Monday, May 4, 2015


No one should be left behind.

This may well be the new rallying call for PhilHealth as it pursues the drive to ensuring universal coverage for all Filipinos. The same call resonates in its vision, “Bawa’t Pilipino, Miyembro. Bawa’t Miyembro, Protektado. Kalusugan Natin Segurado.”

As PhilHealth celebrates two decades of being the premier health insurer in the country, the message is loud and clear: nobody should be excluded from health care because it is every citizen’s birthright that the nation shall take care of its people in every way possible, wherever they may be.

Universal health care is a major challenge for the administration: how does one make sure that every Filipino citizen is a member of the National Health Insurance Program (NHIP) or even sustain the membership of those who are already in?

Indeed, it is easier said than done. But with the passage of Republic Act 10606, PhilHealth made radical changes to address the challenge by implementing programs for every sector possible. It achieved its goals given all the limitations and obstacles brought about by the transition from Medicare to the more expansive NHIP. After 20 years, membership coverage has grown to an estimated 81.63 million beneficiaries or about 82% of the projected population of almost 100 million. This translates to at least 4 out of every 5 Filipinos who are now enrolled in the program.

The target this year is to cover the remaining 18% of the un-enrolled population through various initiatives that will make it easy for them to register in the program. This includes removal of documentary requirements upon membership, expanding access points and pushing for group enrollment schemes. There are programs for mothers and children, the disabled, the more and less fortunate ones, the abandoned and most significantly, a program designed for all Filipino senior citizens. Universal coverage is indeed almost attainable.

Senior Citizens are rare gems

There has always been a demand to cover one of the most vulnerable sectors of society, the senior citizens. While the Lifetime Member Program provides coverage for members who have paid at least 120 months’ premium contribution and have already retired from service, there is still a considerable number of senior citizens that have yet to be covered under the program.

In November last year, President Aquino signed Republic Act 10645, granting automatic coverage to Filipino citizens who have reached the age of 60 and providing them with the full range of PhilHealth benefits. This move opened doors to the aging population to have social health insurance coverage in the simplest way possible, and with the National Government paying for their annual premium contribution. Indeed, this is a way of honoring those who have kept history alive through the stories they share with the younger generation.

Healthy children need healthy mothers

Another giant step that PhilHealth took towards universal coverage is providing coverage for pregnant women who are about to give birth. In support of the country’s commitment to achieve the Millennium Development Goals, PhilHealth liberalized entitlement to benefits to ensure that un-enrolled women about to give birth are granted financial access to essential health services. They only need to pay the corresponding premium for the whole year to be able to avail of their benefits.

Strengthening its resolve to extend adequate maternity-related services to Filipino women, PhilHealth has made sure that access to pre-and-post natal care is available. The wife of a neighbor who missed out on her pre-natal check-ups gave birth to a stillborn child because she thought that she was not qualified to avail of PhilHealth benefits since she missed out on her premium contributions for so many months. With the Maternity Care Package in place, however, no longer shall the nation witness instances when the lack of pre-natal check-ups can severely affect the child in a mother’s womb.

PhilHealth also ensures the well-being and survival of babies with the Newborn Care Package or NCP that now includes Newborn Screening and Newborn Hearing Screening tests at a package rate of P1,750. This paves the way for healthier babies whose predispositions to various illnesses can now be detected within 24 hours from birth.

Coverage for Disabled Parents

Earlier, only parents who are 60 years old and above and not gainfully employed are qualified dependents of member-children, to the detriment of parents who are incapable of fending for their own subsistence. This has always been a problem for Chona* whose 58-year-old mother cannot walk since an accident saw both of her legs amputated. She cannot be declared as her dependent so Chona* ended up paying for the premium contribution of her mother. Pursuant to the new law, however, PhilHealth now provides coverage for parents with permanent disability, regardless of age. This segment of society can now enjoy the full benefits of being a PhilHealth dependent.

Challenges to Opportunities

Indeed, the passage of the NHI Act of 2013 provided the much-needed framework for all the initiatives that PhilHealth is keen on introducing, especially in light of the ever-changing scenarios in the health care industry and in consideration of the many players that influence the way health care is delivered in the country. More than just a mechanism to allow members to gain financial access to quality health care services, the revitalized NHIP is now about ensuring the continuous improvement of quality of services and benefits to respond to the demands of members here and abroad.

Beyond enrolment, PhilHealth needs to work double time to ensure that engaged facilities are where the enrolled members are when they need these most. So far, PhilHealth has engaged the services of about 8,000 health care institutions and facilities nationwide, making 9 in every 10 DOH-licensed hospitals cater to the health care needs of its growing number of members and qualified dependents. PhilHealth believes that an informed member is an empowered member. It is PhilHealth’s given mandate to ensure that all our members are aware and have adequate understanding of their benefit entitlements and more importantly on how to avail them. With the ever growing number of members now covered by the program, the challenge PhilHealth faces is how to reach far and wide for each and every member to get the message across, timely and accurately. Through various communication channels such as radio programs, social media, print ads and TV appearances, accurate and timely information translates to working knowledge on the program. In addition, it is also best to mention that with no less than the PhilHealth President and CEO as the lead spokesperson, it is no wonder that public satisfaction with PhilHealth and awareness and utilization of the services and benefits by members have been excellently rated for the past three years.

Attaining the goals towards universal health care is never an easy journey as PhilHealth sometimes faces criticisms from is stakeholders. These adverse feedbacks only strengthen its resolve to remain steadfast in its commitment to provide true financial risk protection to all Filipinos.

As it commemorates two decades of providing affordable, accessible and adequate health care services to its members, PhilHealth also marks the celebration of how it has vastly evolved from its inception 20 years ago to become the premiere social health insurer in the country today. # (Amelita L. Buted)/Adapted News - PHILHEALTH

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