53 billion

No. of FamiliesPremium @ P2,400DSWD Near PoorPrincipal Families2.41 millionPhP 5.78 billionOther families in the list*2.08 millionPhP4.99 billionTOTAL4.49 millionPhP 10.77 billion

PAMANA and BANGSAMORO 17, 500 Php 42.00 millionGrand Total14.72 millionPhP 35.34 billion(35,337,657,600)

*Funding Requirements to Cover the Poor and Near Poor

EXPANDED COVERAGE as Stated in RA 10606Enroll the remaining vulnerable groupsWomen about to give birth (and as determined by means test recognized by DSWD) (Sec 21, RA 10606)

Barangay health workers, nutrition scholars, and other volunteer workers of the LGU. (Sec 20, RA 10606)

Workers rendering services in government offices such as job order, project-based contractors, and the like (paragraph 3, Sec. 5, Rule I, Title III of the IRR of RA 10606)

Require PhilHealth membershipMake PhilHealth membership a mandatory requirement for doing business or issuing professional or business license or permit like (paragraph 3, Sec. 6 of RA 10606)

Point of CareCover the unenrolled poor and protect them from the financial risks of ill-health at point of care.

Outcome 2: Financial Risk Protection* Depends on NHTS list of DSWD

Strategy 2: Improve Benefit PackageActionStatusTARGETS2014201520161. Implement No-Balance BillingLGUs: 6%

DOH: 11% 15

5035

8050

90 2. Increase access to primary Care Benefit Package5.4 M NHTS Families14.7 M*14.7 M14.7 M3. Implement Case Rates to all conditions12 Surgical 11 Medical ConditionsAll surgical and medical conditions4. Expand Catastrophic Care Package (Type Z)8 conditions122025

Preventive and curative care

Ensure No-Balance Billing (NBB) implementation - No other out-of-pocket expenses will be charged from sponsored members confined in government facilities beyond the prescribed benefit package rates of PhilHealth.

Primary Care Benefit I diagnostic examination including complete blood count, urinalysis, fecalysis, sputum microscopy, fasting blood sugar, lipid profile, chest x-ray and primary preventive services

Primary Care Benefit II outpatient medication for hypertension, diabetes and dyslipidemia

Special Benefit Packages TB treatment through DOTS, Maternity Care Package, Malaria Treatment, HIV/ AIDS treatment, Animal Bites

Z-Benefit Packages health packages for catastrophic conditions

Implementation of All Case rate payments as a more efficient provider payment mechanism.IMPROVED BENEFIT PACKAGE

Continuing PhilHealth Efforts and Activities in the HospitalsDeployment of PhilHealth Customer Assistance Relations Empowerment Staff (PCARES)Best Efforts to reduce turn-around time in processing claims. (CAR is the 3rd place nationwide - fastest TAT in claims processing, 2012)Priority Lane for NBB Claims through the Reg Tag CornerStudy/Survey Regarding Membership Status of Patients Admitted in HospitalsThe Benguet General Hospital Project Iwas RTH

Planned Activities For 2013 and BeyondPoint of Care Engagement of HospitalsIncrease Hospitals Implementing NBB Orientation of the ACR by Province starting 4th week of November 2013Expansion of Study/Survey on Membership Status of Admitted Patients in Private Hospitals

*** Estimated Figure** Estimated Figure***