Presentation of Dr. Francisco Z. Soria, Jr., officer-in-charge and vice president, Quality Assurance Group of the Philippine Health Insurance Corporation at the PhilHealth Maternal, Newborn and Child Health Summit

1. Achieving MDGs 4 and 5 through Kalusugang
Pangkalahatan: Social Health Insurance and
Maternal and Child Benefits
Dr. Francisco Z. Soria, Jr.
OIC-VP, Quality Assurance Group
PhilHealth

2. Universal Health Care
Financial
Risk
Protection
Improving
Access to
Quality
Health
Facilities
Attainment of
MDGmax
Better health
outcomes
Responsive health
system
Equitable &
sustainable health
financing
Health
Financing
Service
Delivery
Policy,
Standards and
Regulation
Health
Human
Resource
Health
Information
Governance
for Health

3. In the Philippines
Source: NSCB, MDG watch

4. PhilHealth
Engagement for
Participation
Payment

5. History – Maternity Care
2001
Low Risk
Maternity Care
Package
1st two
deliveries
2003
Maternity
Care Package
Case
payment
scheme 4.5 k
2006
MCP
expanded to
3rd delivery

6. History – Maternity Care
2008
Expanded to
4th delivery
2009
Revised
standards
Increased
package
rate to 6.5k
2011
Increased
package
rate to 8k
No balance
billing
policy

7. History Newborn Care
2006
Newborn Care Package
Case rate P1000
Newborn care, screening, Hepa B
vaccine
2007
BCG added
2011
Rate increased to
P1750
Newborn Hearing
Screening Test
included

8. • Members and Qualified Dependents
• Up to 4th delivery onlyWho can avail
• Non-hospital facilities
• Engaged Maternity and Lying-in Clinics
• Engaged physicians and midwives
Who provides
• Prenatal care
• Delivery
• Post natal care
• Health education and counselling
What services
• P 1,500 pre-natal care fee
• P 6,500 facility fee including professional fee
• No balance billing
Remarks
Maternity Care Package

9. • Qualified dependents (newborn) of members
• No limit as to number of birthsWho can avail
• Non-hospital facilities
• Maternity and Lying-in Clinics
• Hospitals
Who provides
• Newborn care
• Screening tests – newborn screening and hearing
• Vaccination – hepatitis B and BCG
• EINC protocol
What services
• P 1,750
• No balance billing
Important
Features
Newborn Care Package

10. WHAT ARE WE DOING:
Provide financial access to health care
services for mother and child

11. •
34 74 105
180
269 333
627
742
1020
1201
0
200
400
600
800
1000
1200
1400
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
MaternityClinics
Increase in access with increase in providers
NumberofAccreditedProviders
Year
PhilHealth MCP/NCP providers per year
Source: AD

12. Utilization of MCP, NSD and NCP increase
22022
38073 38990
70043
106509
131561
164797
196806
216955
274390
7 1327
33009
68333
91457
133718
224842
0
50000
100000
150000
200000
250000
300000
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
MCP/NSD
NCP
Source; TFI, date of admissions, extracted 5.24.2013
Number of Claims for MCP/NSD and NCP

13. Number of MCP/NSD Claims per Member Type
0
50000
100000
150000
200000
250000
300000
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Life Member
OWP
Sponsored
IPP
Employed
Source; TFI, date of admissions, extracted 5.24.2013
Number of poor (SP) accessing the benefits
increases

14. WHAT ARE WE DOING:
Engaged private sector providers

15. Private sector engagement increased over
the years
Number of Engaged MCP Providers
Source: AD

16. WHAT ARE WE DOING:
•Ensuring quality of care through quality
assurance program
•Accreditation
•Alignment with the initiatives of the DOH
•Automatic accreditation

17. WHAT NEEDS TO BE DONE
Increase MCP/NCP provider per
municipalities/cities

18. Half of all municipalities and cities in the
country do not have an engaged MCP
provider
Source: AD

19. • Local advocacies to provinces/municipalities
with no or low number of accredited facilities
• Further dissemination of information re:
engagement process, claims filing among
others
• Work closer with different stakeholders to
accomplish this goal
In the next few months

20. In summary
• What we want is !!!