The Insurance Commission (IC) is now conducting a comprehensive study of the health-insurance industry as part of preparations for the enactment of a law that will regulate the operations of health-maintenance organizations (HMOs) in the country.
“We are now doing our own study on health insurance. It seems that the IC never collected any data on health insurance, so we have no ready data on health insurance. Our study is still ongoing,” Insurance Commissioner Dennis B. Funa told the BusinessMirror.
He said the comprehensive study on health insurance will enable the IC to fully comprehend how health insurance works in the country, as well as which sectors are still not covered by some form of health-care service.
The result would be a comprehensive database for the agency that will serve as basis for future reforms on health insurance.
Funa earlier said he is pushing for a new law to further regulate HMOs operating in the country, with the proposal including regulations on capitalization and how to settle disputes among stakeholders of the organization, among others.
In 2015 the Aquino administration issued Executive Order (EO) 192, which transferred the jurisdiction of the HMO industry from the Department of Health (DOH) to the IC. The commission now supervises the establishment, operations and financial activities of the industry players.
Funa said an HMO law will enable the IC to address issues, such as the level of capitalization that will be required from HMOs, how to settle disputes between the company and its members if any, and how to eliminate overlapping policies governing HMOs.
The IC had also approved the acquisition by Fullerton Health Philippines Pte. Ltd., (Fullerton Health) of two
licensed HMOs in the country recently—Asalus Corp. and Avega Managed Care Inc.—in a bid to further enhance the managed health-care services in the Philippines. In a statement issued by Fullerton Health Cofounder and Group CEO Dr. Michael Tan Kim Song, he explained that the Philippines offers growth potential to the company, and will enable it to provide more services and benefits to more patients.
Health Secretary Francisco T. Duque III said around 92 percent of the Philippine population is already covered by public health insurance through Philippine Health Insurance Corp. (PhilHealth), and their goal is to cover all Filipinos. “Certainly, almost all Filipinos have PhilHealth insurance. Our coverage is about 92 percent of our population as of end-2017,” Duque told the BusinessMirror.
The health-care system in the Philippines is serviced by both private and public medical systems, with the public health insurance provided by PhilHealth, while HMOs and life insurance companies offer private health insurance, among others.
Based on the 2016 annual report of PhilHealth, the agency was able to cover 91 percent of the population for the year, which translated to around 93.4 million Filipinos enrolled in its National Health Insurance Program.
The PhilHealth also reported that the agency paid P101.7 billion for the social health insurance benefits of its members, which expanded by 2.7 percent compared to the P99 billion it recorded for 2015. The growth of its benefit payouts was attributed to the continuous enhancement of the agency’s benefits.
It also reported that by the end of 2016, PhilHealth had accredited 100 percent of the hospitals licensed by the
Department of Health. Of the 1,895 institutional health-care providers, 1,137 are private establishments, while government facilities comprised 758 of the total.
Last year Duque pointed out that he wanted to achieve universal healthcare for all Filipinos by 2030. During the State of the Nation Adress of President Duterte in 2016, he had promised to provide health-insurance coverage to all Filipinos under his term.
But Maxicare President and CEO Christian S. Argos said PhilHealth coverage is not enough, as it does not cover outpatient health care.
“PhilHealth coverage is not enough if you choose to get confined in most hospitals. PhilHealth also doesn’t cover outpatient care. HMOs and medical insurance [providers] supplement PhilHealth to cover a bigger share and more medical care,” Argos told the BusinessMirror via SMS.