Title: PhilHealth Vision and Strategies for Health Care Financing Reforms for Better Coverage of Essential Medicines
1PhilHealth Vision and Strategies for Health
Care Financing Reforms for Better Coverage of
Essential Medicines
- Shirley B. Domingo, MD, MPH
- Philippine Health Insurance Corporation
- OIC, Office of the Senior VP, Health Finance
Policy Sector - Group VP, Quality Assurance Group
2Goal of NHIP
Provide all citizens with the mechanism to gain
financial access to health services Repiblic
Act 7875
3- Social Insurance highest growth rate at 24.9
percent or around P4.0 billion increase in 2005. -
SOURCE NSCB, 2005 Philippine National Health
Accounts
4Source 2005 Philippine National Health Accounts
5Trends of Health Expenditure by Source of Funds
Source Philippine National Health Accounts
6SITUATIONER
7In billions
Source Financial Statement
8(No Transcript)
9Situationer
- Drug Reimbursement based on PNDF
- Reimbursement limits are dependent on
- MDRP
- Case type
- Level of hospital
- Rational drug use
- Provider Payment Mechanism
- Fee for Service (Inpatient Care)
- DM Limit depending on case type and hospital
level (2,700 - 40,000) - Case Payment (Selected In and Out Patient Care)
- Payment for DM incorporated into the payment
- Capitation (Out Patient Package)
10STRATEGIES
11PhilHealth BenchBook Standards
- Patient Care
- Drugs are selected and procured based on
organization's usual case mix and according to
policies and procedures consistent with
scientific evidence and government policies - Leadership and Management
- Terms of reference, membership and procedures for
meetings of all committees within the
organization. Minutes of meetings are recorded
and approved (e.g. Therapeutics
Committee) - Safe Practice and Environment
- Policies on rational antimicrobial use based on
the hospital antibiogram in coordination with
Microbiology Laboratory and Pharmacy Therapeutics
Committee (evidence) - Improving Performance
- Conduct of utilization review of drugs,
procedures or diagnostic tests based on CPG
(evidence)
12PhilHealth Strategies Toward Financial Protection
- Shifting to New Payment Mechanism
- Contracting or Preferred Provider Service
Agreements - Investing in Health Care Providers
- Expanding Outpatient Benefits
13Shifting to New Payment Mechanism
- From FFS to DRGs
- Share risk with providers
- Provide a rational, equitable, and quality care
- DPRI as reference to reimbursement cost of drugs
- Pay for Performance
- Provide incentive for good performance among
providers which includes rational drug use
14Contracting or Preferred Provider Service
Agreements
- Use financial leverage to buy quality services
and cost-effective care - Use this to control out of pocket
- Ensure Access to Essential Drugs
- Accreditation of Pharmacies
- Promote quality practices and systems in
pharmacies
15Investing in Health Care Providers
- Provide support/assistance to providers to
improve their facilities and efficiency in health
care delivery - Ensure access to Essential Drugs
16Expanding Outpatient Benefits
- Limited to Sponsored Members expanded to
include other member groups - Expand coverage to include outpatient drugs
- e.g. P100 for take home meds (sponsored members)
- Accreditation for Pharmacies - promote quality
practices and systems in drug outlets
17 Good Day!
18- Per capita health
- Expenditure from all
- sources of funds
- SI Increased by 22.4
SOURCE NSCB, 2005 Philippine National Health
Accounts
19In million pesos