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Module 5 Session 1 National Health Insurance Program (PDF/990KB)

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Module 5 Session 1 National Health Insurance Program (PDF/990KB) Outline • Objectives of the Session • Definition of NHIP • Guiding Principles of NHIP • Importance of NHIP • Partnership as Source of Funds • Inter-LGU Collaboration and Partnership in achieving Universal Coverage • Benefits of NHIP • The Gains and Benefits on adopting the NHIP: The Benguet Experience SessionModule5, 1 1 2 1 OBJECTIVES OF THE SESSION through its integration in their plans and budget. • Understand the significance of the • Learn from the experiences of other NHIP in the region. ILHZs. • Understand and familiarize themselves • Appreciate the results brought about on the important role of the ILHZ in the by the collaboration between PhilHealth coverage of the people. PhilHealth and the ILHZs. • Ensure sustainability of the PhilHealth coverage of their constituents. • Take an active role in the implementation of the PhilHealth programs in their respective areas 3 4 What is NHIP? “AN OVERVIEW OF THE The country’s largest social NATIONAL HEALTH health insurance that…. aims for universal coverage INSURANCE PROGRAM (NHIP)” ensures comprehensive and responsive medical care benefits for program members and beneficiaries Module 5, SessionModule5, 1 5 6 2 GUIDING PRINCIPLES OF THE NHIP • Equity • Devolution • Allocation of National Resources for Health • Fiduciary Responsibility • Universality • Informed Choice • Compulsary Coverage • Maximum Community Participation • Professional Responsibility of Health • Cost – Sharing Care Providers • Quality of Services • Public Health Services • Responsiveness • Care for the Indigent • Innovation • Social Solidarity • Cost Containment • Effectiveness 7 8 IMPORTANCE OF THE NHIP (IN • Provides a challenge to health care providers to improve their skills and CAR) facilities • Provides a venue for LGUs to provide • Provides an opportunity for social insurance coverage to the collaboration and cooperation between people and among agencies • Gives an opportunity for people’s organization (cooperatives, farmers • Provides a chance for the government and women’s groups, etc.) to expand and private sectors not only to forge their services to other ventures new partnerships but also to renew • Provides an opportunity to big-hearted and strengthen existing ones individuals to share their blessings by • Provides additional source of funds for enrolling the less fortunate and health and health – related programs economically challenged members of and activities of the LGUs the community to PhilHealth SessionModule5, 1 9 10 3 SP PARTNERSHIPS (as source of funds) Social Solidarity thru PhilHeath Pooling of funds 1.CONGRESSIONAL/ PROVINCIAL 2. PROVINCIAL/ • The rich subsidizes the poor MUNICIPAL • The healthy subsidizes the sick 3. MUNICIPAL/ • The young subsidizes the old BARANGAY • The employed subsidizes the unemployed 11 12 INTER-LGU COLLABORATION AND PARTNERSHIP IN ACHIEVING UNIVERSAL OTHER SPONSORS COVERAGE • MUNICIPALITIES • 50% - 50% SHARING SCHEME BETWEEN THE PROVINCE AND ITS • BARANGAYS COMPONENT MUNICIPALITIES • ILHZ • 50% - 50% SHARING SCHEME • PEOPLE’S BETWEEN THE OFFICE OF THE ORGANIZATIONS CONGRESSMAN AND THE PROVINCIAL GOVERNMENT • PRIVATE INDIVIDUALS • KABAYAN MUNICIPALITY ALLOCATING P10,000.00/BRGY FOR THEIR SPONSORSHIP Module 5, SessionModule5, 1 13 14 4 BENEFITS FROM PHILHEALTH (PROJECTED PCB FOR 2012) PROVINCE # OF PCB1 PFPR AMOUNT ENROLLEES THE ABRA 29,579 500/FAMILY P14,789,500 BENGUET EXPERIENCE APAYAO 16,581 500/FAMILY 8,290,500.00 15 16 THE SPONSORED PROGRAM IN THE PROVINCE Module 5, SessionModule5, 1 17 18 5 SPONSORED PROGRAM ENROLLMENT SP ENROLLMENT PER ILHZ (JULY, 2011) AS OF DECEMBER, 2011 14,000 12,796 13,270 12,000 14,000 12,895 10,000 12,000 7,955 8,000 10,000 8,000 6,692 6,000 4,606 6,421 4,478 6,000 4,000 3,247 4,000 2,000 1,864 1,735 101 2,000 - 0 19 20 STATUS OF SP ENROLLMENT IN CAR SP ENROLLMENT PER ILHZ (AS OF MAY 31, 2012) AS OF MAY, 2012 35,000 31,288 29,579 31,062 30,000 12,000 10,022 25,000 10,000 20,000 16,581 16,538 17,755 7,639 8,000 15,000 5,890 10,000 6,000 4,791 4,563 5,000 4,000 0 2,000 ABRA 0 SessionModule5, 1 APAYAO IFUGAO BKD BLISSTT 3K MT. TRAIL BGO CITYBENGUET KALINGAMT. PROV 21 22 6 STATUS OF MEMBERSHIP REGISTRATION IN STATUS OF MEMBERSHIP REGISTRATION IN APAYAO (AS OF MAY 31, 2012) ABRA (AS OF MAY 31, 2012) 18,000 30,000 29,579 16,581 16,000 14,000 25,000 12,000 20,000 10,000 8,000 15,000 6,000 10,250 10,000 8,432 8,905 4,000 3,910 7,793 2,967 2,733 2,000 1,786 5,000 286 0 1,795 GOVT PRIV OFW IPP LIFETIME SPONSORED 0 GOVT PRIV OFW IPP LIFETIME SPONSORED 23 24 3K ILHZ BENEFIT AVAILMENT FOR 2010-2011 NO. OF PREMIUM PAID NO. OF AMOUNT BENEFIT ENROLLEES CLAIMS PAID AVAILMENT KAPANGAN-71 P12,240.00 17 P70,403.14 (2011) KIBUNGAN-30 Module 5, SessionModule5, 1 25 26 7 PROVINCIAL/MUNICIPAL SP ILHZ PREMIUM PAID NO. OF NO. OF BENEFIT AMOUNT ENROLLEES CLAIMS BKD 368,775.00 3,005 475 2,715,748.53 BLIISTT 1,019,117.50 4,820 731 6,471,804.81 MATERNITY 3K 562,117.50 2,827 689 4,570,407.12 MT. TRAIL 790,275.00 3,273 896 5,936,648.76 CARE PACKAGE 2,741,017.50 13,925 2,791 19,694,609.22 PROVL SHARE 3,242,910.00 5,983,927.50 TOTAL 27 28 MT. TRAIL ILHZ MUN 2007 2008 2009 2010 2011 TOTAL ATOK BAKUN 3,650.00 19,500.00 23,150.00 TBDOTS PACKAGE BUGUIAS 136,590.00 18,850.00 22,750.00 178,190.00 MANKAYAN 9,000.00 54,850.00 233,650.00 855,350.00 1,152,850.00 TOTAL 1,354,190.00 Module 5, SessionModule5, 1 29 30 8 BKD ILHZ 3K ILHZ MUN 2007 2008 2009 2010 2011 TOTAL MUNICIPALITY 2008 TOTAL BOKOD 2,500.00 4,000.00 6,500.00 KAPANGAN KABAYAN 2,500.00 2,500.00 5,000.00 KIBUNGAN 4,500.00 4,500.00 TOTAL 2,500.00 2,500.00 4,000.00 11,500.00 TOTAL 4,500.00 31 32 MT. TRAIL ILHZ BLIISTT LIHZ MUN 2006 2007 2008 2009 2010 2011 TOTAL MUN 2009 2010 2011 TOTAL ATOK ITOGON BAKUN LA TRIN. BUGUIAS 136,590.00 18,850.00 22,750.00 178,190.00 SABLAN 2,500.00 8,000.00 9,000.00 19,500.00 MANKAYAN 2,500.00 8,000.00 34,500.00 9,000.00 18,500.00 72,500.00 TUBA TOTAL 250,690.00 TUBLAY TOTAL 19,500.00 Module 5, SessionModule5, 1 33 34 9 ANNUAL PCF RELEASES PER MUNICIPALITY MUNICIPALITY 2006 2007 2008 2009 2010 2011 ATOK 130,304.00 431,373.81 218,836.75 329,625.00 458,625.00 437,932.54 BAKUN 130,551.24 149,878.02 177,501.10 71,179.94 206,402.47 101,442.86 BOKOD - 64,392.95 218,434.42 - 352,118.73 434,370.33 BUGUIAS 973,311.26 858,726.92 497,630.71 104,325.00 487,875.00 489,104.21 ALL RHUs IN BENGUET ARE ITOGON 21,586.14 12,225.00 119,002.99 115,732.08 282,557.61 63,055.44 KABAYAN 25,597.83 149,222.28 511,312.09 424,726.65 453,862.50 261,862.50 TBDOTS ACCREDITED FOR KAPANGAN - 15,458.98 166,644.23 54,893.41 288,125.32 209,437.12 2011 KIBUNGAN 165,476.37 379,654.17 469,405.21 82,126.96 995,601.96 402,285.42 LA TRINIDAD 136,638.59 146,993.33 237,531.60 117,450.00 642,043.26 162,621.58 MANKAYAN 592,407.70 294,969.23 203,546.71 89,625.00 405,983.33 333,809.17 SABLAN 28,416.66 30,000.00 30,000.00 44,228.01 194,400.00 223,374.46 TUBA 45,600.00 45,600.00 91,200.00 - 269,475.00 29,299.73 TUBLAY 9,956.04 4,500.00 500,325.00 265,650.00 405,088.04 538,048.33 TOTAL 2,259,845.83 2,582,994.69 3,441,370.81 1,699,332.97 5,442,158.04 3,686,643.69 35 36 IN-PATIENT BENEFITS PAID TO HOSPITALS IN-PATIENT BENEFITS PAID TO HOSPITALS (2006-2011) (2006-2011) LGU OWNED HOSPITALS PRIVATE HOSPITALS ABATAN EMERGENCY HOSPITAL 12,287,812.02 LEPANTO CONSOLIDATED MINING 32,542,774.62 CORPORATION HOSPITAL ATOK DISTRICT HOSPITAL 10,994,804.05 LUTHERAN MEDICAL MISSION 38,557,739.64 AND REHABILITATION BENGUET GENERAL HOSPITAL 196,983,017.98 FOUNDATION, INC. DENNIS MOLINTAS MEMORIAL 4,024,654.55 STO. NINO HOSPITAL OF PHILEX 6,043,389.67 HOSPITAL MINING CORPORATION ITOGON MUNICIPAL HOSPITAL 1,163,803.30 TOTAL 77,143,903.93 KAPANGAN MEDICARE 4,612,644.19 COMMUNITY HOSPITAL TOTAL 230,066,741.09 Module 5, SessionModule5, 1 37 38 10 PCF UTILIZATION BY THE PROGRAMS/ACTIVITIES INITIATED BY LGUs THE ILHZs IN SUPPORT TO PHILHEALTH • REPAIR OF RHUs • 3K ILHZ enrolled 101 families under • PURCHASE OF DRUGS and the Sponsored Program MEDICINES • Integration of the Sponsored Program • CAPABILITY TRAININGS to their plans and budget (CHTF) • PURCHASE OF EQUIPMENT AND • The conduct of a health summit where OFFICE SUPPLIES FOR RHUs PhilHealth was invited to give an orientation on the NHIP 39 40 • BLIISTT ILHZ forwarded a resolution • Encouragement of the owners of small to the office of Congressman Cosalan businesses to enroll as Individually for the renewal of the Paying Program (IPM) members Congressional/Provincial sponsorship • Allocation of funds to aide the • LCES and Barangay Officials actively indigent families in the payment of participate in the conduct of IECs their hospital bills • Crafting of a resolution requesting the MLGUs to require business owners to • Sharing of manpower and facilities to enroll their employees to PhilHealth as fast track PhilHealth acrreditation part of the issuance and renewal of their business permits Module 5, SessionModule5, 1 41 42 11 DOs OF THE SPONSORED PROGRAM IMPLEMENTATION MOA SIGNING • Intensive orientation on the NHIP FOR THE (Mobilize and strengthen the community) SPONSORED PROGRAM FOR • Active support of the LGUs • Preparation and submission of reports 2012 – 2013 required by PhilHealth • Timely payment of premiums (LOCK-IN) • Increase enrolment • Accreditation of health care providers (both personnel and facility) 43 44 MOA SIGNING WITH THE PROVINCIAL GOVT AND ITS COMPONENT SessionModule5, 1 MUNICIPALITIES MOA SIGNING WITH VARIOUS PARTNERS 45 46 12 THE MUNICIPALITY OF BUGUIAS AND ITS BARANGAYS 47 48 COMMUNITY ORGANIZING TRAINING FOR MUNICIPAL SessionModule5, 1 AND BARANGAY OFFICIALS, MSWDO STAFF AND BHWs 49 50 13 NARAGSAK NGA ALDAW TAYO AMIN 51 .
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