Ghana, India, Indonesia, Kenya, Malaysia Mali, Nigeria, The Philippines and Vietnam ----------------------------------------------------------------------------------------- www.jointlearningnetwork.org [email protected]Workshop Proceedings JLN Population Coverage Technical Initiative Workshop Manila, Philippines December 8-10, 2014 1. Executive Summary 2. Background on JLN Population Coverage Technical Initiative Workshop 3. Workshop Sessions and Outputs 4. Next Steps Annex 1: Participant Feedback on Workshop Annex 2: JLN Population Coverage Technical Initiative Next Steps - Potential Options for New Work Annex 3: Philippine’s Department of Social Welfare and Development Assessment Form Workshop participants visit the Rizal Medical Center as part of the site visit organized by PhilHealth.
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Ghana, India, Indonesia, Kenya, Malaysia Mali, Nigeria, The Philippines and Vietnam -----------------------------------------------------------------------------------------
Indigent, poor, informal sector: Registration agents lead
enrollment via house-to-house visits and office
registration. Members of the informal economy eligible
to pay a premium pay directly to the district office or
through the agents.
Other groups: In-person enrollment at scheme offices. Biometric enrollment was piloted in 2014 in Greater Accra region. Currently, it is implemented in six regions and will be fully rolled out nationally by middle of 2015.
Interventions/strategies. Recent strategies to improve
targeting have included:
Enrollment of existing organized groups of vulnerable populations to bypass stringent definition of the “indigent” and rigid documentary requirements
Improved enrollment form to capture additional data on beneficiaries
Piloting and rolling out biometric enrollment mechanism
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Targeting and Enrollment: Report-Out by JLN Country Pairs
In the afternoon of Day 1, JLN representatives met in country pairs and had active discussions about their countries’
challenges and solutions to in-practice implementation of targeting methodologies. Representatives then introduced
their pair country and its targeting experience to the broader group, presenting one challenge, strategy, and unexpected
learning they gleaned from discussions with their peer country (summarized in table below).
Table 1: Report-Out by JLN Country Pairs
Malaysia (presented by Nigeria)
Challenge: Ensuring sustainability of funding
Strategy: Foreigners pay more than nationals for services
Unexpected learning: Malaysia is working towards creating
a single payment system. As part of this, Malaysia’s
Ministry of Health is 1) considering how to harmonize
public and private health service provision 2) considering
implementing a social-health-insurance-like scheme
Nigeria (presented by Malaysia)
Challenge: 1) Limited funding for scheme coverage of
beneficiaries 2) Leakages in enrollment
Strategies and solutions: 1) Creating new UHC fund 2)
Biometric registration for new members for the primary
school pupils program
Unexpected learning: Mobile money mechanism used to
collect premium contributions from informal sector
Indonesia (presented by Kenya)
Challenge: Manual enrollment process slower than online
Strategy: BPJS is planning to implement sanctions for the
informal sector to enroll in health insurance. For example,
requiring BPJS membership to obtain and renew a passport
and driver license
Unexpected learning: The major challenge faced by the
scheme with enrollment is administrative capacity to
manage the large number of new member applications
Kenya (presented by Indonesia)
Challenge: Enrollment is compulsory for formal sector, but
voluntary for all other groups. There is a lack of incentive for
the poor, near poor and informal groups to enroll
Strategy: Innovative partnerships between Kenya’s NHIF and
1) mobile network providers to collect premiums via mobile
money; 2) National Registration bureau to require
membership to renew work permits and licenses
Unexpected learning: NHIF is designing a program to provide
refugees with insurance coverage
Mali (presented by India)
Challenge: Local governments are responsible for
identifying indigent populations and contributing funds for
their coverage in the RAMED program. Mayors don’t report
the indigent to avoid paying for their RAMED coverage
Strategy: Mali is implementing a major information and
awareness campaign at national scale
Unexpected learning: Central government is delegating
responsibility to local governments
India (presented by Mali)
Challenge: Lack of incentive for HMOs to enroll populations in
rural areas
Strategy: Scheme managers place informal pressure on HMOs
to encourage enrollment of rural groups
Unexpected learning: Biometric enrollment camps have been
very successful.
Vietnam (presented by Ghana)
Challenge: Corruption leads to errors of inclusion in
targeting; commune leaders responsible for identifying the
poor according to defined poverty line sometimes
incorrectly report individuals as “poor” to provide them with
benefits and premium exemption
Strategy: Individuals identified as poor have their names
placed on a list, which is published in a public area (reduces
the risk of leakages)
Ghana (presented by Vietnam)
Challenge: Registration Agents occasionally enroll new
members incorrectly as indigents members to offer them
premium exemption.
Strategy: Use of biometric enrollment technologies
Unexpected learning: Ghana allocates 17.5% of the funding
from the VAT towards its national health insurance scheme
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Unexpected learning: Strong political will to extend health
coverage to poor and near-poor populations
Workshop Day 2
Site Visit
PhilHealth, in its role as workshop hosts, planned a site visit to Rizal Medical Center and to a PhilHealth local health
insurance office. The visit to the medical center provided participants with an in-depth view of the Onsite Rapid
Enrollment (ORE) system, described in the box below, which enrolls critically poor populations seeking care at
hospitals into PhilHealth. At the PhilHealth office, participants also learned about the implementation of the
Philippines Anti-Red Tape Act, which requires government agencies (including PhilHealth) to display a Citizen’s
Charter that outlines the standards of services to individuals. PhilHealth also presented on the scheme’s primary
care benefit, TsEkAp (“Check-Up”), which provides enrollment, data verification, consultation, and preventive and
promotive services to users. The site visit provided participants with a rich understanding of PhilHealth programs,
including both the processes used by the scheme for targeting and enrolling beneficiaries (discussed on workshop
day 1) and the experience of users (discussed on workshop day 3).
Box 4: Philippines Onsite Rapid Enrollment (ORE) system
According to the Philippines’ No Balance Billing policy, Filipino citizens who are “critically poor” (defined as in the poorest 25%)
are exempt from paying medical cost and are eligible for free health coverage under PhilHealth’s Sponsored Program. In April
2013, PhilHealth launched a pilot in select hospitals of its Onsite Rapid Enrollment (ORE) system to capture and expedite
enrollment for the critically poor eligible for scheme coverage into the PhilHealth Sponsored Program. The ORE Program was
developed in response to a mandate from the government (Joint Order No 2013-0031, ‘Enrollment of the Critically Poor under
the Sponsored Program of the national health Insurance program at Point-of-Service”), as part of efforts by President Aquino’s
administration to expand health coverage to the poorest Filipino citizens.
ORE: step-by-step process
ORE database is used to determine the patient’s membership status within PhilHealth (whether they are already a
member, dependent, other).
If the patient is unenrolled in PhilHealth, a Medical Social Welfare Assistance Officer (MSWAO) conducts an interview and
completes an assessment form (form included in Annex 3) to determine their need for assistance, taking into account both
financial status and other factors, such as the severity of illness.
If eligible, the new member is enrolled to PhilHealth on-site using the ORE system. The data is sent to the MSWAO, who
transmits the information to the Department of Social Welfare and Development (DSWD).
The premium and medical costs for the visit are covered by the health facility. After the patient receives care, the hospital
submits a claim to PhilHealth, which is paid to the health facility within 30 days (expedited claims reimbursement). The
patient is not billed for any healthcare costs, even those beyond the amount reimbursable by PhilHealth.
DSWD conducts follow-up household visits and interviews to validate the eligibility of the new enrollee. Once validated,
the enrollee’s information is kept on file to ensure continued premium sponsorship. If the enrollee is not deemed to
qualify for the Sponsored program during this process, they will be asked to pay the requisite premium amount in the
following year.
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Box 5: PhilHealth Presentation: 10 things to know about the implementation of the 2007 Anti-Red Tape Act
In April 2013, the Philippines passed the Anti-Red Tape Act (Republic Act No. 9485), which requires government
agencies (including PhilHealth) to set up and display a Citizen’s Charter that states the standards of service to
individuals. The Citizen’s Charter is mandated to be displayed in the office entrance/ the most conspicuous space to
be viewed by all.
1. Applies to all government offices that provide frontline services
2. Limits number of signatures of officials to a maximum of 5
3. Requires government offices to draw Citizen’s Charter which identifies the
services offered, procedures, fees, and complaint/feedback mechanisms
4. Citizen’s Charter must be posted at main entrance/most conspicuous place
and in published materials
5. Public assistance and complaints desk should be attended even during
breaks. All officers interacting with public should wear an ID
6. All applications/requests for frontline services shall be acted upon within 5-
10 working days
7. Denial of request for access shall be fully explained
8. Disciplinary action for violating act, based on the severity of the violation
9. Head of agency is primarily responsible and accountable for implementation of
the rule
10. CSC shall conduct Report Card Survey of Citizen’s Charter
Box 5: TSeKaP: “Tamang Serbisyo para su Kalusugan ng Pamily”
In 2014, PhilHealth re-introduced its Primary Care Benefits Package under a new brand, Tamang Serbisyong
Kalusugang Pampamliya (TSeKaP – or “check-up”). The purpose of redesigning this package creating the new
brand was to make it more attractive to PhilHealth users in order to encourage them to seek preventive health
care services.
Beneficiaries: TSeKaP was first piloted for members of the Department of Education. It is now available to
PhilHealth beneficiaries and their dependents in the following membership categories: Indigent, Sponsored
Members, Organized Groups, and Overseas Workers. There are plans to scale up TSeKaP to other PhilHealth
member categories in the future.
Benefits: Covers primary preventive services, diagnostic examinations, drugs and medicines for specified
diseases.
Providers: All public and private facilities providing primary care services can provide TseKap; Participating
facilities are required to meet accreditation standards.