Representatives from the Philippine Health Insurance Corporation (PhilHealth), in collaboration with the European Union (EU)-EPOS delegation to the Philippines, have been visiting health care facilities in the country, gathering data on costs that will have an impact on the amount of health insurance coverage PhilHealth pays.
Under the EU-Philippine Health Sector Reform Contract (PHSRC), experts from EPOS Health Management trained PhilHealth Benefits Development and Research Department (BDRD) personnel on the use of survey tools prior to the conduct of this costing activity. BDRD determines PhilHealth’s case rates (or the amount of health insurance coverage per case) and leads the design of its benefits. It is a recipient of the EU-EPOS technical assistance on strategic purchasing, costing, and policy development within a national health insurance environment.
In Cebu, a team of trained BDRD personnel does the costing survey and interviews key informants in preselected hospitals. EPOS health financing expert Melahi Pons joined the team for EU.
“The European Union was requested by the PhilHealth to help on this,” Pons said, referring to the costing survey, “to capture real scenarios as evidence of the BDRD, na ipakita sa mga (to show to the) board members na (that) they have to take a look at our case rates,” continues the EPOS Health Management expert. The BDRD will use data gathered from these costing surveys and interviews to assess PhilHealth’s existing coverage rates.
The costing survey prioritizes high-volume cases such as pneumonia (moderate and high risk), hypertension, asthma, dengue, stroke, dialysis, and caesarean section. The Our Lady of the Rule Maternity and General Hospital and the Cebu North General Hospital, Inc., facilities in the province with the highest number of claims filed for the mentioned cases, serve as survey respondents. Using a cost data capture tool, the team examines the facilities’ overall costs corresponding to their physical structure, equipment, human resource, drugs and medicines, and other expenditures.
The team looks into specific costs that may be incurred in the treatment of patients, from the moment they enter the facility up until they leave. In particular, they look into the diagnostics and laboratory exams that patients are made to undergo, and the number of medicines and dosages that patients have to take, including take-home medicines, if any. The team even checks the number of minutes it takes for facility security guards and attending nurses to receive individual patients. (END) (Marie Beatrix S. Elias)
(Reference: Dr. Israel Francis A. Pargas, Head Executive Assistant and Concurrent OIC-Vice President for Corporate Affairs Group, Tel. 0917-8089399)