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Gregorio C. Rulloda
Vice-President and Spokesperson
Corporate Affairs Group
PhilHealth :
Achieving Universal
Health Care for All
Filipinos
Strategic Thrusts - UHC
2. Improved access to quality
hospitals and health care facilities
1. Financial risk protection by
expanding NHIP enrollment
and benefit delivery
Strategic Thrusts - UHC
3. Attainment of the health-related MDGs:
 reduction of maternal and child mortality,
morbidity and mortality from TB and malaria
and the prevalence of HIV/AIDS
3. Preparedness from emerging
disease trends
4. Prevention and control of non-
communicable diseases
PhilHealth’s ROLE & GOAL
Vision
Bawat Pilipino Miyembro
Bawat Myembro Protektado
Kalusugan Natin Segurado
Mission
"Sulit na Benepisyo sa Bawat Miyembro,
Dekalidad na Serbisyo para sa Lahat"
Specific Goals
• Willingness to pay a fair premium
Payor’s appreciation of
Philhealth’s value
• Universal coverage for basic healthcare needs
Enrolment of entire
population
• Transparent provision of needed goods and
services to all members at set PhilHealth rates
Providers’ enthusiasm
to partner with
PhilHealth
• PhilHealth contributes to all medical
transactions
Patients’ utilization of
benefits and packages
• Trust in the institution for partnership and
employment opportunities
Enhanced Reputation
as a center of
governance excellence
Bawat Pilipino, Miyembro
Employees
OFWs
Individually
Paying Members
Lifetime Members
Sponsored Members
SOCIAL SOLIDARITY: Bayanihan into the National Health Insurance
Program where the healthy, wealthy and unaffected look after the
sick, poor and afflicted.
 No one is excluded, everybody are entitled to the care of the nation. All
are members and all have rights & responsibilities, and being a contributing
member alone allows everybody to fulfill their responsibilities.
Children who
are below 21
years old
Spouse of the member
Parents who
are 60 years
old & above
who are not
members
Who are the qualified dependents…?
Bawat Pilipino, Miyembro
Bawat Pilipino, Miyembro
85%
“Sa kalusugan naman po: Nang
dumating tayo, animnapu’t
dalawang porsiyento lamang ng
mga Pilipino ang naka-enrol sa
PhilHealth. …..Ngayon po, 85
percent ng lahat ng mamamayan,
miyembro na nito. Ang ibig pong
sabihin, 23.31 million na Pilipino
ang naidagdag sa mga saklaw ng
PhilHealth mula nang bigyan tayo
ng mandato. “
Sector
Registered
Members
Dependents
Members
and
Dependents
Employed 11.36 13.69 25.05
Government 2.03 4.00 6.03
Private 9.33 9.69 19.02
Sponsored Members 10.06 29.83 39.89
Individually-Paying 4.74 6.07 10.81
Lifetime Members 0.61 0.42 1.03
Overseas Workers 2.63 2.55 5.18
Total 29.40 52.56 81.96
Bawat Pilipino, Miyembro
Bawat Pilipino, Miyembro
 Bringing information closer to Members and
Empowering Members
Bawat Pilipino, Miyembro
 Bringing information closer to Members and
Empowering Members
The Corporate Website
Bawat Pilipino, Miyembro
Bawat Pilipino, Miyembro
 Bringing information closer to Members and
Empowering Members
PhilHealth Taps Social Media for SHI Advocacy
www.facebook.com/philhealth
teamphilhealth
email.actioncenter@philhealth.gov.ph
From: carina_mana@yahoo.com.ph
Sent: Thursday, June 07, 2012, 3:27 PM
To: actioncenter@philhealth.gov.ph
Subject: PHILHEALTH number verification
Hi,
This is so great, I hope PAGIBIG service will follow your footsteps
in serving their people. Anyways, I will continue with my
contributions starting this month and again thank you very much
for your immediate assistance on this matter 
Cheeers!
Bawat Pilipino, Miyembro
 Bringing information closer to members and
Empowering members
Bawat Pilipino, Miyembro
 Bringing information closer to members and
Empowering members
Bawat Pilipino, Miyembro
 Bringing information closer to Members
and Empowering members
PhilHealth SHInES at House of
Representatives
PhilHealth Launched SHInES in Iloilo City
Bawat Pilipino, Miyembro
 Bringing information closer to
Members, Empowering them
PhilHealth Expo Launches the
"Be PhilHealth Now" Campaign
Bawat Pilipino, Miyembro
 Bringing information closer to Members
and Empowering Members
PhilHeath's e-Innovations for
Health Launched
Enables individuals to register
online
Enables employers to
post payments of their
employees on real time
Registration, billing and query of
Organized Groups
Electronic Payment Facilities
Remittance-By-Air thru text
Bawat Pilipino, Miyembro
PhilHeath's e-Innovations for
Health Launched
Facility for viewing the locations of health
facilities and visualization of various
corporate data using maps
Facility for checking membership status of
Sponsored Members under the NHTS-PR
during benefits availment
Facility for checking
eligibility of membership
and filing of claims by
HCPs
 Bringing information closer to Members
and Empowering Members
Bawat Pilipino, Miyembro
PhilHeath’s presence and visibility
in various fora, conventions,
special events and similar
activities
 Bringing information closer to Members
and empowering Members
2012 Kabisig National
Government Expo
2nd Philippine
Print Media
Congress
Umagang Kay Ganda
Kapamilya Services
DZMM’s "Takbo para sa
Karunungan"
Region 6 Inter Agency
Tournament
Iloilo Charter Day
PhilHealth’s Deliverable to the Society: Financial Risk
Protection
 Every Filipino can get financial assistance, have
access to excellent providers where health care is
paid for, use the assistance when needed, and
receive significant support
• Bawat Miyembro, Protektado
Bawat Miyembro, Protektado
 To have the opportunity to get
financial assistance whenever it
might be needed
ANG PREMIUM AY ABOT
KAYA!!!
Sa halagang P3.33 /day or
P100.00/month o depende
sa buwanang kita para
sa mga empleyado at
professionals
Bawat Miyembro, Protektado
 To have accessibility to health professionals
and facilities where quality health care is
paid for;
Bawat Miyembro, Protektado
 To actually use
the assistance
when needed
when doing so, to
receive a
significant
amount of support
54%
13%
13%
9%
11% Outof Pocket
National
Local
SocialHealth Insurance
Others
BENEFITS
Hospital
BENEPISYO sa PHILHEALTH
Hospital
In-Patient Care
Out-Patient Care
Health Center
Bawat Miyembro, Protektado
 Assistance to members at the point of
service
Bawat Miyembro, Protektado
PhilHeath's e-Innovations for
Health Launched
Facility for viewing the locations of health
facilities and visualization of various
corporate data using maps
Facility for checking membership status of
Sponsored Members under the NHTS-PR
during benefits availment
Facility for checking
eligibility of membership
and filing of claims by
HCPs
 Easy access to members and stakeholders
in benefit availment
Kalusugan Natin, Segurado
 No Filipino will ever be financially afraid of
getting sick, and that no one will left behind
in the race toward universal health care and
financial risk protection
 PhilHealth needs to and will leverage its
purchasing power to help break the silos
and foster increased collaboration
 Adress inequities in Health
Kalusugan Natin, Segurado
 How to use PhilHealth’s purchasing power?
 Use Performance Commitment
Contracts to ensure that health
facilities are safe and high
quality;
 Provide incentives to ensure that
health human resource is
adequate in number, purposely
distributed and properly
compensated
Kalusugan Natin, Segurado
 How to use its purchasing power?
 Negotiate for lower costs and charges of health
care goods and services
Kalusugan Natin, Segurado
 PhilHealth want to change HOW health care
services are rendered by providers with care
and received by members with pride
 Case payment for all diseases – provides clear,
explicit and predictable financial support;
Case Rates - Since
September 1, 2011,
there were 11 medical
cases and 12 surgical
procedures being paid
through case rate
Kalusugan Natin, Segurado
“…Ito po ang proseso ng
pagpapagamot para sa kanila:
Papasok ka sa alinmang
ospital ng gobyerno. Ipapakita
mo ang iyong PhilHealth card.
Magpapagamot ka. At uuwi
kang maginhawa nang walang
inilabas ni isang kusing…”
 No Balance Billing Policy (SAPAT NA ANG BAYAD NG
PHILHEALTH)
Thank You!
Panatag ang Loob at Masayang
Pamilya Kapag Naka PhilHealth

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Philhealth presentation

  • 1. Gregorio C. Rulloda Vice-President and Spokesperson Corporate Affairs Group PhilHealth : Achieving Universal Health Care for All Filipinos
  • 2. Strategic Thrusts - UHC 2. Improved access to quality hospitals and health care facilities 1. Financial risk protection by expanding NHIP enrollment and benefit delivery
  • 3. Strategic Thrusts - UHC 3. Attainment of the health-related MDGs:  reduction of maternal and child mortality, morbidity and mortality from TB and malaria and the prevalence of HIV/AIDS 3. Preparedness from emerging disease trends 4. Prevention and control of non- communicable diseases
  • 4. PhilHealth’s ROLE & GOAL Vision Bawat Pilipino Miyembro Bawat Myembro Protektado Kalusugan Natin Segurado Mission "Sulit na Benepisyo sa Bawat Miyembro, Dekalidad na Serbisyo para sa Lahat"
  • 5. Specific Goals • Willingness to pay a fair premium Payor’s appreciation of Philhealth’s value • Universal coverage for basic healthcare needs Enrolment of entire population • Transparent provision of needed goods and services to all members at set PhilHealth rates Providers’ enthusiasm to partner with PhilHealth • PhilHealth contributes to all medical transactions Patients’ utilization of benefits and packages • Trust in the institution for partnership and employment opportunities Enhanced Reputation as a center of governance excellence
  • 6. Bawat Pilipino, Miyembro Employees OFWs Individually Paying Members Lifetime Members Sponsored Members SOCIAL SOLIDARITY: Bayanihan into the National Health Insurance Program where the healthy, wealthy and unaffected look after the sick, poor and afflicted.  No one is excluded, everybody are entitled to the care of the nation. All are members and all have rights & responsibilities, and being a contributing member alone allows everybody to fulfill their responsibilities.
  • 7. Children who are below 21 years old Spouse of the member Parents who are 60 years old & above who are not members Who are the qualified dependents…? Bawat Pilipino, Miyembro
  • 8. Bawat Pilipino, Miyembro 85% “Sa kalusugan naman po: Nang dumating tayo, animnapu’t dalawang porsiyento lamang ng mga Pilipino ang naka-enrol sa PhilHealth. …..Ngayon po, 85 percent ng lahat ng mamamayan, miyembro na nito. Ang ibig pong sabihin, 23.31 million na Pilipino ang naidagdag sa mga saklaw ng PhilHealth mula nang bigyan tayo ng mandato. “
  • 9. Sector Registered Members Dependents Members and Dependents Employed 11.36 13.69 25.05 Government 2.03 4.00 6.03 Private 9.33 9.69 19.02 Sponsored Members 10.06 29.83 39.89 Individually-Paying 4.74 6.07 10.81 Lifetime Members 0.61 0.42 1.03 Overseas Workers 2.63 2.55 5.18 Total 29.40 52.56 81.96 Bawat Pilipino, Miyembro
  • 10. Bawat Pilipino, Miyembro  Bringing information closer to Members and Empowering Members
  • 11. Bawat Pilipino, Miyembro  Bringing information closer to Members and Empowering Members
  • 12. The Corporate Website Bawat Pilipino, Miyembro
  • 13. Bawat Pilipino, Miyembro  Bringing information closer to Members and Empowering Members PhilHealth Taps Social Media for SHI Advocacy www.facebook.com/philhealth teamphilhealth email.actioncenter@philhealth.gov.ph From: carina_mana@yahoo.com.ph Sent: Thursday, June 07, 2012, 3:27 PM To: actioncenter@philhealth.gov.ph Subject: PHILHEALTH number verification Hi, This is so great, I hope PAGIBIG service will follow your footsteps in serving their people. Anyways, I will continue with my contributions starting this month and again thank you very much for your immediate assistance on this matter  Cheeers!
  • 14. Bawat Pilipino, Miyembro  Bringing information closer to members and Empowering members
  • 15. Bawat Pilipino, Miyembro  Bringing information closer to members and Empowering members
  • 16. Bawat Pilipino, Miyembro  Bringing information closer to Members and Empowering members PhilHealth SHInES at House of Representatives PhilHealth Launched SHInES in Iloilo City
  • 17. Bawat Pilipino, Miyembro  Bringing information closer to Members, Empowering them PhilHealth Expo Launches the "Be PhilHealth Now" Campaign
  • 18. Bawat Pilipino, Miyembro  Bringing information closer to Members and Empowering Members PhilHeath's e-Innovations for Health Launched Enables individuals to register online Enables employers to post payments of their employees on real time Registration, billing and query of Organized Groups Electronic Payment Facilities Remittance-By-Air thru text
  • 19. Bawat Pilipino, Miyembro PhilHeath's e-Innovations for Health Launched Facility for viewing the locations of health facilities and visualization of various corporate data using maps Facility for checking membership status of Sponsored Members under the NHTS-PR during benefits availment Facility for checking eligibility of membership and filing of claims by HCPs  Bringing information closer to Members and Empowering Members
  • 20. Bawat Pilipino, Miyembro PhilHeath’s presence and visibility in various fora, conventions, special events and similar activities  Bringing information closer to Members and empowering Members 2012 Kabisig National Government Expo 2nd Philippine Print Media Congress Umagang Kay Ganda Kapamilya Services DZMM’s "Takbo para sa Karunungan" Region 6 Inter Agency Tournament Iloilo Charter Day
  • 21. PhilHealth’s Deliverable to the Society: Financial Risk Protection  Every Filipino can get financial assistance, have access to excellent providers where health care is paid for, use the assistance when needed, and receive significant support • Bawat Miyembro, Protektado
  • 22. Bawat Miyembro, Protektado  To have the opportunity to get financial assistance whenever it might be needed ANG PREMIUM AY ABOT KAYA!!! Sa halagang P3.33 /day or P100.00/month o depende sa buwanang kita para sa mga empleyado at professionals
  • 23. Bawat Miyembro, Protektado  To have accessibility to health professionals and facilities where quality health care is paid for;
  • 24. Bawat Miyembro, Protektado  To actually use the assistance when needed when doing so, to receive a significant amount of support 54% 13% 13% 9% 11% Outof Pocket National Local SocialHealth Insurance Others
  • 26. BENEPISYO sa PHILHEALTH Hospital In-Patient Care Out-Patient Care Health Center
  • 27. Bawat Miyembro, Protektado  Assistance to members at the point of service
  • 28. Bawat Miyembro, Protektado PhilHeath's e-Innovations for Health Launched Facility for viewing the locations of health facilities and visualization of various corporate data using maps Facility for checking membership status of Sponsored Members under the NHTS-PR during benefits availment Facility for checking eligibility of membership and filing of claims by HCPs  Easy access to members and stakeholders in benefit availment
  • 29. Kalusugan Natin, Segurado  No Filipino will ever be financially afraid of getting sick, and that no one will left behind in the race toward universal health care and financial risk protection  PhilHealth needs to and will leverage its purchasing power to help break the silos and foster increased collaboration  Adress inequities in Health
  • 30. Kalusugan Natin, Segurado  How to use PhilHealth’s purchasing power?  Use Performance Commitment Contracts to ensure that health facilities are safe and high quality;  Provide incentives to ensure that health human resource is adequate in number, purposely distributed and properly compensated
  • 31. Kalusugan Natin, Segurado  How to use its purchasing power?  Negotiate for lower costs and charges of health care goods and services
  • 32. Kalusugan Natin, Segurado  PhilHealth want to change HOW health care services are rendered by providers with care and received by members with pride  Case payment for all diseases – provides clear, explicit and predictable financial support; Case Rates - Since September 1, 2011, there were 11 medical cases and 12 surgical procedures being paid through case rate
  • 33. Kalusugan Natin, Segurado “…Ito po ang proseso ng pagpapagamot para sa kanila: Papasok ka sa alinmang ospital ng gobyerno. Ipapakita mo ang iyong PhilHealth card. Magpapagamot ka. At uuwi kang maginhawa nang walang inilabas ni isang kusing…”  No Balance Billing Policy (SAPAT NA ANG BAYAD NG PHILHEALTH)
  • 34.
  • 35. Thank You! Panatag ang Loob at Masayang Pamilya Kapag Naka PhilHealth

Editor's Notes

  1. Protection from financial impacts of health care use by improving benefit delivery ratio of the NHIP Upgrading of government-owned and operated hospitals and health facilities.
  2. Improving health is central to the Millennium Development Goals (MDG)
  3. The new corporate website, www.philhealth.gov.ph , which promises to be more user-friendly but is still packed with the necessary information on the National Health Insurance Program that a PhilHealth stakeholder needs. The new website opens to three major sections, namely, MEMBERS, CORPORATE PARTNERS and ONLINE SERVICES. The MEMBERS section leads site visitors to the five (5) member-categories, while the CORPORATE PARTNERS section leads to our accredited facilities, health care professionals, collecting agents, as well as to private partners. Finally, the ONLINE SERVICES features several electronic facilities that include the eRegistration, eClaims, and PhilGIS.
  4. Pending the complete payment mechanism of case payment for all types of illness, Philhealth will still continue the fee for service payment. Fee for service reimbursements is the kind of health insurance policy wherein payment to health care providers is made at the time of service. The benefits are subject to some limits which differ based on the level of the health care facility (Level 1, 2, 3, 4) and the severity of the cause of admission (Case type A, B, C, D)