PhilHealth Vision and Strategies for Health Care Financing Reforms for Better Coverage of Essential Medicines - PowerPoint PPT Presentation

1 / 19
About This Presentation
Title:

PhilHealth Vision and Strategies for Health Care Financing Reforms for Better Coverage of Essential Medicines

Description:

... .00 26019.00 28651.00 1729.00 5935.00 8726.00 10430.00 12479.00 15482.00 17339.00 19351.00 22206.00 22258.00 17838.00 23807.00 24772.00 23271.00 2363.00 3014 ... – PowerPoint PPT presentation

Number of Views:382
Avg rating:3.0/5.0
Slides: 20
Provided by: metaphili
Category:

less

Transcript and Presenter's Notes

Title: PhilHealth Vision and Strategies for Health Care Financing Reforms for Better Coverage of Essential Medicines


1
PhilHealth 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

2
Goal 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
4
Source 2005 Philippine National Health Accounts
5
Trends of Health Expenditure by Source of Funds
Source Philippine National Health Accounts
6
SITUATIONER
7
In billions
Source Financial Statement
8
(No Transcript)
9
Situationer
  • 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)

10
STRATEGIES
11
PhilHealth 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)

12
PhilHealth Strategies Toward Financial Protection
  • Shifting to New Payment Mechanism
  • Contracting or Preferred Provider Service
    Agreements
  • Investing in Health Care Providers
  • Expanding Outpatient Benefits

13
Shifting 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

14
Contracting 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

15
Investing in Health Care Providers
  • Provide support/assistance to providers to
    improve their facilities and efficiency in health
    care delivery
  • Ensure access to Essential Drugs

16
Expanding 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
19
In million pesos
Write a Comment
User Comments (0)
About PowerShow.com