The project aimed to (1) establish a mainstreamed referral and communication system; (2) increase membership coverage of qualified poor families; and (3) increase utilization of PhilHealth benefits right at the point of care. This shows that the project shall not only involve information dissemination and validation, but more importantly an increase in PhilHealth membership coverage, and benefits utilization for the poor members at the hospital level. The project is also cost-efficient because of the regular schedule of the PhilHealth personnel to the LGU-owned Hospital. Thus, the indigent patient (non-member) would not incur any cost to travel to the Local Health Insurance Offices (LHIO). Likewise, it is a synergistic approach of the Filipino friendly collaterals and the revitalized PhilHealth MOVES (Mobile Orientation Validation and Enrollment Scheme).
Background and Problem
The PhilHealth is mandated to cover all Filipinos with health care insurance that shall improve their health and social conditions through Financial Risk Protection. In line with the President’s Social Contract of Poverty Reduction, the challenge of PhilHealth is in the membership coverage and benefits availment of the marginalized sector. Typically, an indigent family that is oftentimes burdened by sickness is much more troubled when hospitalized without PhilHealth.
Solution and Impact
Basically, the existing Point of Care for DOH licensed hospitals depend on hospital sponsorship in which the Strengthened Point of Care (SPOC) expands by means of seeking assistance from Local Government Units (LGUs). Thus, SPOC safeguards the rights of poor families at the hospital level. For instance, once an indigent patient is identified and certified (by a medical social worker) to be under the classification of C-3 and D, then the indigent patient will automatically become a PhilHealth member and will be entitled to all forms of PhilHealth benefits.
Likewise, SPOC implements a No-Balance Billing Policy. This means that there shall be no out of pocket expenses from a PhilHealth indigent member once he/she or his/her dependents get confined. Hence, it translates to an improved social condition for the poor sector that becomes enrolled at SPOC. Furthermore, this complements the Social Contract on Poverty Reduction through Universal Health Care (UHC). In conclusion, SPOC contributes to LGUs and their LGU-owned hospitals as both forms of health and return on investments. In other words, instead of a mere dole-out per confinement, LGUs are assured that PhilHealth will pay the claims of SPOC at a reduced turnaround time and at a lesser cost for them.
SPOC has been piloted at the Caloocan City Medical Center or the CCMC (formerly Pre. Diosdado Macapagal Memorial Medical Center). The City Government of Caloocan was very willing to participate as shown by the letter of intents submitted by the city mayor and the CCMC hospital administrator. In due course, SPOC process flow was presented to showcase a mechanism that disclosed the requirements and responsibilities of PhilHealth, Caloocan City, and the CCMC. At present, SPOC Manual of Procedures is still a work in progress. Upon consolidation of significant reports, the project’s Post – Implementation involves a supplemental guide for SPOC in coordination with the IT and Member Management Group of PhilHealth Central Office. In the long run, further enhancements in the system in terms of automation and policy guides on the replication of the SPOC across all LGU-Owned Hospitals are expected.
Note: This initiative is based on the Public Management Development Program (PMDP) Re-Entry Plan of Mr. Jerico C. Pascual of the PMDP Middle Manager Class Batch 3 (Bulawan).