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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
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Atty. Jerry F. IbayRegional Vice PresidentPhilHealth-CAR
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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
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Outcomes and Strategies of UHC
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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
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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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range.
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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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range.
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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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range.
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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
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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
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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
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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
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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
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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
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*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)
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*Funding Requirements to Cover the Poor and Near Poor
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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.
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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
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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
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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
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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
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*** Estimated Figure** Estimated Figure***