A Critical Checkpoint in Universal Health Care

A representative of Caloocan City Medical Center presents their admission statistics.

The Philippine Health Insurance Corporation (PhilHealth) was established to ensure that all Filipinos have comprehensive health insurance coverage should they need medical attention for what ails them, an article of faith that PhilHealth lives by in its everyday existence.

Recently, a joint Assessment and Evaluation of the Point of CARE (POC) Enrollment Program was undertaken by PhilHealth and the Department of Health (DoH) to gauge the health agencies’ efforts to bridge the gap in providing all citizens of the country with financial risk protection from medical confinements and surgical procedures. The assessment put importance on non-PhilHealth members who belong to socioeconomic classes C-3 and D. The activity was overseen by the PhilHealth Member Management Group led by its Vice President, Alberto C. Manduriao.

Present during the said workshop were PhilHealth Executive Vice President and Chief Operating Officer Ramon F. Aristoza, Jr., DoH officials, hospital delegates, and PhilHealth employees directly associated with the implementation of POC.

Some of the hospitals represented were Caloocan City Medical Center; Philippine General Hospital; East Avenue Medical Center; Rizal Medical Center; Ospital ng Muntinlupa; Vicente Sotto Memorial Medical Center of Cebu; and Cabadbaran District Hospital of Agusan del Norte.

Presentations of hospitals implementing the POC gave participants a clear view on how POC supports PhilHealth’s thrust for universal health coverage, especially the segment of population perpetually challenged by financial predicaments. In addition, the activity was an opportunity for both partners; PhilHealth and hospital implementers, to raise their concerns and challenges and agree on solutions.

As of September 2015, the POC enrolment scheme is being implemented in 355 hospitals, compared to the previous year’s number of 263. In terms of benefits payment, PhilHealth paid P4,798,289,241.80 for 415,121 POC-enrolled members. The amount of premiums totalled to P976,476,700.

The participating agencies and facilities must carry this responsibility as a testament that our nation still holds on to the adage that no one should be left behind. The POC is a means to ensure the sick and the poor that we will not allow them to be left behind, as we march towards a tomorrow full of promises and realized dreams without being hindered by health quandaries.

POC is not, by a long shot, the final resolution in perfecting the NHIP, but it is a stop-gap solution to provide coverage for the poor/near poor not identified/included in the National Household Targeting System for Poverty Reduction (NHTS-PR). Still, it contributes to the grand blueprint which aims to build an immovable fortress that houses the creed by which the universal health care system of the nation is carried out.

PhilHealth and the DOH are continually ironing out every facet of POC, and with the valuable contributions of hospital partners, it is definitely possible to make POC an instrument that shields the poor from the struggles that medical conditions entail.

Indeed, POC is a critical checkpoint in the implementation of borderless health care in the country.