Preparing for Universal Health Care Law: PhilHealth gears up for improved health system

In anticipation of the imminent passage of the Universal Health Care (UHC) bill into law next month, the Philippine Health Insurance Corporation (PhilHealth) said that its 6,000-strong organization is ready to take on the challenges of a new era of improved health system.

PhilHealth acting chief Dr. Roy B. Ferrer said that the state agency has been gearing up in recent years even way before debates on the UHC have begun, citing various reforms in its membership enrolment, benefit program and provider payment system, among many others.

The PhilHealth chief narrated that in 2014, enrolment into the program was made easier and convenient by waiving the usual documentary requirements that hinder especially the marginalized to enlist as members and avail of social health insurance. The said policy in tandem with aggressive registration greatly helped in ensuring coverage for 100 million beneficiaries or a total of 94 percent population coverage.

It also enhanced and introduced new benefits in response to the varying needs of its members. Aside from packages for specific epidemics and those that help meet the country’s millennium development goals, it also introduced the Z Benefits for financially-draining catastrophic illnesses such as childhood leukemia; breast, colon and prostate cancers; kidney transplant; and heart surgeries, among many others. Recently it extended primary care coverage to additional 41 million beneficiaries from the formal economy and the elderly nationwide.

In 2015, the state health insurer shifted to case rates in paying its partner health care providers. Piloted in 2011, the new system made it easy for members to know their benefits at once. The case rates effectively cut claims processing by half to 31 days from the usual 60 days prescribed under the law.

Ferrer believed that all these together with the massive internal organizational reforms that they and even the past administrations in the state agency have initiated adequately prepared PhilHealth and its workforce for the looming UHC era.

He stressed that even the recent decisions by the Civil Service Commission (CSC) denying the appeal made by some of its middle managers against being reassigned manifested the Commission’s recognition that the move is above board and augurs well to efforts at further strengthening the PhilHeath organization from the senior management down to the rank and file.

The CSC recently dismissed the petition of at least three officers and affirmed that the Corporate Personnel Orders issued by the agency are in order, with one decision clearly indicating that the Order “was issued not in contravention of the applicable rules on reassignment.”.

The decision stemmed from the appeals filed by the concerned officers opposing Corporate Personnel Order Nos. 2018-0763 dated April 23, 2018 and 2018-1278 dated July 4, 2018 issued by then Interim President and CEO Dr. Celestina Ma. Jude P. dela Serna and PhilHealth Acting President and CEO Dr. Roy B. Ferrer, respectively.

The decision is final and executory but can still be appealed in applicable courts.

The state agency is expecting the CSC to release its decisions for the rest of the appeals filed by the middle managers, most of whom have been in their posts in the last 23 years and have resisted all attempts by PhilHealth’s past administrations to reassign them.

The PhillHealth chief asserted that the decision clearly recognizes the authority of its Board of Directors as delegated to the head of agency to rotate and reassign officers in order to provide fresh leadership opportunities, maximize the expertise its leadership bench and to avoid familiarity with stakeholders in the area that could lead to corruption.