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PhilHealth shows stronger performance in 2018; gears up for Universal Health Care January 16, 2019

THE Philippine Health Insurance Corporation (PhilHealth) posted stronger performance in 2018, surpassing previous year's records on its net income, benefit payments and membership coverage; showing strong indication that the state health insurer is prepared to take on the challenges of Universal Health Care which President Rodrigo R. Duterte will soon sign into law.

Strong financials

In its November-end financial status, PhilHealth realized a net income of P8 billion which is 671% higher than last year's P1 billion, a virtual seven-fold growth. With just a month left before the year comes to a close, PhilHealth expressed optimism that it will end the year with a positive bottom line.

Owing to its intensified collection activities, the state agency registered a premium income of P118 billion or 21 percent higher than last year's P97.180 billion. Releases by the National Government for the premium contributions of around 21 million indigent and senior citizen members and their qualified dependents topped the billing at P49.7 billion which is 15 percent higher against P43 billion from the same 11-month period last year.

Coming in next are the premiums paid on behalf of private sector workers at P43.6 billion, having the highest year-on-year growth with 34 percent or P11 billion increase from last year's P32.5 billion.

Meanwhile, its investment portfolio rose to P152 billion which is 21 percent higher than last year's level.

According to PhilHealth Acting President and CEO, Dr. Roy B. Ferrer, such performance is enough proof that the National Health Insurance Fund is intact and protected to meet the rising health care demand of its 100 million beneficiaries here and abroad. "As stewards of the National Health Insurance Fund, we owe it to the members and stakeholders to keep their fund in excellent shape to meet all our financial obligations," Ferrer emphasized.

Increased benefit expense

In benefit payments, PhilHealth released P111 billion, 15 percent higher than last year's P96 billion, paying its health care providers at an average of P3 billion a week.

Some 26 percent of its total benefit payouts, amounting to P29 billion, were availed of by senior citizens and lifetime members. Close on their heels the indigent members and their dependents who were paid P28 billion. Interestingly, they comprise 25 percent of claims payouts, aside from having the highest year-on-year growth at 62 percent.

Ferrer pointed out that the increasing amount of claims payments is a result of PhilHealth's aggressive educational campaign on PhilHealth benefits and entitlements, and how to effectively avail of them. Among these information drives include the ‘PhilHealth Forward', ‘Project ReachOut', various stakeholders fora, and its signature ‘Alaga Ka', a grassroots level road show aimed at increasing awareness and appreciation of the National Health Insurance Program. These campaigns were mainly for PhilHealth marginalized members.

Ferrer declared that alongside its increasing benefits payouts is "the new speed with which claims are processed." Good claims processing had taken only 22 days – which is 38 days faster than the 60 days provided for by law. Good claims refer to filed claims with complete documentary requirements. These do not include claims that are under investigation, return-to-hospital and those denied by its local health insurance offices.

Increasing population reach

PhilHealth earlier disclosed in June that it reached the 100 million mark in terms of population coverage, translating to 94 percent of the 2018 projected population of 106 million. The biggest segment of its beneficiaries base is made up of the formal economy or those employed from the private and government sectors, which represent over 30 percent of its total coverage. This is followed by its indigent beneficiaries with close to 30 percent; the informal economy at 22 percent; while its senior citizens, lifetime and sponsored members representing the balance of 14%.

Improved internal controls

Ferrer further expressed assurance that they will continually aim for improvement and consistency in performance for the greater benefit of its members and its partner stakeholders.

"Since I assumed the helm of PhilHealth in June of last year, we have exerted all our best to better our operational efficiency through the various internal reforms, leadership transformation, and better relationship with our external partners. Our members can count on us to carry these out in keeping with our commitment of better health insurance coverage for our 100-million strong beneficiaries." he vowed.

Intensified monitoring to protect the funds

PhilHealth also introduced reforms – both internal and external – to safeguard its funds against abusive practices and fraud. Mechanisms have been instituted to strictly monitor the performance of its accredited providers which resulted in legal actions totaling 298 cases against at least 71 hospitals nationwide due to various violations.

From 2010 to present, it already suspended at least 31 hospitals and revoked the accreditation of another two facilities for serious violations. PhilHealth is also now imposing fines against erring hospitals instead of outright suspension or revocation of their accreditation to ensure that members continue to access health services and avail themselves of their benefits even if these facilities were charged for their fraudulent practices.

The present administration also instituted corporate-wide efforts to curb abusive and corrupt practices within its ranks. It earlier announced that there are several investigations ongoing against employees and officers for different violations. "Be warned. If you have plans of taking advantage of the Corporation, better think twice", Ferrer once emphasized.

Better PhilHealth on public's perception

PhilHealth also remains to be the most trusted agency in the country based on multiple citations and independent surveys. In the 2017 Philippine Trust Index (PTI) conducted by the communication agency EON Group, PhilHealth received the highest trust rating at 95 percent among social protection agencies. In 2018, Novo Trends conducted its nationwide client awareness and satisfaction survey wherein the state health insurer received an average of 94.1% pleasing mark, with the respondents lauding its frontline services.

"With these citations brought about by our consistent performance, we can confidently say that the 6000-strong workforce of PhilHealth is now fully geared to take on the challenges of the forthcoming Universal Health Care", Ferrer stressed.

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PhilHealth shows stronger performance in 2018; gears up for Universal Health Care