CITIZENS REPORT CARD ON THE SPONSORED PROGRAM...

CITIZENS’ REPORT CARD ON THE SPONSORED PROGRAM OF THE

NATIONAL HEALTH INSURANCE PROGRAM (PHILIPPINES)

ACTION FOR ECONOMIC REFORMS

JUNE 2014

A PROJECT SUPPORTED BY US-AID IN COOPERATION WITH RESULTS FOR

DEVELOPMENT (R4D) AND THE Bandung Institute of Governance Studies (BIGS)

About AER Action for Economic Reforms (AER) is a public interest organization that conducts policy analysis and advocacy on key economic issues. Its mission is to put in place a favourable economic environment conducive to equity, democratization, and sustainability, promote policy alternatives, and build capacity of civil society to intervene in economic policy issues. Founded in 1996, AER seeks to address a major weakness of the Philippine civil society movement – limited technical understanding of economic issues, including fiscal policy.AER has made fiscal reforms and transparency part of its core program. It is the main civil society organization that partners with government in the advocacy for the reform of the sin taxes towards meeting health and revenue objectives and the passage of a law on the citizens’ right to public information (Freedom of Information). Similarly, it plays a lead role in the Alternative Budget Initiative, towards making the budget sensitive to equity and poverty-reduction goals.

About the Project This study is part of a three-year project of Action for Economic Reforms (AER) on Allocating and Tracking Sin Tax Revenues for Universal Health Coverage undertaken in cooperation with Results for Development Institute (R4D) and the Bandung Institute of Governance Studies (BIGS). The Project aims to monitor the utilization of the incremental revenues generated from the newly legislated law on the Sin Taxes; assess the effectiveness of the expanded program for universal health care in addressing the healthcare needs especially of poor Filipino families; and ensure effective, feasible and socially desirable funding mechanism and program for universal healthcare targeting especially the poorest families. As part of this project, appropriate instruments will be developed for tracking utilization of funds allocated in accordance with the General Appropriations Act. It will recommend specific measures to ensure transparency and effectiveness of the health protection and insurance for the poor. This scheme to finance universal health care out of the revenues generated from the new Sin Tax Law is justified given the current underinvestment in health. This supports the Health Agenda of the present Aquino administration towards ensuring the achievement Universal Health Care through better health outcomes, sustained health financing and responsive health system focusing especially on the poor and disadvantaged groups. The health reform currently being implemented by the current administration shall: 1) strengthen the National Health Insurance Program (NHIP) to enhance financial risk protection especially among the poor; 2) improved access to quality hospitals and health care facilities, and; 3) attaining health-related MDGs, focusing on reducing maternal and child mortality, morbidity and mortality from TB and malaria, and the prevalence of HIV/AIDS, in addition to being prepared for emerging disease trends, and prevention and control of non-communicable diseases. Three major research and advocacy initiatives are included in this project: the Public Expenditure Tracking Survey; the Citizens Report Card; and the Social Audit. These studies and advocacy initiatives are designed to ensure the transparency, feasibility, effectiveness and social desirability of the expanded coverage of the Philhealth program.

Table of Contents

Frontmatter ……..………………………………………. About AER About the Project Acronyms

2

Introduction and Study Objectives ………….…

5

Study Methodology ….…………………………….…

11

CRC Survey Results ……………………………….……

14

Summary of Findings and Analysis ……………..

27

Recommendations ……………………………………

30

References …………………………………………….….

33

Annex A – Survey Instrument …………………….

36

Acronyms AER Action for Economic Reforms

AHA Aquino Health Agenda

COA Commission on Audit

CRC Citizens’ Report Card

DBM Department of Budget and Management

DOF Department of Finance

DOH Department of Health

DSWD Department of Social Welfare and Development

FY Fiscal Year

GAA General Appropriations Act

HCP Health Care Provider

HSRA Health Sector Reform Agenda

IRR Implementing Rules and Regulations

LGU Local Government Unit

LHIO Local Health Insurance Office

MCP Maternity Care Package

MDGs Millennium Development Goals

MDR Membership Data Record

NBB No Balance Billing

NDHS National Demographic and Health Survey

NHIC National Health Insurance Corporation

NHIP National Health Insurance Program

NHTS-PR National Household Targeting System for Poverty Reduction

NSCB National Statistical Coordination Board

PCB Primary Care Benefit

PRO Philhealth Regional Office

RA Republic Act

RHU Rural Health Unit

SP Sponsored Program

TB Tuberculosis

Introduction The Philippines continues to face serious challenges in improving the health situation of Filipinos, particularly the poorest among them. As of 2011, the prevalence of underweight children under 5 years of age stood at 20.2%, while under-five and infant mortality rates were recorded at 30 and 22 deaths per 1,000 live births, respectively. Maternal mortality remains high at 95-163 deaths per 100,000 (2010) while deaths associated with tuberculosis stood at 27.6 deaths per 100,000 population (2009). The latest Philippine MDG assessment noted that the country will likely miss the MDG health targets on hunger and nutrition, maternal mortality and infectious diseases, particularly tuberculosis. (NSCB, 2013) Poverty remains pervasive especially in rural communities and urban slums with consequent impact on the health situation of the poor. As of 2012, 25.2% of Filipinos were living below the poverty threshold of P52 per day or about US$1.25/day (NSCB, 2013). New vulnerabilities in health emerged as a result of series of disasters that badly hit most areas of the country in recent years. Inequities in health access and outcomes persist and are most apparent by economic status, educational level and geographical location. The latest National Demographic and Health Survey (NDHS, 2008) shows that under-five mortality rates are significantly higher in rural areas (nearly twice compared to urban areas) and among the poorest income quintile (more than 3 times compared to the richest quintile). The incidence of death of children whose mothers have no education is more than 7 times compared to those whose mothers have attended college. Similarly, the risks associated with pregnancy and childbirth are much higher among poor women. The poorest 20% are six times more likely to deliver at home and are 14 times more likely to be attended by traditional birth attendants compared to the richest 20%. The Nationwide Tuberculosis Prevalence Survey (TFDI, 2007) also noted that the lowest income groups are 1.4 times more likely to be positive for tuberculosis compared to the highest income groups. By geographical location, richer regions of the country such as the National Capital Region and the nearby regions of Central Luzon and Calabarzon have the highest number and most advanced health facilities. In comparison, the poorer regions, specifically Muslim Mindanao and Eastern Visayas, have far lesser health facilities and with fewer available health services. It is against this backdrop that the current administration of President Aquino responded to the challenge by formulating and implementing its agenda for the health sector. The (President) Aquino Health Agenda (AHA) is directed towards ensuring the achievement of Universal Health Care through better health outcomes, sustained health financing and responsive health system focusing especially on the poor and disadvantaged groups. It builds on the previous health reform strategies Health Sector Reform Agenda (HSRA) in 1999, and FOURmula One (F1) for Health in 2005. The health reform currently being implemented by the current administration shall: 1) strengthen the National Health Insurance Program (NHIP) to enhance financial risk protection especially among the poor; 2) improved access to quality hospitals and health care facilities, and; 3) attaining health-related MDGs, focusing on reducing maternal and child mortality, morbidity and mortality from TB and malaria, and the prevalence of HIV/AIDS, in addition to being prepared for emerging disease trends, and prevention and control of non-communicable diseases. The goal of universal healthcare is to provide efficient, accessible, equitable, and adequately funded health services to an informed and empowered citizenry. Thus, every Filipino, regardless of their socio-economic status, is able to get the preventive care and treatment needed with the same level of quality without discrimination. To realize this goal, health facilities and services must be accessible geographically with sufficient number of facilities and qualified health staff.

Health financing provides the biggest challenge in achieving universal health care. The enactment of Republic Act 10351 (more popularly known as the Sin Tax Law) in December 2012 is, therefore, seen as a major breakthrough as it offers a great opportunity of having more resources available for health care from increased taxes on tobacco and alcohol. The law allocates a significant share of the incremental revenue for universal health care, specifically to fund and expand health insurance for the poor, to improve health facilities and to attain health MDGs. In 2012 and 2013, a little over Php 12 billion was allocated to the Philippine Health Insurance Corporation (Philhealth) to support the government’s Sponsored Program which caters to the poorest 20% Filipinos. By 2014, the allocation increased substantially to Php 35.34 billion1 to expand Philhealth’s Sponsored Program to cover the next 20% poorest Filipinos and other marginalized and vulnerable sectors of society such as persons with disabilities, and survivors of conflicts and disasters. Study Objectives For this particular study on the Citizen’s Report Card (CRC), the main research question is to determine level of access, utilization, quality of service provision and level of satisfaction of indigent beneficiaries on the health insurance package, specifically, the Sponsored Program designed for the 20% poorest Filipino families. The CRC study has the following specific objectives:

1. Develop a viable monitoring and feedback mechanism on the health insurance package designed for indigent beneficiaries;

2. Strengthen capacity of CSO and beneficiaries to monitor performance of health package providers (LGUs, health facilities, Philhealth);

3. Increase transparency, effectiveness and accountability in the public sector by providing beneficiary feedback.

The Policy Environment for Universal Health Care Article XIII of the 1987 Constitution of the Republic of the Philippines declares that the State shall adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goods, health and other social services available to all the people at affordable cost. Priority for the needs of the underprivileged, sick, elderly, disabled, women and children shall be recognized. Likewise, it shall be the policy of the State to provide free medical care to paupers. The National Health Insurance Program. In 1995, Republic Act 7875 or the National Health Insurance Act was adopted by the Philippine Government and subsequently amended by Republic Act 9241. The law established the National Health Insurance Program (NHIP) as a mandatory health insurance program of the government designed to provide universal health insurance coverage for Filipino citizens. The law designates the Philippine Health Insurance Corporation (Philhealth) to implement the program with the following objectives: a. provide all citizens of the Philippines with the mechanism to gain financial access to health services; b. establish the NHIP to serve as the means to help the people pay for health care services; and c. prioritize and accelerate the provision of health services to all Filipinos, especially that segment of the population who cannot afford these services.

1 PhilHealth’s budget for the Sponsored Program is expected to further increase as taxes

continue to increase annually.

The NHIP covers the following beneficiaries: employed members in the government and private sectors; individually paying members; retirees under the Lifetime member program; members of the Overseas Workers Program and indigent members covered by the Sponsored program. Also included as beneficiaries are these members’ dependents – children below 21 years old and parents over 60 years old. The Aquino Health Agenda. In December 2010, the new administration under President Aquino launched the “Aquino Health Agenda: Achieving Universal Health Care for All Filipinos" designed to improve, streamline and scale up reforms in the health sector with deliberate focus on the poor to ensure that nobody is left behind as the implementation of health reforms moves forward. The initiative seeks to address inequities in health outcomes by ensuring that all Filipinos, especially those belonging to the lowest two income quintiles, have equitable access to quality health care. It is designed to strengthen the National Health Insurance Program by improving financial risk protection of the poorest. The success of this initiative shall be measured by the progress made in preventing premature deaths, reduce maternal and newborn deaths, controlling both communicable and non-communicable diseases, improvements in access to quality health facilities and services and increasing NHIP benefit delivery rate, prioritizing the poor and the marginalized. In August 2011, the Department of Health came out with the implementation roadmap of the Aquino Health Agenda which identified three phases: 1) launching phase (August 2010-December 2011); 2) Scale-up phase (2012-2013); and, 3) sustainability phase (2014-2016). Target outputs were set for each phase and for each year with the following highlights:

- Implementation of No Balance Billing policy for indigent families - Expansion of the outpatient primary care benefits - Increase coverage of the Sponsored Program - Upgrading of rural health units and district, provincial, and DOH-retained hospitals - Attainment of all MDG health goals

The Sin Tax Law. Republic Act 10351 or the Sin Tax Law, signed into law on December 20, 2012 by President Aquino, is designed as both a revenue and health measure. The law allocates a significant portion of the incremental revenue generated from increased excise taxes on tobacco and alcohol to fund the government’s universal healthcare agenda, while curbing the incidence of cigarette smoking especially among poor and young Filipinos. The Department of Finance projected that in the first year of implementation, the government expects to collect P34 billion in incremental revenue from excise taxes on cigarette and alcohol products. Of this amount, about 80% is earmark for universal health care and health facilities enhancement. The bulk of the fund is allocated to fund PhilHealth’s Sponsored Program. In terms of health objectives, the Department of Health projects a substantial reduction of tobacco consumption in the Philippines which currently causes the deaths of 87,600 Filipinos annually. The Implementing Rules and Regulation (IRR) of the Sin Tax Law was approved and signed on 18 January 2014 by the heads of the five concerned agencies, including the Department of Health and PhilHealth. Under the IRR, the Department of Health was tasked to identify the annual funding requirements for financial risk protection, health programs, medical assistance and health facilities enhancement. The department is also required to submit a list of projects and programs to be implemented for the universal health care program, including funding requirements and guidelines for prioritization. The New Philhealth Law, The National Health Insurance Act of 2013 (Republic Act 10606). The Philippine Health Insurance Corporation (Philhealth) was established on February 14, 1995 as a

Government-Owned and Controlled Corporation (GOCC) to administrate the National Health Insurance Program (NHIP). The law was amended in 2013 to incorporate the key strategies of the Aquino Health Agenda. NHIP is the compulsory health insurance program of the government that provides universal health insurance coverage and ensures affordable, acceptable, available and accessible health care services for all citizens of the Philippines (IRR of R.A. 10606).2 Philhealth’s primary purpose is to ensure that all Filipinos, especially those who cannot afford the cost of health care, are given real financial risk protection. Its key functions are:

Enrol all Filipino citizens covered under the NHIP;

Coordinate with the other government agencies, specifically DOH, DSWD and LGUs for the enrollment and coverage of eligible indigents, sponsored members and those members in the informal economy;

Establish a system of accreditation of health facilities and health personnel;

Establish an efficient premium collection mechanism, and maintain an updated membership and contribution database;

Conduct information campaigns on the principles of the Program to the public and private accredited health care providers.

Philhealth draws its funds from three main sources:

1) premiums collected from its paying members 2) proceeds from its investments 3) allocation from the national government as enacted under the General Appropriations Act

(GAA) to fund its NHTS-PR Sponsored Program There are currently five membership types/programs under the NHIP. These are:

1. Sponsored Program 2. Individually Paying Program 3. Employed Sector Program 4. Overseas Workers Program 5. Lifetime Member Program

A Sponsored Member is one whose contribution is being paid by the national or local government, or by a private entity according to the rules as prescribed by the Corporation. Currently, the Sponsored Program aims to cover indigents belonging to the lowest 40% (Quintiles 1 and 2) of the Philippine population, including:

1. Families listed under the National Household Targeting System for Poverty Reduction (NHTS –

PR) of the Department of Social Welfare and Development (DSWD); and 2. Families identified as poor by the sponsoring Local Government Units (LGUs).

Philhealth members and their dependents are entitled to the following minimum services.

a. In-patient care: 1. Room and board; 2. Services of health care professionals; 3. Diagnostic, laboratory, and other medical examination services; 4. Use of surgical or medical equipment and facilities; 5. Prescription drugs and biologicals, subject to the limitations of the Act; and, 6. Health Education.

2 Discussions in this section on Philhealth are based on the Implementing Rules and

Regulations of R.A. 10606.

b. Out-patient medical and surgical care:

1. Services of health care professionals; 2. Diagnostic, laboratory and other medical services; 3. Personal preventive services; 4. Prescription drugs and biologicals, subject to the limitations of the Act; and, 5. Health Education.

c. Emergency and transfer services; d. Health Education Packages; and, e. Such other health care services that the Corporation and the DOH shall determine to be appropriate and cost-effective.

A specific provision of the new Philhealth law provides for “No Balance Billing” (NBB) for indigent confined in public health facilities. This means that no other fee or expense shall be charged to indigent in public health care institutions subject to the guidelines issued by the Philhealth. Local government units (LGUs) play an important role in the NHIP because they serve as the frontline agency in providing health care services to indigent families. Along this line, LGUs are enjoined to:

1. Develop policies and plans appropriate to their locality and consistent with the implementation of the national government’s health agenda

2. Mobilize and utilize local resources, Philhealth reimbursements, user-fees, capitation fund, and other resources to organize and sustain the local health delivery system;

3. Improve the capacity of local hospitals and other public health facilities to deliver services; and

4. Establish partnership with the private sector for effective delivery of health service packages Relevant Provisions under the Implementing Rules and Regulations (IRR) of the New Philhealth Law The most important implementing provision of the new Philhealth Law is the expansion of the coverage which stipulates full national government subsidy for indigents as identified by DSWD through a means test rules. Base on initial estimate for 2014, the number of sponsored beneficiaries will increase from 5.2 million to 14.87 million families. This will cover the poor and the near poor families. In addition, the premium contributions for orphans, abandoned and abused minors, out of school youth, street children, PWDs, senior citizens and battered women shall be included in the GAA of DSWD. Moreover, the needed premium contributions of all Barangay health workers, nutrition scholars and other barangay workers and volunteers shall be fully borne by the LGUs concerned. The implementing rules also provided for the coverage of women who are about to give birth – the annual required premium for the coverage of un-enrolled women who are about to give birth shall be fully borne by the national government and/or the LGUs and/or the legislative sponsor which shall be determined through means testing recognized by DSWD. Enrollment at Point of Care provides for automatic membership and benefit availment of critical poor in government facilities. Premium contributions shall be borne by the government facility, provided that they are certified poor by the medical social worker at the time of admission. The rules on proof of membership have now become more lenient under new guidelines issued by Philhealth. There are less documentary and administrative requirements for registering with Philhealth. Intensified information campaigns were also done together with other national agencies

and with LGUs and other partners. ID cards are no longer necessary during confinement for as long as the confined person appears in the registry as member of dependent. Philhealth has also introduced a comprehensive approach to provide Primary Care Benefits (PCB) for the poor through facility assignment and profiling. Primary Care Benefit 1 include diagnostic examination (CBC, urinalysis, fecalysis, sputum microscopy, fasting blood sugar, lipid profile and chest x-ray) and primary preventive services (consultations, visual inspection with acetic acid, regular blood pressure measurements, breastfeeding education, clinical breast examination, counselling for lifestyle modification and smoking cessation). Primary Care Benefit 2 includes outpatient drugs for diabetes, hypertension and dyslipidimia. In summary, three methods of coverage and benefits have been introduced by Philhealth:

1) Primary care benefit package - to promote health and well-being of enrolled families through preventive measures, screening diseases and management of common illnesses.

2) Case Rates System - all confinements are paid through a case-based payment mechanism – making Philhealth benefits more clear and predictable.

3) No-Balance Billing - this ensures that no additional expenses are required from indigent and sponsored members over and above the fixed rates.

Membership, Accreditation and Benefits. In the 2013 Statistics and Charts by Philhealth (December 31, 2013), it was reported that there were 31.27 M total registered members, 45.63 M dependents and 76.90 M combined. The sponsored program on the other hand has 9.61 M registered members, 21.77 M dependents and 31.38 M combined. This can be broken down into 4.45 M registered members, 5.91 M dependents and 1610.37 M combined under Regular & DOH, and 5.16 registered members, 15.85 M dependents and 21.01 M combined under NHTS-PR.3 It was also reported that were 699 level 1 hospitals (437 private and 262 government), 257 level 2 hospitals (213 private and 44 government), 114 level 3 (68 private and 46 government) hospitals and 691 unclassified/other hospitals (335 private and 356 government) which are Philhealth-accredited. Philhealth’s annual report for 2013 on Institutional Health Care Providers (IHCP) listed 1,761 accredited facilities, 708 government and 1053 private. There were 2538 outpatient clinics accredited for Primary Care Benefit (PCB) Package, and 2065 outpatient clinics accredited for Maternity Care Package (MCP) package, and 1453 clinics accredited as TB-DOTS package providers. In addition, among the Local Government Units (LGUs) across the country, 94% have PCB providers, 60% of LGUs have accredited MCP providers, while 67% have TB DOTS providers. In terms of benefit payments, Philhealth reported that it paid Php 55.6 billion to an estimated 5.8 million claims. Forty percent of the total number of claims for the year which amounted to 21.4 billion pesos were paid to the formal sector (Private and Government employed) followed by 22% of claims amounting to 10.4 million which were paid to the individually paying sector while 27% of claims totaling 17.97 billion were from the sponsored program. The Philhealth annual report for 2013 showed that only a third of the total claims for the sponsored program were fully covered under the No Balance Billing policy. The top three medical case rates paid were for Pneumonia I, Acute Gastroenteritis and Newborn Care Package, while the top three surgical case rates paid were for Hemodialysis, Normal Spontaneous Delivery Package and Caesarian section.

3 All data on membership, accreditation and benefit payments are based on the latest Statistics and Charts of Philhealth for 2012.

Study Methodology Background Research. Available literature related to CRC was reviewed to assist the project team in designing the survey framework and methodology, and in identifying the key indicators that will be monitored. Update literature were also review on the most recent health legislation, policies, and statistics particularly those related on the utilization of the Sin Taxes and on Philhealth. Additional background information were gathered from interviews of key informants, and from the participation of the project team forums and legislative inquiries related to Philhealth and the implementation of the Sin Taxes Law. The study identified the following specific areas of inquiry:

1. Socio Demographic information of the Respondent Family 2. Enrollment and membership status of beneficiaries 3. Information and knowledge about the program, benefits & processing 4. Accessibility of health facilities/services 5. Utilization of health services/benefits and reasons 6. Quality of services provided 7. Level of Satisfaction 8. Confinement information 9. Assessment of Sponsored Program 10. Perceived problems and recommendations

Definition of Terms/Key Indicators:

- Sin Taxes – the taxes levied on sales of alcohol and tobacco (additional taxes were imposed by a new law approved in Dec 2012)

- Philhealth – Agency in charge of implementing the national health insurance program and the sponsored program for indigent families

- Access – enrolment in the sponsored program; card membership; orientation/workshop attended; knowledge of program

- Utilization – actual availment of health services; free consultations, medical tests, treatment and confinement

- Quality –availability of the needed services, facilities, equipment, medical personnel; completeness of treatment package.

- (the study will not measure the effectiveness or efficacy of the clinical diagnosis and treatment)

- Satisfaction – in terms of adequacy of information, availability of services required, facilities, patient relations, expectations

Questionnaire Development The survey questionnaire was developed based on the research objectives, the areas of inquiry and the identified indicators. CRC survey instruments used in similar studies were also consulted to help in the finalization of the questionnaire. The draft CRC questionnaire was pretested to test the appropriateness and sensitivity of the questions. The pretest was conducted in August 2013 in Angono Rizal, covering both the town center and remote villages. The result of the pretest was instrumental in firming up the research design and in finalizing the survey instruments. The pretest result was instrumental in finalizing the list of indicators that will be used in the CRC survey. The result also helped to improve the formulation and sequencing of the questions.

Actual Conduct of CRC Survey The Survey was conducted in five municipalities, specifically in the following:

1 Greater Manila area (Angono, Rizal Province) 3 Central Luzon (Sta. Rosa and Guimba, Nueva Ecija Province; Samal in Bataan Province) 1 Bicol Region (Buhi, Camarines Sur Province)

The local areas were selected purposively according to the following criteria:

With identified/listed Sponsored Program beneficiaries

Presence of local partner NGOs, community organisations or with programs implemented by partner NGOs

With accredited health center/Rural Health Unit and accessible health facilities/hospitals

Cooperative local government units (LGU) to provide data on Sponsored Program and facilitate/endorse the survey

Peace and order situation is manageable

Area is not difficult to reach; cost of travel is within budget Sampling Design: A total of 100 respondents were randomly selected in the identified local areas through the following:

- Stratified sampling of villages according to whether urban/center or rural/outside center - Two villages were selected for each municipality. However, if the number of eligible families

is not enough, then a nearby village is added. - For the selected villages, systematic sampling with a random start was employed; if the

number of eligible families is about the same as the target respondents, then complete enumeration is done for the particular village.

- The Universe is based on the listing of Sponsored Program beneficiaries provided by Philhealth and/or the Local Government

A total of 527 respondents were covered by the survey. The completed questionnaires were reviewed and callbacks done in two areas to complete the number of target respondents and to check validity of questionnaires with inconsistent responses. Encoding and Data Processing A customized survey encoding program was developed which automated the encoding process and increased the accuracy through automatic verification. The software (CSPro) is the official encoding program software used by the US Census agency. AER contracted another group to developed the encoding program and undertake the encoding of the survey questionnaires. The encoded data were processed and statistical tables generated – both one-way frequency tables and crosstabulations. CRC Indicators culled from both secondary sources and survey results The study identified indicators that can provide clear information about the extent of access, utilization, availment, and satisfaction of members on Philhealth services and benefits. These indicators are also easy to measure through surveys that make use of structured questionnaires. The selected indicators are listed below. Secondary sources (national level statistics; regional or local breakdowns not available for all indicators)

1. Number of beneficiaries enrolled 2. Proportion of the poor enrolled based on latest poverty statistics 3. Availability of accredited health facilities; Percent of municipalities covered 4. Availment rate 5. Amount paid/refunded

Survey Data 1. Access - Percent of card holders with basic documents necessary for availment 2. Utilization of benefit package

- Primary Care benefits availment rate - Percentage able to avail of needed diagnostic and laboratory tests - Percent able to avail of free hospitalization - Frequency of availment - Duration of confinement - Most frequent services availed

3. Quality of membership - Percent attended orientation seminar; received info materials; individually briefed - Percent with adequate knowledge about the program, benefits and processing

4. Quality of healthcare benefits received - Health services available - Percent able to get all the services needed in health facility or referred to another - Percent with No Balance Billing (no out-of-pocket cost) - Average out-of-pocket expenses

5. Satisfaction rating - Perception rating of quality of health facilities - Perception rating of quality of health services provided - Overall satisfaction with the Sponsored Program

6. Areas for Improvement - Percent mentioning expand services; ensure no out of pocket cost; adequate facilities;

personnel; equipment Study Limitations Majority of Sponsored Program members (84.3%) were male household heads. Most of the respondents, however, who provided information about the Sponsored Program members were the wives who were more likely to be at home than their husbands at the time of interview. This may introduce some bias in the survey results even if the women family members (wives and elder daughters) are usually more concerned with and knowledgeable about family health matters. Nonetheless, the ideal situation would have been an interview with both the member and the spouse present to ensure more complete and accurate responses. The survey initially targeted only two villages per municipality. However, because of the limited number of Sponsored Program members, the actual number of villages covered ranged from two to seven villages. This is done to reach the required number of respondents (100) for each of the municipalities.

CRC Survey Results

A total of 527 respondents were interviewed covering 5 Municipalities in three (3) regions - Central Luzon, CALABARZON and Bicol. At least 100 respondents listed as indigents under the National Household Targeting System (NHTS) of the government were selected in each of the covered Municipality. Number of Respondents by Municipality

Municipality Frequency Percent

Municipality of Angono, Rizal 104 19.7%

Municipality of Buhi Camarines Sur 112 21.3%

Municipality of Guimba, Nueva Ecija 101 19.2%

Municipality of Samal, Bataan 100 19.0%

Municipality of Sta. Rosa, Nueva Ecija 110 20.9%

TOTAL 527 100.0%

Profile of Sponsored Members The respondents provided information about the Philhealth members under the NHTS Sponsored Program (SP) whose premium payments to the national social health insurance were fully subsidized by the national government from the revenues generated through the new Sin Taxes. These Philhealth sponsored members were indigents belonging to the lowest 20% of the Philippine population. The respondents were asked information concerning the Philhealth NHTS SP member. The survey showed that most (84.4%) of the SP members were males and only a few (15.6%) females. The ages ranged from 22 years old to 82 with the average at 45 years old. About 9.5% were considered senior or 60 years old and over. In terms of civil status, majority (81.8%) of the SP members were married and/or widow/er while the rest reported that they were either in a live-in arrangement, separated or single. On the average, each member has 4 eligible dependents. Dependents here refer to qualified dependents of Philhealth members which generally consists of the legal spouse, their children below 21 years old who are unmarried and unemployed, and their parents who are 60 years and above. It is important to note that 72 respondents have live-in partners (13.7%). Under the current Philhealth rules, the spouses of Philhealth members who are not legally married will not be covered by the benefits accorded to eligible dependents. About half (51.8%) of the SP members either reached only elementary level or worse, did not attend school while 20.3% reached secondary level education and another 20.5% completed secondary level. Some 7.4% have taken up or completed post-secondary technical/vocation studies or college education.

Profile of Sponsored Members

Sex Number Percent

Male 444 84.4%

Female 83 15.6%

Age (Average) 45 years old

60 and over 51 9.5%

Civil Status

Married/Widow/er 431 81.8%

Live-in 72 13.7%

Separated 10 1.9%

Single 14 2.7%

No. of Dependents (Average) 4 Persons

Level of Education

None/Elementary 273 51.8%

High School 107 20.3%

HS Graduate 108 20.5%

Post Secondary TVET/College 39 7.4%

Total SP Members Covered 527

At the time of interview, majority were engaged in livelihood/income generating activities. About one third or 35.1% reported they were working as farmers and fisherfolks; 24.7% were drivers (tricycle or pedicab) and carpenters; 12.6% were laborers or unskilled workers such as those in constructions work, vendors or helpers; 8.5% were service workers such as security guards and Manicurist; 0.7% were professionals; and 9.3% reported that they did not have any occupation. Occupation of Sponsored Member

Farmers and fisherfolks 35.1%

Traders & related worker (Driver, Carpenters) 24.7%

Laborer/unskilled workers (Construction, vendors, helpers) 12.6%

Service workers/shop/market sales workers (Security Guard, Manicurist) 8.5%

Professionals 0.7%

Others 9.1%

None /No occupation 9.3%

Membership Status A proof of membership to the Philhealth sponsored program are the Identification card (ID) of the Philhealth member and the Membership Data Record (MDR) which contains the list of dependents of the member. Majority (90.2%) of respondents4 claimed to have in their possession the Philhealth

4 In this section, the term respondent is loosely used to refer to both the person responding to the survey

interview or the SP member. Since the entire family is covered under the Sponsored Program, the person responding to the survey is assumed to be covered by the program, even if the spouse or another family member is the actual card-bearing member.

ID Cards although when asked to show this card to the interviewer, only 67.2% were able to do so. Respondents were also asked if they have with them their MDR and most (85.7%) said yes they have it with them but when asked to show this MDR to the interviewer, only 65.9% were able to do so. At the time of interview, both Philhealth IDs and the MDR are important documents that should be in the members’ possession at all times. Both the ID and MDR are required documents when accessing Philhealth services upon hospitalization. Possession of ID Cards and MDR

With Philhealth Identification card (Philhealth ID Shown to surveyor)

90.5% (67.9%)

With Membership Data Record (MDR) (MDR Shown to surveyor)

86.7% (65.8%)

Respondents were asked who subsidized their current membership to the Philhealth sponsored program. Nearly half (44.4%) claimed they do not know who sponsored them, while the rest of the respondents mentioned various agencies and political personalities such as the current Philippine President (PNOY), the local government, the provincial governor, the district representative, and even the former President. This shows the lack of awareness of the beneficiaries on the sponsored program of the national government as administered by Philhealth. When asked when they became sponsored program members, majority (80%) replied 2012 or 2013 while the remaining 20% said either before 2012 or they do not know. Majority of the respondents (76.9%) were aware that they are covered only for the current year. However, a significant percentage (24.1%) was not aware or had an incorrect understanding of the duration of their membership. Sponsor of Philhealth membership

President Aquino (PNOY) 21.3%

Local Government 16.7%

Barangay 10.6%

Governor 6.5%

Congressman/Former President GMA 0.6%

Don't Know 44.4%

Year acquired membership under the Sponsored Program

2012/2013 78.9%

Before 2012 13.5%

Don't Know 7.6%

Duration of membership to Philhealth sponsored program

2012/2013 76.9%

Beyond 2013 6.5%

Lifetime 0.9%

Don't Know 15.7%

Respondents were also asked if they have been a Philhealth sponsored member before 2012/2013. About a third (38.1%) claimed they have previously been a Philhealth sponsored beneficiary while two thirds (62.2%) are new beneficiaries, implying expansion in coverage among the poor.

Of the 201 respondents who had been sponsored before, only 172 knew who provided the sponsorship. Some of the sponsored beneficiaries claimed they have been a beneficiary since year 2000 while the others were sponsored fairly recently. Previous Philhealth sponsored member

Yes 38.1%

No 60.5%

Don't Know 1.3%

Previous sponsor of Philhealth membership

Mayor/Local Government 12.5%

Village Council (Barangay) 8.0%

Former President GMA 4.6%

Governor 4.4%

Congressman 0.6%

Private Company 1.7%

Government 0.9%

Don’t Know 5.6%

Not Applicable 61.8%

Knowledge and Awareness The survey explored the information programs on Philhealth that were initiated in the targeted communities. More than half of respondents (61.2%) reported that someone explained the benefits offered to sponsored program members; 60.7% claimed that they attended a meeting/seminar on the Philhealth sponsored program; about half (51.6%) said they were given brochures and/or reading materials on Philhealth; and nearly half (48.1%) claimed they were invited to a meeting explaining Philhealth benefits and processes. Information Program initiated in the Community*

Invited to a meeting explaining Philhealth 48.1%

Someone explained benefits for SP member 61.2%

Attend meeting/seminar on SP Philhealth 60.7%

Given brochure/reading materials 51.6% *Multiple Response

Did you attend a meeting/seminar

explaining Philhealth Sponsored Prog?

Yes No

Did you receive any invitation

about a meeting explaining

Philhealth?

Yes 226 30

88.3% 11.7%

No 86 180

32.3% 67.7%

Pearson Chi-Square =169.8; p < .000; Highly Significant


explaining Philhealth Sponsored Prog?

Yes No

Did someone explain the benefits

of being a sponsored member?

Yes 273 46

85.6% 14.4%

No 40 165

19.5% 80.5%

Pearson Chi-Square=226.4; p < .000 Highly Significant The tables above indicated that majority of those who received invitation (88.3%) actually attended a meeting/seminar explaining about Philhealth’s Sponsored Program. Of those who attended a meeting/seminar, 85.6% said that someone explained about the benefits of being a sponsored member. When asked about their awareness of the benefits of members under Philhealth's sponsored program, more than half of the respondents (60.5%) reported that they know their benefits as SP members. When asked to describe what these benefits are, the most frequently cited benefit was that Philhealth is applicable to and can be used when confined in hospitals due to sickness; for child delivery or for an operation; free hospitalization during confinement covering the entire cost; and discounts on hospital bills and medicines. The responses indicate that the respondents have only partial knowledge about the full range of benefits offered by the program to identified beneficiaries with most citing only benefits related to cases of hospital confinement. Some of the cited benefits were not even accurate. Awareness about benefits of Philhealth sponsored program beneficiaries

Benefits cited by Respondents Frequency Percent

Philhealth applicable/can be used only when confined in hospital (for sickness or operation) 109 49.5%

Discount on hospital bill 56 25.5%

Free hospitalization/Philhealth will cover the whole cost of confinement in hospitals 26 11.8%

Can be used in child delivery 17 7.7%

Only for acute illness 6 2.7%

Discount in cost of medicines 5 2.3%

Children below 20 years old are covered/dependents 1 0.5%

Total 220 100.0%

Respondents were generally not familiar with the other benefits available to SP members, particularly the Primary Care Benefit (PCB) package offered to members and dependents. The PCB is an out-patient benefit package meant to provide preventive care through consultations and regular laboratory/diagnostic tests. When asked about the PCB package, only a fifth of respondents (21.3%) acknowledged hearing about this package designed specifically for sponsored program members. Similarly, only a fourth of respondents claimed to have heard about the case rate package. This refers to the case-based payment scheme, a payment method that reimburses health care providers a predetermined fixed rate for each treated case or disease.

Respondents’ awareness about Philhealth benefits

Know the benefits of Philhealth Sponsored Program 60.5%

Know or Have heard of Primary Care Benefit Package of Philhealth 21.3%

Know or Have heard about Case Rate Package of PHilhealth 25.2%

When asked about levels of awareness on Philhealth sponsored program benefits and processes, half (52.9%) of the respondents claimed they have adequate awareness while 31% said their awareness was not adequate, and 14.5% admitted that their awareness level was very inadequate. Respondents Perceived Level of awareness on Philhealth SP benefits

Adequate 52.9%

Not Adequate 31.0%

Very Inadequate 14.5%

No Response 1.7%

When asked about how to improve their awareness of Philhealth services and benefits, the respondents proposed various ways to do so. The most frequently cited effective ways to promote awareness was through seminar/orientation (51.8%) followed by house-to-house visits (19.7%) then television (14.5%); brochures (4.6%); and radio broadcast (2%). Majority of the respondents favored seminar meetings regardless of whether they have actually attended one or have been oriented about the benefits of being a sponsored member. Most effective way to promote awareness on SP Benefits

Seminar/Orientation 51.8%

House to House visit 19.7%

Television 14.5%

Brochure 4.6%

Radio broadcast 2.0%

No Response 7.4%

Level of awareness on Sponsored Program benefits

Adequate Not Adequate Very Inadequate


explaining Philhealth Sponsored

Prog?

Yes 212 78 26

67.1% 24.7% 8.2%

No 67 86 50

33.0% 42.4% 24.6%

Pearson Chi-Square=61.6; p < .000 Highly Significant

Have you heard of Primary Care

Benefit?

Yes No



Prog?

Yes 88 228

27.8% 72.2%

No 24 187

11.4% 88.6%

Pearson Chi-Square=20.5; p < .000; Highly Significant

Attendance in a meeting or seminar about Philhealth facilitated awareness on the benefits of the Sponsored Program as claimed by the respondents. While most said they have not heard about the Primary Care Benefit program of Philhealth, a significantly higher percentage of respondents who attended a meeting/seminar knew about the PCB program.





Yes 206 87 24

65.0% 27.4% 7.6%

No 72 75 52

36.2% 37.7% 26.1%



Benefit?

Yes No



Yes 93 226

29.2% 70.8%

No 19 186

9.3% 90.7%

Pearson Chi-Square= 29.3; p < .000 Highly Significant Similarly, having someone explain about the benefits of being a sponsored member is an effective way of improving awareness level of beneficiaries. A significantly higher percentage of respondents who said someone had explained to them about Philhealth benefits claimed to have adequate awareness on Philhealth sponsored program and has heard about the PCB program.



Were you given any brochure /

reading material?

Yes 183 68 18

68.0% 25.3% 6.7%

No 94 96 58

37.9% 38.7% 23.4%



Benefit?

Yes No

Were you given any brochure /

reading material?

Yes 85 184

31.6% 68.4%

No 27 229

10.5% 89.5%

Pearson Chi-Square=34.6; p < .000; Highly Significant

Those who received reading material on Philhealth claimed to have adequate knowledge of the benefits of the Sponsored Program. More of them have also heard about the PCB program of Philhealth. These findings indicate that information drives such as seminars, personal explanations and distribution of information materials are effective ways of improving awareness of beneficiaries on the benefits of Philhealth’s Sponsored Program.

Preventive Healthcare Services Availed From the 527 enrolled sponsored members covered by the survey, 2,383 individuals (members and dependents) were covered or insured in Philhealth's sponsored program. Among these individuals, some 1,073 (45%) went to the health center/Rural health units for consultations and diagnostic procedures, while 47 women went specifically for pre-natal checkups. The survey also showed a glimpse of the health practices of the respondents and family members, specifically in accessing/utilizing preventive healthcare services. A little over half (56.6%) of the Philhealth sponsored program members and their spouses have availed of medical consultations and/or laboratory tests. However, only 16.9% of the dependent children or parents of Philhealth member have availed of the same. The most common types of services availed were the free medical consultations, blood pressure measurement and prenatal check-up. The most common cases consulted were for colds/fever, diarrhea, vaccinations, and de-worming. Other services sought were diagnostic/laboratory tests such as complete blood count, urinalysis, chest x-ray, nebulisation, and sputum microscopy. However, not all tests were free of charge since they were referred to other health facilities for the tests. Availed Consultation/Lab Test

Individuals Availing All Areas

Member and Spouse 56.6%

Other Family Members 16.9%

Types of Services Availed

Regular BP measurements 106

Complete blood count (CBC) 104

Urinalysis 45

Urinary tract infection (UTI) 29

Chest X-Ray 30

Asthma (Nebulisation services) 20

Sputum Microscopy 5

Pre Natal 47

Satisfaction Rating Respondents were asked to rate their level of satisfaction on the PCB package as part of the sponsored program benefits. More than half (61%) of the respondents mentioned they were satisfied and another 7.4% said they were very satisfied with the PCB package. However, some 18.7% expressed dissatisfaction and 3.0% were very dissatisfied with the PCB services.

Level of satisfaction on the Primary Care Benefit Package

Very Satisfied 7.4%

Satisfied 61.0%

Dissatisfied 18.7%

Very Dissatisfied 3.0%

No Response 9.8%

How satisfied with the PCB benefits

Very

Satisfied Satisfied Dissatisfied

Very

Dissatisfied



Prog?

Yes 27 192 57 6

9.6% 68.1% 20.2% 2.1%

No 10 112 36 9

6.0% 67.1% 21.6% 5.4%

Pearson Chi-Square=5.0; p = .166 Not Significant

How satisfied with the PCB benefits

Very

Satisfied Satisfied Dissatisfied

Very

Dissatisfied



Yes 24 194 63 5

8.4% 67.8% 22.0% 1.7%

No 13 109 30 10

8.0% 67.3% 18.5% 6.2%

Pearson Chi-Square=6.6; p=.083; Not Significant It is important to note that even those who are not aware about benefits of Philhealth’s Sponsored Program claimed to be basically satisfied with the hospitalization and PCB benefits. There is hardly any significant difference in the level of satisfaction regardless of whether one had attended a meeting/seminar or had received information materials about the benefits of being a sponsored member. This indicates a low level of expectation, assertion of entitlements and claim-making initiatives by the poor on public health services. Recommendations to Improve Primary Care Benefit Package The survey solicited the recommendations of respondents in improving the PCB package for sponsored program beneficiaries. The most frequently cited area for improvement were expanding PCB services/benefits; ensuring awareness through sustained information dissemination; and ensuring that all services, laboratory tests, medical supplies and medicines are provided free. The respondents also recommended that there should be more medicines, doctors and laboratory equipments in the health centers or rural health units.

Improving the Primary Care Benefit Package of Philhealth

Recommended Improvements No. of

Respondents

Expanding/adding benefits/services 93

Ensuring awareness through sustained information dissemination 66

Ensuring that all services, laboratory tests, medical supplies and medicines are provided free 26

Additional Medicines 31

Additional Doctors 19

Additional Laboratory equipment 10

Those who did not visit the health center were also asked their reason/s for not going to the center. More than half (61%) claimed they were not sick, implying that the respondents only visit the health centers once they are sick. This indicates the need to improve understanding and practice of primary care and preventive approaches to healthcare. Other reasons cited for not going to the health center were: not aware about PHilhealth benefits (5.5%); no money (2%); and busy/had no time/far from house (9.2%). Reasons for not visiting Health Center for Checkup/consultation

Not Sick 61.0%

Not aware about Philhealth Benefits 5.5%

No Money 2.0%

Others (No Time/Busy; RHU/Center far from house) 9.2%

No Response 22.4%

Of the 527 respondents or Philhealth sponsored program member with beneficiaries, only 220 or 41.7% had at least one family member who either got sick, was injured or gave birth. But less than half or only 44.19% of those families who had at least one member who got sick, was injured or gave birth consulted a doctor/nurse/midwife. In some instances there were families having 6 individuals/cases (Philhealth members or dependents) of sickness in a year. Among respondents who did not consult, the reason cited was because the illness was not serious. Incidence of Illness, Injury, Child Delivery

Got sick, injured, or gave birth 220 or 41.7%

Consulted doctor, nurse, or midwife 97 (44.1% of 220)

Hospital Confinement, Benefits, Claims and Reimbursement The survey also looked into the situation of those who were confined in hospitals during the period July 1, 2012 until June 30, 2013. Of the 527 respondents, 112 individuals were hospitalized or had family members confined during the specified time. Most of those who were confined went in public hospitals (74.6%) which are Philhealth accredited (92.6%). Half of those hospitalized (53.9%) availed the no balance billing (NBB) bed. Most of the patients (92%) claimed they were given meals three times in a day. More than two thirds or 71.7% reported that the water in the hospital was potable. Majority (90.1%) claimed that the hospital had clean rooms. In addition, 86.4% reported that their rooms were well ventilated and 55% claimed they shared room with others.

Hospital Confinement

Public Health Facility 74.6%

Philhealth Accredited 92.6%

Patient in No Balance Billing (NBB) bed 53.9%

Patient given meal 3 times a day 92.0%

With potable water 71.7%

Clean rooms 90.1%

Room well-ventilated 86.4%

Beneficiary shared room with others 55.0%

Patient asked to buy medicine/supplies 86.9%

Patient paid something at billing station 63.3%

Hospital reimbursed expenses 18.1%

Philhealth personnel present in the hospital 71.0%

Philhealth personnel explained process 60.4%

Encountered difficulty/problem with processing 25.4%

Total Confined 112

The survey also looked into hospital related expenses of those confined. Most patients (86.9%) were asked to buy medicine or supplies during their confinement. Nearly two thirds or 63.3% of the patients paid an amount at the billing station while only 18.1% were reimbursed their hospital expenses. This indicates that SP beneficiaries are not yet enjoying the full benefits accorded to them based on the applicable benefit package of Philhealth. There were also inquiries on the presence of and assistance provided by Philhealth personnel. More than two thirds (71%) acknowledged the presence of Philhealth personnel in the hospital where they were confined. However, only 60.4% of the respondents who were confined reported that the Philhealth personnel explained processes and benefits related to the sponsored program beneficiaries. When asked about difficulties encountered during the processing of their Philhealth benefits, 25.4% of concerned respondents admitted that they had some problems in availing their benefits. Satisfaction level with benefits/services while confined

Satisfied 81.5%

Dissatisfied 18.5%

In terms of satisfaction of sponsored program beneficiaries on Philhealth benefits/services during confinement, most respondents with cases of confinement (81.5%) claimed they were satisfied. The relatively high satisfaction rating shows that respondents appreciate the services accorded to them even if they did not receive the full benefit package. This level of satisfaction is higher compared to those who availed of the primary care benefit package of Philhealth where only 68.4% of the concerned respondents expressed satisfaction with the outpatient services extended to sponsored program beneficiaries. The lower satisfaction level on PCB benefits may be because respondents were not familiar with and had lower utilization of this service package. The survey also inquired about case of illnesses, delivery and hospital confinement of unmarried spouses (live-in partners) during the previous 12 months. Of the 72 cases of living-in arrangements, 19 spouses of SP members were reported to need medical attention (either due to illness or child delivery) during the period. Most of them consulted a doctor (18 of the 19 cases) while 6 were confined in a hospital. In 15 of the 19 cases of illness, consultation and confinement, out-of-pocket expenses were incurred as these cases are not covered by Philhealth because unmarried spouses are not eligible dependents.

Sickness and Hospital Confinement of Live-in Partners

Number of Cases

Reported illness, child delivery 19

Consulted doctor 18

Illness Flu, Fever 5

Infections 4

Child Delivery 3

Digestive ailment 2

Respiratory ailment 2

Others 3

Cases of confined 6

Expenses incurred (consultation & confinement) 15

Total Number of Live-in Partners 72

Recommendations to Improve the Sponsored Program The survey solicited the recommendations of respondents in improving the primary care benefit (PCB) package of Philhealth for sponsored program beneficiaries. The most frequently cited area for improvement is in expanding the PCB services/benefits followed by making sure that beneficiaries are aware of the PCB through seminars/meetings that explains to them the services and benefits of availing the PCB. The respondents also suggested that sponsored program beneficiaries availing of the primary care benefit package should not be charged for medicines, laboratory tests or for doctors’ services in the health centers or rural health units. In addition, the respondents also recommended that there should be more medicines, doctors and laboratory equipments in the health centers or rural health units. Recommendations to improve the Primary Care Benefit package

Recommendations Number of

respondents

Additional/improve Services/Benefits 82

Information campaign on PCB through seminars/meeting/info bulletins 66

All should be free – doctors, laboratory, medicines 26

Additional medicine 31

Additional Doctor 19

Additional Laboratory equipment 10

Respondents with cases of confinement complained of difficulties in processing their documents, of not being able to avail of Philhealth benefits, and of making advances for medical expenses. When asked how to improve Philhealth services and benefits for hospitalized sponsored program beneficiaries and dependents, they recommended the following:

1. By providing more medicines, more doctors, additional laboratory equipment and expanding the Philhealth services;

2. By making sure that provision of services and benefits are continuous/uninterrupted; 3. By making certain that sponsored program beneficiaries are not charged for medicines,

doctors and laboratory tests or are discounted for services rendered; 4. By accrediting all health facilities. 5. By making sure that sponsored program beneficiaries can use the Philhealth services and

benefits in any hospital and without restrictions

Recommendations to improve the hospital benefits and services provided

Recommendation to Improve Services and Benefits No. of

Respondents

Add/improve services (doctors, medicines, lab. equipment) 30

Continue the services/benefits provided 6

Make all services free (medicines, doctors, laboratories) 5

All health facilities must be accredited 3

Provide discounts for services rendered 3

Should use benefit for all cases without restrictions 6

Summary of Findings and Analysis Philhealth's Sponsored Program is designed to provide essential healthcare services and benefits to indigent families as part of the program to achieve universal health care for Filipinos. The CRC survey basically validated the programs target population group which represents the country's poorest families – the 20% poorest of Filipino families. A large majority of the survey respondents are engage in low income economic activities or were not gainfully employed at all. Most of the respondents have had only elementary education or no education at all. However, there were a few who were employed or working as professionals and who have had tertiary level education. This may raise certain issues about the accuracy of identifying indigent families who should benefit from the sponsored program. This has been a common issue raised by local government officials who have repeatedly raised questions about the methodology and accuracy of the NHTS administered by DSWD. These questions have been articulated during interviews of concerned LGU officials and in forums participated by the same. Better coordination between the national agencies, specifically DSWD, DOH and Philhealth, and the local government is, thus, recommended and can go a long way toward improving the sponsored program. The survey noted that a large majority of the SP beneficiaries have the proper documents as proof of their Philhealth membership. This should come handy particularly in cases of illness and hospital confinement. The list of dependents as contained in the Members Data Record (MDR) is particularly important because this will certify who are covered and insured under Philhealth's sponsored program. There is a need to regularly update the MDR so that proper documentation is ready when the need for such arises. There are important issues that have been raised by both the SP beneficiaries and LGU officials concerning the coverage of the program. A common question articulated relates to the non-coverage of unmarried spouses, disabled children above 21 years of age, and grandchildren who are part of the same poor household, among others. These have been partly addressed by the new Philhealth law and by subsequent guidelines issued by the agency. However, there are still critical issues related to coverage. This led to the suggestions of some respondents that Philhealth benefits should be provided to all without restriction. Majority of the PHilhealth sponsored members are males identified also as the household head. The legal spouses of Philhealth members are insure and covered by the same program. However, for couples who are not legally married, the female spouse is not covered by the social health insurance and is not eligible to the benefits of the sponsored program members. In this study, there were 72 Philhealth members with unmarried/live-in partners (13.7% of the 527 cases covered by the survey). Of these, 19 cases needed medical attention due to cases of illness or child delivery and, thus, incurring out-of-pocket expenses since they are not covered by Philhealth benefits as eligible dependents. While membership to the program has been significantly expanded with funds generated from the Sin Taxes, the quality of membership remains a key weakness of the sponsored program. This is particularly in terms of knowledge and awareness, access and utilization of health services and benefits provided under Philhealth's sponsored program. The survey indicates low awareness about the sponsored program, and the benefits which members and their dependents can avail of. While a significant percentage are aware about their membership status, most of the respondents have only partial knowledge of the full range of services and benefits available, and the procedure for availing such. As noted by the survey, only a fifth of survey respondents heard about the primary care benefit package and only a fourth heard about the case rate package. Most of the respondents think that Philhealth benefits are available only in cases of confinement, and not valid for out consultations and out-patient services. While majority of the

survey respondents claimed that their awareness about Philhealth's sponsored program is adequate, this has not been validated by the actual knowledge they have as indicated by the survey results. Respondents have only partial knowledge of Philhealth services and benefits and mostly benefits related to cases of confinement. Concerned agencies are implementing information campaigns to improve knowledge of beneficiaries and, thus, maximized the benefits offered. This has been validated by the survey with respondents citing the holding of meetings/seminars, home visits, television and radio ads, and distribution of information materials. They also mentioned the presence of Philhealth personnel in hospitals and in the communities who provide information on Philhealth's benefit packages and claims processing. The respondents further mentioned that for them, orientation meetings and home visits are the most effective ways to disseminate information. There were others, however, who mentioned that the best way is through television which is the most common and accessible information source in most communities and among the poor. Apparently, the survey showed that such information campaigns had not been adequate to improve awareness and acquire the necessary information to take advantage and utilize the services and benefits extended to indigent families. Clearly, more pro-active sustained initiatives are needed to ensure effective communications that will raise the awareness level of the SP beneficiaries. Coordination among the concerned agencies and the local government is essential to ensure effective information dissemination. Appropriate communication strategies must be studied and employed, considering differing local context and the particular circumstances of the target population groups. The lack of awareness partly explains the relatively low utilization of Philhealth services and benefits extended to indigent families. This is clear from the survey results which show the low utilization particularly of the PCB package. Most are not familiar about the full range of services and benefits available to them and their dependents. Thus, available benefits such as medical consultations, laboratory tests, and the No Balance Billing in case of confinement are not maximized. It should also be noted further that visits to health centers are required for most of the Philhealth sponsored program members who are also beneficiaries of another program which provides for cash transfers subject to compliance to certain conditions including visits to health centers. Thus, utilization of the PCB package may even be lower if visits to health centers are not required under the said cash transfer program. The low utilization of Philhealth services and benefits is also explained by two other factors: on the supply side - the availability of accredited health facilities, doctors, health personnel, equipment, medical supplies and medicines; and on the demand side – the poor health knowledge and practices especially among the poor. The survey was able to give a glimpse of these factors. The respondents have consistently recommended for the expansion of services, additional doctors, supplies, equipment and medicines. Access to accredited health facilities is also an issue given that a large percentage of municipalities have no accredited birthing facilities and no easy access to tertiary level hospitals. Respondents also mentioned that they incurred out-of-pocket expenses and have to purchase medicines and medical supplies without being reimbursed for such purchases. The survey also noted that SP beneficiaries do not visit the health center for preventive health care and diagnostic tests because they are not sick or are too busy to go through this exercise. This indicates that the culture for preventive health care has yet to be developed especially among the poor. The lack of pro-active promotion of primary healthcare in local areas is another reason why sustained information and education campaigns are needed not only to provide information about Philhealth's sponsored program but also to promote preventive healthcare and good health practices.

The respondents may have indicated that there were certain gaps and improvements needed, but most were generally satisfied with Philhealth services and benefits for confined members/dependents. They also expressed satisfaction on the PCB package even though this service has not really been maximized. This pattern of response is typical of poor Filipinos who tend to be satisfied with services made available to them even if there are gaps in terms of quality, coverage and adequacy of such services. As mentioned earlier, the survey indicates a low level of expectation and assertion of entitlements by the poor on public health services. The poor can easily be pleased especially if they lack the proper information and have limited claim-making experience on the right to health. This explains in large part the high satisfaction rating even at a time when officials admitted that the program is still in a transition phase, and not fully and smoothly implemented yet. Again, this attitude provides a further reason on the importance of sustained information and education campaign so that the poor acquire adequate knowledge and are able to claim such benefits as their rights. In this regard, the role of organized groups becomes important to serve as facilitators and catalyst for initiating change. Future studies should look more deeply into the issue of entitlement and satisfaction among the poor. Such attitude may be due to the lack of information or access to information about programs designed to address the health needs of the poor. It may be also due to marginalization and neglect by the government which makes the poor appreciate whatever little assistance is given to them. The low level of organization and participation in community affairs may also be factors that can explain such attitude.

Recommendations5 On Monitoring and Reporting

a) Develop an effective, transparent, and participatory monitoring system to track the flow of funds generated from the Sin Taxes to Philhealth and to health facilities, local governments, and Sponsored Program beneficiaries and Philhealth members. A parallel monitoring system should be initiated by civil society groups to enhance transparency and facilitate participation in program evaluation and policy development among the beneficiaries and other stakeholders. This project can contribute to this objective by initiating the development of a monitoring toolkit.

b) Identify a set of indicators which can be aggregated and disaggregated at regional, provincial, municipality and health facility levels to facilitate easy tracking and validation check. In this way, outliers among claimants, health facilities, health personnel and LGUs can be checked for potential leakages. Nature of illnesses, geographical location and medical services provided can be tracked to assess the responsiveness of Philhealth services and benefit packages. For this purpose, the key items covered by the PETS questionnaire can be considered for inclusion in the set of indicators. If feasible, the Benefit Delivery Rate should also be generated at regional, provincial and municipal levels. In addition, the indicators used in the CRC study should be included – awareness, utilization and availment, accessibility, service availability, and satisfaction rating. The impact on the health situation should also be studied and developed – specifically on maternal deaths, attended births, neo natal mortality, and incidence of and deaths due to infectious and non-communicable diseases.

c) Philhealth, DOH, LGUs and health facilities should prepare quarterly and annual monitoring reports on the key indicators related to membership, information dissemination, awareness program, accreditation, claims, reimbursements, and benefit payments. The same report should also contain information on funding, income and revenues generated, and disbursements. Such reports should be made available to concerned agencies, the oversight committee of the legislature, interested parties and the general public.

d) Pertinent documents related to the utilization of the earmarked funds shall also be made available by concerned agencies and the general public to ensure transparency and accountability in the use of funds.

Identification of Beneficiaries and Coverage of the Sponsored Program

a) Strengthen the NHTS-PR for better targeting and coverage of the poorest families, allowing LGU and CSO to participate in the survey design, training of enumerators and evaluation of the survey process. A more effective, acceptable and participatory validation process should be installed. A credible system for reviewing the list of selected NHTS-PR beneficiaries with participation from LGUs and CSOs. Part of the strategy to strengthen the NHTS is to undertake independent and localized poverty monitoring surveys for validation purposes.

b) Ensure the enrollment of indigent families/individuals who have not selected through the NHTS-PR system. In this regard, LGUs and local CSOs should be supported and respected in identifying additional beneficiaries.

c) Provide all relevant data to the concerned LGUs, including the complete roster of Philhealth members in the local areas.

5 These recommendations build on the earlier Public Expenditure Tracking Survey study undertaken as part of

the same project and the Annual Reports of Philhealth. Thus, not all of the recommendations are directly linked to the results of this particular survey.

d) Conduct periodic review to assess coverage of the target beneficiaries through broad consultations with concerned agencies and stakeholders.

e) Expand coverage of the Sponsored Program to fully utilize the earmarked funds generated from the Sin Taxes to include the following:

- Persons with disabilities (PWDs) - Under-five children - Senior citizens - Survivors of disasters, wars, armed conflicts and human rights abuses - Ex-prisoners/detainees during the first two years of release or until they are able to find

gainful employment - Displaced Overseas Filipino Workers (OFW) who were repatriated due to disasters, wars,

trafficking, and human rights abuses (free coverage for the first two year after repatriation or until they are able to find gainful employment

- Consider the enrolment of pregnant and lactating women, regardless of marital status (whether legally married/eligible dependent or not), as priority target for the Sponsored Program

Review the expanded listing of SP beneficiaries based on the addition revenues generated from the Sin Taxes. Assess which recommendations have been acted upon by the concerned agencies, specifically by DSWD and Philhealth.

Information Dissemination and Awareness-Building

a) Implement an effective information, education and communications (IEC) program to improve awareness and knowledge of SP beneficiaries on Philhealth services and benefit package, particularly towards promoting knowledge and utilization of primary care benefits and to avail of all the benefits during confinement, specifically the No Balance Billing benefit and case rate packages.

b) The DOH, Philhealth and LGUs should take a pro-active role to sustain the IEC initiatives with concrete results, specifically in terms of improved health practices and increased utilization of Philhealth benefits. Ensure coordination among the concerned agencies and local governments and CSOs to maximize the impact of the IEC initiatives.

c) Conduct sustained information campaigns using effective and preferred communication strategies such as seminars/orientation meetings, home visits to personally explain Philhealth services and benefits, and television ads.

These information drives should be complemented by outreach healthcare programs and personal health advising because of the tendency of most individuals to ignore ailments until these have become serious.

Accreditation of Health Facilities

a) Ensure the accreditation of all national and local health facilities, including Rural Health Units and lying-in clinics. A clear timeline should be targeted for the accreditation of such facilities.

b) The DOH and Philhealth should rationalize its accreditation system, ensuring a unified and standardized system of accreditation.

c) Hasten the process of accreditation by providing the needed assistance to LGU and local health facilities. The DOH and Philhealth should take a pro-active stance to fast-track the accreditation of all public health facilities. Both agencies, along with the concerned LGUs, should be jointly liable for problems and delays in the accreditation process.

d) Improve access to health services by Increasing the number of LGU/DoH accredited health facilities able to provide primary care benefit package, TB-dots, health MDGs and hospitalization benefits for common and critical illnesses.

Expansion of Benefit Package

a) Develop more benefit packages (case rate packages) to cover the most common illnesses of indigents to ensure responsiveness to the health needs of the poorest.

b) Increase in Philhealth investment in primary health care, specifically by increasing the “capitation” fund and improving the monitoring of the utilization of the fund by PCB providers.

c) Conduct periodic review with the participation of LGUs, CSOs and other stakeholders to assess and improve the benefit packages, case rate payments and allocation for PCB.

Inter-Agency Coordination

a) Conduct regular continuing consultations among concerned government agencies, including LGUs, DOH, Philhealth, CSOs and other stakeholders.

b) Hold regular dialogues between concerned government agencies and Philhealth members/SP beneficiaries.

Information Management System

a) Install a sound system for recording, processing, retrieval and management of all relevant information and data related to Philhealth services, performance and financial transactions.

b) Establish clear guidelines to improve recording, encoding, and management of data for all Philhealth services and benefits.

c) Consolidate/interface existing databases, specifically Philhealth, DSWD’s NHTS-PR; NSO, DOH, LGU administrative data and DILG’s CBMS.

d) Ensure easy access and retrieval of disaggregated information related to Philhealth membership, claims, and benefit payments. For this purpose, the Philhealth information sheet used in this tracking study may be used as one of the references.

References Commission on Audit (COA). (2013). Annual Audit Report on the Philippine Health Insurance

Corporation, for the year ended December 31, 2012. Retrieved from http://www.coa.gov.ph/2012_AAR/GOCCs/Zipfiles/PHIC_aar2012.zip

Department of Budget and Management (DBM), Department of Health (DOH), Philippine Health

Insurance Corporation (NHIC). (2012). Joint Circular No. 2012-0424. Guidelines on the Implementation of Special Provision (SP) No. 15 on the National Health Insurance Program (NHIP) for Indigents, Department of Health (DOH) under Republic Act (RA) No. 10155, the FY 2012 General Appropriations Act. Retrieved from http://www.philhealth.gov.ph/joint_circulars/2012/jc2012-0424.pdf

Department of Health (DOH). (2010). Administrative Order No. 2010-0036. The Aquino Health

Agenda: Achieving Universal Health Care for All Filipinos. Retrieved from http://www.doh.gov.ph/sites/default/files/Aquino%20Health%20Agenda%20-%20Universal%

Department of Health (DOH). (2010). Toward Financial Risk Protection, Health Care Financing

Strategy of the Philippines 2010-2020. Health Sector Reform Agenda Monograph No. 10. Manila: DOH. Retrieved from http://www.scribd.com/doc/35105401/Health-Care-Financing-Strategy 2010-2020-Philippines

Department of Health (DOH). (2011). Department Order No. 2011-0188. Kalusugan Pangkalahatan

Execution Plan and Implementation Arrangements. Retrieved from http://www.doh.gov.ph/sites/default/files/Kalusugan%20Pangkalahatan.pdf

Department of Health (DOH). (2012). National Objectives for Health Philippines, 2011-2016 Health

Sector Reform Agenda Monograph No. 12. July 2012. Manila: DOH. Retrieved from http://www.doh.gov.ph/content/national-objectives-health-2011-2016.html

Lagrada, L. (2013). Philhealth Primary Care Benefit – Assessment of Initial Implementation. (Powerpoint Presentation). Retrieved from the website of Philippine National Health Research System of the Department of Science and Technology http://www.healthresearch.ph/

National Statistics Office (NSO) [Philippines], and ICF Macro. (2009). National Demographic and

Health Survey 2008. Calverton, Maryland: National Statistics Office and ICF Macro. National Statistical Coordination Board (NSCB). (2013). NSCB website for data on poverty and the

MDGs retrieved from http://www.nscb.gov.ph National Statistical Coordination Board (NSCB). (2013). The Philippine National Health Accounts,

2005-2011. Retrieved from http://www.nscb.gov.ph/stats/pnha/publication/ NSCB_PNHA%202005-2011.pdf

Philippine Health Insurance Corporation (PHIC). (2013a). 2012 Annual report, Arangkada Tungo sa

Pangkalahatang Kalusugan. Retrieved from http://www.philhealth.gov.ph/about_us /annual_report/ar2012.pdf

http://www.scribd.com/doc/35105401/Health-Care-Financing-Strategy

http://www.scribd.com/doc/35105401/Health-Care-Financing-Strategy

http://www.doh.gov.ph/content/national-objectives-health-2011-2016.html

http://www.nscb.gov.ph/stats/pnha/publication/%20NSCB_PNHA%202005-2011.pdf

http://www.nscb.gov.ph/stats/pnha/publication/%20NSCB_PNHA%202005-2011.pdf

Philippine Health Insurance Corporation (PHIC). (2013b). 2012 Stats and Charts. Retrieved from

http://www.philhealth.gov.ph/about_us/statsncharts/snc2012.pdf

Philippine Health Insurance Corporation (PHIC). (2013c). Financial Statements as of September 30,

2013. Retrieved from http://www.philhealth.gov.ph/about_us/annual_report/

PhilHealth_FS_2013September.pdf

Philippine Health Insurance Corporation (PHIC). (2013d). Philhealth Citizen’s Charter 2013. (Revised

November 2013). Retrieved from http://www.philhealth.gov.ph/news

/updates/2013/Citizens_Charter_2013_Revised.pdf

Philippine Health Insurance Corporation (PHIC). (2013e). Strategic Initiatives Profile. Retrieved from

http://www.philhealth.gov.ph/about_us/transparency/

major_programs_projects/PhilHealth_Strategic_Initiative_Profile_PES2_090213.pdf

Philippine Health Insurance Corporation (PHIC). (2013f). Table on Distribution of Philhealth members

by Province and membership category. (Table in letter of PHIC submitted to the Department

of Health dated February 28, 2013). Retrieved from

http://www.philhealth.gov.ph/about_us/

transparency/accomplishment_report/2012_PhilHealth_Corporate_Accomplishment_Repor

t.pdf

Philippine Health Insurance Corporation (PHIC). (2013g). Table on Distribution of Philhealth members

by Province and membership category with count of Dependents as of September 2013.

Retrieved from http://www.philhealth.gov.ph/about_us/transparency

/accomplishment_report/ PHIC_Enrollment_September2013.pdf

Republic Act No. 10606. National Health Insurance Act of 2013. Retrieved from

http://www.philhealth.gov.ph/about_us/ra10606.pdf Republic Act No. 10606 and its Implementing Rules and Regulations. Retrieved from

http://www.philhealth.gov.ph/about_us/ra7875_as_Amended_NHIActof2013.pdf

Republic Act No. 10155. General Appropriations Act Fiscal Year 2012 (Philippine National Budget for

2012). Retrieved from http://www.dbm.gov.ph/?page_id=775.


2013). Retrieved from http://www.dbm.gov.ph/?page_id=5280.


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of the Actual Coverage and Variations Across Regions and Provinces. Discussion Paper Series

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No. 2014-19, Philippine Institute for Development Studies. Retrieved from

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Soria, F. ( ). Philhealth’s Initiatives: Financing and Access to Medicines. Retrieved from

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content/uploads/2013/09/Soria_Drug_policy_forum_AIM.pdf

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http://uhc-medicines.org/wp-content/uploads/2013/09/Soria_Drug_policy_forum_AIM.pdf

ANNEX A - Survey Instrument

Citizen Report Card Questionnaire: Individual Philhealth Members

Sponsored Program Beneficiaries (NHTS-PR)

Target Respondent: NHTS-PR Sponsored member or spouse/partner of sponsored member, or household member 21 years old and above with adequate knowledge of the sponsored family’s health situation. Reference is masterlist of NHTS-PR in the area. INTRODUCTION OF SURVEYOR: How are you? My name is _______and I am working with Action for Economic Reforms. We are conducting a survey about the Philhealth sponsored program. We would very much appreciate your participation in this survey. All of the answers you give will be confidential

Household/Respondent number:

I. Identification 1. Province: 2. Municipality /City : 3. Barangay:

4. Interviewer: 5. Date of Interview: (DD/MM/YYYY) 6. Time:

start end

7. Name of Interviewee/Respondent:

8. Relation to Sponsored member:

II. Background of Philhealth Sponsored Member 9. Name of Philhealth sponsored member:

______________________________________________________

(SURNAME) (FIRST NAME)

10. Sex: 1 Male 2. Female 11. Age: 12. Civil status:

13. Economic Activity/Job: 14. Educational Attainment:

15. Name of spouse/live-in partner:

___________________________________________________________

((SURNAME) (FIRST NAME)

16. Age: 17. Civil status:

19. Economic Activity/Job: 20. Educational Attainment:

III. Membership Status

21. Does the sponsored member have a PhilHealth card/ID? 1 YES 2 NO

22. May we see this Philhealth card/ID? 1 Shown 2 Not

shown

# of families in HH _____________ # of Philhealth members _______

23. Does the sponsored member have a Member

data record (MDR)?

DATE 1 YES 2 NO

24. May we see this MDR (Member Data Record)? 1 Shown 2 Not

shown

25. How many Philhealth beneficiaries are there (count member and

his/her dependents? Number:

26. Does the sponsored member know who sponsored his/her

current Philhealth membership? 1 YES 2 NO

27. If YES, who sponsored his/her current Philhealth membership?

28. Since when did he/she become of member of the Philhealth Sponsored

program? Date:

DK

29. Until when is this Philhealth sponsorship valid? Date: DK

30. Has he/she been a sponsored Philhealth member before this? 1 YES 2 NO DK

31. If YES, since when? Date: DK

32. Who sponsored this previous membership to PHilhealth? DK

IV. Information

33. Did your family receive any information/invitation explaining the

benefits of the Philhealth sponsored program? 1 YES 2 NO

34. Has anyone explained to you the benefits and processes involved

in the Philhealth sponsored program? 1 YES 2 NO

35. Did you attend any meeting/seminar/orientation on the

Philhealth sponsored program? 1 YES 2 NO

36. Did you get any material (e.g. reading material, brochure) about

the benefits and processes of the Philhealth sponsored program? 1 YES 2 NO

37. Do you know the benefits of the Philhealth Sponsored Program? 1 YES 2 NO

38. If YES, what are these benefits?

39. If Free, please identify what would you say is free?

40. How adequate is your knowledge/information about the Philhealth sponsored program

benefits and processes? (Select one answer from the visual)

1. HIGHLY ADEQUATE 2. ADEQUATE 3. INADEQUATE 4. HIGHLY INADEQUATE

41. What is the most effective way for members to get information on the Philhealth sponsored

program?

1 Radio 2 TV 3 House-to-house 4 Brochure 5 Others

_____________________

V. Family Health and the Primary Care Benefit (PCB) Package 42. Have you heard of/Do you know the Primary Care Benefit package of

Philhealth? 1 YES 2 NO

Explain the primary care benefit package before proceeding to the next question. Table for RHU/health center and health services availed during July 1, 2012 until June 30, 2013? 43. Who are the Philhealth

Sponsored Beneficiaries in

the family? (List all the

Philhealth family – name of

member and all his/her

dependents)

44. Has ___ visited the

Rural Health

Unit/health center for

check up or

consultation between

July 1, 2012-June 30,

2013?

1 YES

2 NO

45. What free

laboratory or

diagnostic test did

____ undergo?

1 for blood

2 for urine

(urinalysis)

3 X-ray

4 others (specify___)

(NOTE IF NOT RHU &

WHY)

46. Who had pre-

natal check up

between July 1,

2012-June 30,

2013?

1 YES

2 NO

3 Not applicable

1.

2.

3.

4.

5.

6.

7.

*IF Philhealth family is more than 7, write total number and use a separate sheet of paper to record the information in the matrix. 47. For those who visited the health unit/center, how satisfied are you with the benefits and

services for the Philhealth sponsored member; Were you very satisfied, satisfied, dissatisfied

or highly dissatisfied with the benefits/services?

1. VERY SATISFIED 2. SATISFIED 3. DISSATISFIED 4. HIGHLY DISSATISFIED

48. How can Philhealth improve the Primary Care Benefit Package for the sponsored

program?

49. For the Philhealth member and dependents who did not go for check up or consultation

at the rural health unit/health center, why did they not consult? (Primary reason only)

1. Do not know the benefits of the PCB 2. Do not have time to visit the health center/rural health unit 3. The RHU/health center is far 4. Do not have money 5. Not sick 6. Others. Specify ________________________________________________________

VI. Family health and hospitalization 50. Did anyone got sick, injured, or gave birth between July 1, 2012 to

June 30,2013 among the Philhealth sponsored member and his/her

dependents?*

YEAR

1 YES 2 NO

*If NO, skip to # 90 if not married.

51. If YES, how many got sick, injured or gave birth? Bilang:

52. If YES, who got sick, injured or gave birth? List all their names.

1. 2. 3. 4.

5.

53. Did they consult/sought medical care from any health worker such as a doctor,

nurse or midwife? 1 YES 2 NO

54. If NO, did not consult, why did they not consult/seek medical care?

1. Do not know the benefits of Philhealth sponsored program beneficiary 2. Do not have time, or busy, or have many other things to do 3. The hospital or health center/Rural health unit is far. 4. Do not have money 5. Others, specify

___________________________________________________

55. Among those who got sick, was injured or gave birth, was there anybody

confined in a hospital or health facility? 1 YES 2 NO

56. If YES, how many were confined (for more than 24 hours)? Bilang:

57. Among those who got sick, was injured or gave birth, was there anybody

confined in a hospital or health facility Para sa mga nagkasakit, naaksidente o

nanganak ngunit hindi na-confine sa ospital o paanakan, bakit hindi na-confine?

1. Do not know the benefits of Philhealth sponsored program beneficiary 2. Do not have time, or busy, or have many other things to do 3. The hospital or health center/Rural health unit is far. 4. Do not have money 5. Others, specify

___________________________________________________

IF SOMEONE WAS CONFINED IN THE HOSPITAL/BIRTHING FACILITY, SKIP TO QUESTIONS 58 – 89 IN CRC QUESTIONNAIRE B. EACH PERSON CONFINED SHOULD ANSWER CRC QUESTIONNAIRE B. REFER TO THE NUMBER OF CONFINED BASED ON RESPONSE TO QUESTION #56. IF THE COUPLE IS NOT LEGALLY MARRIED, FILL UP QUESTIONS 90 – 95 BEFORE PROCEEDING TO QUESTIONNAIRE B.

XII. For couples who are not legally married

90. Did the partner get sick anytime from July 1, 2012 to June 30, 2013? 1 YES 2 NO

91. If yes, what was the sickness?

92. Did he/she sought medical care or consult a health worker? 1 YES 2 NO

93. Did he/she spend for this sickness? 1 YES 2 NO

94. Is he/she a Philhealth member? 1 YES 2 NO

95. When did he/she become a PhilHealth member? Date:

CRC Questionnaire B: For Cases of Confinement

VII. Hospitalization

58. Name of confined member/dependent:

59. Did the confined beneficiary go directly to the hospital/birthing facility

or was referred by the health center/RHU to the hospital? 1 Direct 2 Referred

60. Name of the healthcare facility/hospital where beneficiary was confined:

61. Is the hospital/facility Public or Private? 1 Public 2 Private

62. Is the hospital/facility Philhealth Accredited? 1 YES 2 NO

63. Is the reason for confinement included in the case rate packages?

(aided by the enumerator)? 1 YES 2 NO

64. If yes, which Case Rate Package (CRP) was applied?

65. If the CRP used was not known, what was the sickness/ailment?

66. How long was the patient confined in the hospital/facility? (Number of

days)

67. Were you asked to buy medicines or medical supplies? 1 YES 2 NO

68. Did you pay for anything at the billing station prior to being

discharged?

1 YES 2 NO

69. Did the hospital/facility reimburse the cost of medicines or medical

supplies you bought? 1 YES 2 NO

70. How satisfied are you with the Philhealth benefits and services provided during confinement; are

you very satisfied, satisfied, dissatisfied, na natanggap ninyo habang nasa ospital kayo; Kayo ba ay

Lubos na Kuntento …?

1. VERY SATISFIED 2. SATISFIED 3. DISSATISFIED 4. HIGHLY DISSATISFIED

71. How can Philhealth improve the benefits/services and processes of the PHilhealth sponsored

program for those who are confined/hospitalized?

VIII. Admission and Confinement

72. Did the hospital/facility request for the Sponsored Member’s

PhilHealth ID? 1 YES 2 NO DK

73. Did the hospital request for the Member Data Record (MDR)? 1 YES 2 NO DK

74. Did anyone explain the benefits and processes of the Philhealth

sponsored program in the hospital/facility? 1 YES 2 NO DK

75. Was the patient assigned to a No Balance Billing (NBB) bed? 1 YES 2 NO DK

IX. Philhealth Assistance

76. Was there a PhilHealth staff in the hospital/facility? 1 YES 2 NO DK

77. Did Philhealth explain the process/Benefits of the sponsored

program? 1 YES 2 NO DK

78. Did you encounter difficulties/have problems related to Philhealth

processes/benefits for sponsored program beneficiaries? 1 YES 2 NO DK

79. What were these difficulties/ problems encountered?

X. Hospital expenses 80. Did you see/review the document on hospital charges/ claims before

signing on it? 1 YES 2 NO DK

81. Do you have a copy of the document you signed in the hospital? 1 YES 2 NO DK

82. Did the hospital/facility show the list/itemization of expenses that they

charged the patient? 1 YES 2 NO DK

83. Did you see/review the Claim Form 1 of Philhealth? 1 YES 2 NO DK

XI. Room and Board Evaluation

85. Did the patient have 3 meals every 24 hours of confinement? 1 YES 2 NO

86. Was there accessible drinking water? 1 YES 2 NO

87. Were there a clean and accessible comfort rooms within the

room/ward

1 YES 2 NO

88. Was the room well-ventilated? 1 YES 2 NO

89. Did the patient share the bed with other patients? 1 YES 2 NO

*****************************

THANK YOU

CITIZENS REPORT CARD ON THE SPONSORED PROGRAM...

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