This project intended to increase compliance among providers on the enlistment and profiling of eligible PhilHealth members and their dependents to improve the latter’s availment of the TSeKaP package with the end goal of improving health outcomes.
Background and Problem
It is the mandate of PhilHealth to provide comprehensive health care services to all Filipinos through a socialized health insurance program as declared in the National Health Insurance Act of 2013. In pursuit of this mission, PhilHealth has embarked on improving its benefits, particularly the expansion of its primary care services. However, reports revealed that there has been low availment rate of the TSeKaP package in Region 1 resulting from the low enlistment and profiling of beneficiaries. It is very vital to address this gap because solving this problem will greatly contribute to the early detection and treatment of illness at the primary care level and the prevention of disease complications. Significantly improving the rate of availment of TSeKaP will lead to strong primary health care, fewer hospitalizations, fewer cost for PhilHealth and the government as a whole, and improved health outcomes for Region 1.
Solution and Impact
In response to the said gap, the project implemented four identified interventions, namely: (1) furnished complete and updated master list of PhilHealth members and dependents to TSeKaP providers to facilitate proper enlistment and profiling and correct processing of Per Family Payment or PFP; (2) strengthened coordination with and monitoring of providers on reporting and TSeKaP implementation; (3) improved awareness of the PhilHealth members and their dependents of their TSeKaP benefits; and (4) recommended policy to PhilHealth Central Office on the proper implementation of PhilHealth’s TSeKaP program and the proper utilization of PFP.
In general, the project is considered successfully implemented in the sense that all the activities and outputs committed were accomplished and most were delivered on time with few modifications in parameters and period of accomplishment. Additionally, new outputs were delivered which have enriched further the implementation of the project.
The intervention strategies delivered thirteen outputs, nine of which were committed in the Action Plan, while four of them were additional outputs. The outputs delivered are as follows:
- TSeKaP providers given complete and updated master list of PhilHealth members and dependents;
- Monitoring template and pro-forma letter to non-complying providers presented to Local Health Insurance Office TSeKaP point persons as guide;
- Disbursed unpaid PFP for 3rd to 4th quarter 2012 and CY 2013;
- Conducted reorientation of accredited health providers on TSeKaP;
- Established regular radio program to promote TSeKaP and other PhilHealth benefits;
- Produced and distributed flyers and tarpaulins regarding TSeKaP to providers;
- Launched TSeKaP package;
- Trained Department of Health nurses under the Nurse Deployment Project (NDP) 2014 on TSeKaP package and other programs as PhilHealth advocates;
- Recommended policy to PhilHealth Central Office on the proper implementation of PhilHealth’s TSeKaP and proper utilization of PFP;
- Collaborated with the Philippine Information Agency (PIA) Regional Office 1 to promote TSeKaP and other PhilHealth benefits;
- Conducted TSeKaP providers’ meeting in La Union to provide updates and reminders, distribute PFP checks, and review TSeKaP implementation;
- Achieved additional media mileage through sponsorship with DZWN Bombo Radyo to further intensify awareness of PhilHealth beneficiaries on TSeKaP; and
- Adopted the PFP System created by PhilHealth Regional Office 1 IT team.
To sustain the deliverables of the project, some activities were recommended for further action and study. These are:
- Evaluation of the project implementation in La Union;
- Motivation of providers to properly implement TSeKaP by giving awards;
- Institutionalization of the conduct of quarterly “TSeKaP Providers’ Meeting”; and
- Replication of the project implementation in other provinces in Region 1.
Note: This initiative is based on the Public Management Development Program (PMDP) Re-Entry Plan of Ms. Maricar M. Arzadon of the PMDP Middle Manager Class Batch 3 (Bulawan).