- Even without updated list from DSWD (NHTS) the agency gives a certificate of eligibility for indigents so they can enjoy benefits. - For women about to give birth, if they can pay contributions but are not enrolled, they will be asked to pay 1-year premium. If they are not financially capable, they will be enrolled as NHTS member. - “The Universal Health Care Law is a gift to the Filipino people, because it ensures that everyone will be covered under the National Health Insurance Program.” The question will no longer be IF you can avail of the service, but only what type of membership. - Since the UHCL is law, it has more teeth to go after those who would abuse the system, be it the health care provider or even PhilHealth staff. Ensuring that the program will remain fair and equitable, and the providers well-behaved. - To provide better preventive care under the UHCL, PhilHealth will accredit outpatient units of private hospitals. This is in connection with the creation of a Service Delivery Network. - Advocating for hospitals/service providers to do more quality service and go the extra mile for beneficiaries and patients. They made a “benchbook” which assures quality of service thru performance indicators from the book. Both private and public hospitals argued that this is an added layer of standards testing together with the DOH accreditation, so PhilHealth said that they will accredit partners with DOH accreditation. DOH eventually integrated some of the benchbook standards in their monitoring checklist. PhilHealth still does monitoring along with deploying their P-Cares staff to selected hospitals. - Several public/partner consultations including the Alaga Ka Forum, which is meant especially for indigent members, Health Care Providers Forum, PhilHealth Forward which gathers all relevant stakeholders including private hospitals and local executives to discuss programs and initiatives and ways forward with the agency. - They give awards for service providers who have done best practices and gave quality service. They also give recognition to exemplary staff thru the PHRASE Program. 3. Key performance indicators for the agency - Collection of contributions/premiums from all sources (Collection Efficiency Rate) - Turnaround time for payment of claims, Satisfaction rate, 4. The challenges that the agency face in the realization of its mandates - Fraud still happens, (Fraud among hospitals and other service providers) and there are a lot of overlap payments. There are also problems within the organization that hinders the realization of the agency’s mandates. - Some higher care (level 3) hospitals still serve very basic or lower level of care ailments. This is a problem because they often occupy resources meant for complicated cases. - Lack of doctors, and service providers in GIDA. - There is a lack of adequate number of staff due to the very large area of coverage in the region. PhilHealth will cover all Filipinos, so it is basically the biggest social protection provider/national government agency in the country. - The list coming from DSWD for NHTS contains lots of errors and it entails more work to “clean” it. 5. Upcoming plans/initiatives with respect to policy/program development - Focus on coverage for the remaining 2% which are still not enrolled in PhilHealth. - Thru the UHCL, fast track the creation of the restructured organization in because that will define how many people are needed to provide the service. 65