NHIP FP MCH

8/19/2019 NHIP FP MCH

1/49

Updates on NHIP Utilization on NHIP

FP-MCH Benefits

November , 201

Neoman !" !o#as


2/49

Conte#t

Kalusugang Pangkalahatan or Universal Health Care identified the role of

NHIP as one of the three major strategies in insuring Universal Health Care

for All Filipinos.

Private $e%tor Mobilization for Famil& Healt' 2


3/49

$(CI)* H+)*H IN$U!)NC+

A scheme for mobilizing andutilizing resources through a RISKPOOLING & SHARING mechanism

to INAN!" the health care needsof the members in a manner thatre#ects the $alues of SOLI%ARI'

and SHAR"% R"SPONSI(ILI' forhealth care)


4/49

RA !" as amended #$ RA %&'(

)he National Health Insuran*e +a, and RA (- &-(/

Philippine Health InsurancePhilippine Health Insurance

CorporationCorporation

The Mandate of PhilHealth was founded onArticle 13, Section 11 of the 1987 PhilippineConstitution

It stated ! The State shall adopt aninte"rated and co#prehensi$e approach tohealth de$elop#ent which shall endea$or to#a%e essential "oods , health and other

social ser$ices a$aila&le to all the people at


5/49


6/49

o attain niversal %overa.e P'ilHealt'o attain niversal %overa.e P'ilHealt'

'as a pro.ram for /"'as a pro.ram for /"

ear $alar&Cap

Ma# otalContribtion

Per Mont'

&-- P /-0--- P "-.--

&-- P &"0--- P &".--

&--" P &-0--- P "--.--

&--' P ("0--- P /".--

&--& P (-0--- P &"-.--

&--( P 0"-- P (!."-

&--- P "0--- P (&".--

2"3 of t'e

$alar&


7/49




8/49

Individall& Pa&in. Pro.ram

P2,400 )nnal Premim Contribtions




9/49




10/49

$ponsored Pro.ram for t'e Poor

NH$5 $ponsored6 Per Famil& Performan%e!ate

o attain niversal %overa.eo attain niversal %overa.e

P'ilHealt' 'as a pro.ram for /"P'ilHealt' 'as a pro.ram for /"


11/49

C'allen.es fa%in. FP-MCH pro.rams

Improve

FP-MCHoutcomes

NHIP as a lever supporting PPP for FP-MCH

Public Health attained through PPP


12/49

NHIP FP-MCH Benefits

FP-MCHBenefits &pe of Pa&ment )mont

1CP Case Pa$ment P!0---

N23 Case Pa$ment P0"--

NCP Case Pa$ment P(0"-

4)+ Case Pa$ment P'0---

N25 Case Pa$ment P'0---

N23 ,ith 4)+ Case Pa$ment P(-0"--

IU3 Fee for 2ervi*e P(--- 6&--- R5U2*ale

7P48PC4 PFPR 9per famil$pa$ment rate: P"-- per famil$Private $e%tor Mobilization for Famil& Healt' 2


13/49

Nmber of Claims

N$7, MCP and C$

'ear


14/49

)mont Paid for N$7, MCP and C$


15/49

(acilit) Mappin" *as of Apr +1+-

**+ Accredited ,!P -ro$iders

.7 munici-alities out of 1./. munici-alities andcities ha$e at least one ,!P -ro$ider

Total no.

off Mun =

1646 44 (/( !( (/- (-- (-% ((' (// (/& ('/ ( %/ '% '% / ((% 75

w/ MCP & &! && / /( &( " " & ((" ' / (% (! &! &/ &!

w/o MCP ( (-/ "% %' % !! "! (- &! &" " /- /( '" % '


16/49

'e NHIP 8ale C'ain for FP MCH


"nrolment .tilization of P /(L0 NS10I.%2 and ,!H /NS%0 ,!P0N!P2 bene3ts in accredited

facilitiesAccreditation

4%octors0 mid5i$es4Hos-itals0

,!P0N!P

!laims for Pand ,!H

-ac6ages

!laimreimbursemen

t for P and,!H -ac6ages

ProcessingPhilHeal

th(ene3ts

deli$ered to P7

,!Hclients

inancing

-rotection

for (L0NS10 I.%

inancing

-rotectionfor NS%0

,!P0 N!P

Amoun

t ofbene3t

-a8me

nt fromNHIP


17/49

NHIP +nrolled Families in NC!as of Mar%' 1, 2011

0nrol#ent.tilization of P /(L0 NS10 I.%2 and ,!H/NS%0 ,!P0 N!P2 bene3ts in accredited


4%octors0 mid5i$es4Hos-itals0 ,!P0N!P

!laims for P and ,!H

-ac6ages

!laim reimbursementfor P and ,!H

-ac6ages

Processing

PhilHealth(ene3ts

deli$ered toP7,!H clients

inancing-rotection for

(L0 NS10 I.%

inancing

-rotection forNS%0 ,!P0 N!P

Amount ofbene3t

-a8mentfrom NHIP


18/49

Nmber of NHIP )%%redited Fa%ilitiesas of Mar%' 1, 2011

0nrol#ent.tilization of P /(L0 NS10 I.%2 and ,!H/NS%0 ,!P0 N!P2 bene3ts in accredited


2octors, #idwi$esHospitals, MCP,CP


-ac6ages


-ac6ages

Processing

PhilHealth(ene3ts



(L0 NS10 I.%

inancing


Amount ofbene3t

-a8mentfrom NHIP


19/49

MCH Claims9 :an 2011- 7e%ember 2011

49:):; of deli$eries

* o ; P a & m e n t


20/49

FP %laims9 :an 2010 - Mar%' 2011


21/49

Potential NHIP FP Benefits in NC!

0nrol#ent4tili5ation of (P *6T, S, I42- and

MCH *S2, MCP, CP- &enets inaccredited facilities

Accreditation



-ac6ages


-ac6ages

Processing

PhilHealth(ene3ts



(L0 NS10 I.%

inancing


Amount ofbene3t

-a8mentfrom NHIP

Nmber of nmetneed

)%tal

Potential #enefit from4)+ 9;Num#er oflimiters8/< = P'0---

Php ((.' 1 Php (.' 1

Potential #enefit fromIU39;Num#er of limiters8/<= P/--:

!. 1 &0&(

Potential #enefit from

FP

(&".( 1 (.' 1


22/49

*osses in implementation and %'allen.es

"nrolment .tilization of P /(L0 NS10I.%2 and ,!H /NS%0 ,!P0N!P2 bene3ts in accredited


4%octors0 mid5i$es4Hos-itals0

,!P0N!P

!laims for Pand ,!H

-ac6ages

!laimreimbursemen

t for P and,!H -ac6ages

ProcessingPhilHeal

th(ene3ts

deli$ered to P7

,!Hclients

inancing

-rotection

for (L0NS10 I.%

inancing

-rotectionfor NS%0

,!P0 N!P

Amoun

t ofbene3t

-a8me

nt fromNHIP

Members need FP-MCH services

Did not useUsed but did not claim

or reimburse

Health professionals and institutions

are able to provide FP-MCH services

Did not provideProvided but did not

reimburse or was not

paid

PhilHealth is willing and able to pay

Can only pay clients and

providers upon

compliance with

procedures

LGU could secure additional

financing

Did not or could not

avail

DOH need to

increase outcomes

Minimal

influence


23/49

UP7)+$

Ne, >ngagement Pro*ess for Health Providers? PHICCir*ular? (/ ser. &-(&

Features@

Automati* a**reditation of government health fa*ilities

health personnel

3evelopment of ne, additional medi*al 9//: and

surgi*al 9(%: *ase rates

3e*entraliBe a**reditation 2$stem 9third part$

a**reditation :

+aun*hing of enhan*ed 1CP pa*kage 9in*ludes FP

#enefit pa*kage0 IU3 as *ase pa$ment:



24/49

MCP $mmit

7#je*tives

2ho,*ase good pra*ti*es

Highlight efforts of ea*h organiBation

>mphasis on *ooperation and partnership to,ards a

*ommon goal

Agreement to ,ork together in the *onte=t of so*ial

health insuran*e and Kalusugang Pangkalahatan


25/49

MCP $mmit

Conferen*e of organiBations ,orking for 1aternal

and Child Health

>a*h organiBation ,ill present their efforts and plans Re +aun*hing of 1CP pa*kage

3e*laration of Commitment to,ards 13D ' and "


26/49

Maraming Salamat!


27/49

FP Case rates in%lded in t'e development of an en'an%ed

MCP Pa%


28/49

Potential MCH Benefits from NHIP in NC!

0nrol#ent4tili5ation of (P *6T, S, I42- and

MCH *S2, MCP, CP- &enets inaccredited facilities

Accreditation



-ac6ages


-ac6ages

Processing

PhilHealth(ene3ts



(L0 NS10 I.%

inancing


Amount ofbene3t

-a8mentfrom NHIP

Nmber ofdeliveries

NHIP eli.ible =1"2

3 >3 of Birt's ;it'Birt' order 4 andBelo;?

MCP-N$7 P'p@,000

NCP P'p

1,=0

CA::CA :+0?)+ ,

MA;ATI 99+ :): , @)> ,

MA2A4


29/49

*zon Healt' e%'ni%al )ssistan%e for P'ilHealt'

FP-MCH Benefits9


$pport in a%%reditation of MCP >Fa%ilit& and

Providers?

7evelopment of assessment tool to fa%ilitate

a%%reditation"

$pport in )%%reditation of !HUs for PCB 1>Fa%ilit& and Providers?

7evelopment of assessment tool to fa%ilitate

a%%reditation"


30/49

PHI*H+)*H$ N(!M)*

7+*I8+! )N7 M)+!NIC)!+ P)C)D+$


31/49

7efinition of erms

Normal Spontaneous Delivery Package (NSD)

• Package applicable to accredited hospital facilities

Maternity Care Package (MCP)

• Package applicable to non-hospital facilities/ outpatient

providers that can provide services required of them


32/49

!eimbrsement !les

• Utilizes the case rate (PC 11 s. 2011)

o

Level 1 and Outpatient clinics – Php 8,000o Level 2 to 4 – Php 6,500

• Only duly accredited hospital or out-patient clinicshall be reimbursed

• Strict enforcement of No Balance Bill (NBB) policy

in all MCP/ NCP providers

o For all of membership types and their dependents


33/49

•

Nmber of )%%redited N$7 and MCP

Providers


34/49

•

)%%redited MCP Providers


35/49

•

)%%redited MCP Providers >per P!(? as of

7e%ember 1, 2011


36/49

$tandards for )%%reditation of Professional

Providers

)he provider for the 1CP shall #e 1id,ife or

Ph$si*ian dul$ a**redited #$ PhilHealth

(. 2tandards for A**reditation of 1id,ives as

Providers of the 1CP&. 2tandards for PhilHealth A**reditation of

Ph$si*ians as Providers of the 1CP

)he provider shall render the 1C Pa*kage servi*es

in a non6hospital fa*ilit$ a**redited #$ PhilHealth )he Provider shall #e allo,ed affiliation to a

ma=imum of three a**redited fa*ilities for the 1CP

$tandards for )%%reditation of MCP


37/49

$tandards for )%%reditation of MCP

Providers >Clini%?PhilHealth Circular No. 30 s. 2009

(. 2ervi*e Capa#ilities

&. )e*hni*al 2tandards

&.( Deneral Infrastru*ture

&.& 4asi* Consultation and 3eliver$ Room

>Euipment

&./ 2tandard supplies

&.' Re*ords management

&." Availa#le transport vehi*le for emergen*$

*ases

&. Human Resour*e

/. ualit$ Assuran*e A*tivities


38/49

1. Provide Services for:

Prenatal Care

Normal 3eliver$

Ne,#orn Care In*luding Ne,#orn

2*reening 9RA %&!!:

Health >du*ation

1aterials for health edu*ationFamil$ Planning

4reastfeeding

Post Partum Care


39/49

2" e%'ni%al $tandards

&.( Deneral Infrastr%tre 3eliver$ room ,hi*h in*ludes the follo,ing?

4irthing area

Area for *leaning #a#$8 instruments Patient room8s

AdeEuate signage

)oilet 91inimum of ( for ( to #eds and additional

( toilet for ever$ additional #eds:

/%


40/49

2"2 Basi% Consltation and 7eliver& !oom

+Eipment Non6mer*urial thermometer and 4P

apparatus

Neonatal or pediatri* am#u#ag ,ith neonatal

mask

N23 set 9minimum of & sets:

Cord dressing set 9minimum & sets:

3roplight


41/49

(t'er !eEirements9Fire safet& provisionBassinet or ne;born ress%itation

tableProperl& labeled, %olored .arba.e%ontainers$eparate re%epta%le for disposin.

pointed or s'arp obe%ts$terilizer or its eEivalentPatients bed+#aminin. table


42/49

2"4 !e%ords Mana.ement

2"4"1" )dmission !e.ister ;it'

mont'l& smmar&Case no"

Nameofpatient

7ate ofbirt'

)ddress

Members'ip >NHor NN?

7ateandtime ofadmission

)dmittin.dia.nosis

7ate andtime of7is%'ar.e

&-((6--(

Re$es0Goan1artin

7*t. (0(%!"

& 3on1anuel2t.0 +a+oma 0

C

NH 1ar*h&%0 &-((/?'" P1

D&P(PU/%,ksin

la#or

1ar*h /-0&-(((?/-P1

&-(-6&

2antos0GosefinaRamos

Ganuar$(-0(%

!%A (-th Ave.0Caloo*anCit$

NN 1a$ !0&-(('A1

D"/!,ks inla#or

1a$ !0 &-((((P1

2 A H !


43/49

2"A" Hman !esor%e

P'ilHealt' a%%redited professional provider

Clini% )ide >fll time or on-%all?

(n-%all partner p'&si%ian5s of professionalprovider

Pro$ider Partner M2s

Obstetrician7g8necologist Ph8sician for Pediatriccases

Pediatri*ian Ph$si*ian for o#stetri* *ases

7thers 9mid,ife0 generalpra*titioner0 internist0 Famil$Ph$si*ian:

Ph$si*ians for o#stetri**ases and Pediatri* *ases


44/49

THE MIDWIFE:Licensed practitioner.

Member in good standing of a PHIC recognized nationalassociation of midwives.Possesses competency on the expanded functions ofmidwives.raduates from school year !""# and onwards

$ need not submit a certificate of training

raduates before !""# shall submit a trainingcertificate any of the following%

&raining program accredited by the CP' Council ofthe (oard of Midwifery of the Professional

)egulation Commission *P)C+, or -H$recognized training program

/ 0hall have one partner M- for b cases and one forpedia cases


45/49

The midwife shall have two (2 P!"T#E"PH$SI%I!#S& o'e for ostetric cases a'do'e for 'ewor' cases

/ 1 -iplomate or 2ellow of the P)*S+ PPS+P!FP, or

/ raduate of P03 PP03P12P accredited b$yne 3 Pediatrics 32amily Medicine residency

training program, or/ Physician who completed at least a six

months in$service training in ($45' *forgovernment physician+ or &raining on,Em)#% or %Em)#%


46/49

I' lie- of the M)! with the art'er h/sicia's&the followi'0 ma/ also e s-mitted:

M1 with PhilHealth accredited hospital *atleast level two+

ILH6 M1 which allows sharing ofresources *municipalities or cities withexisting ILH6+

M1 with -H$certified ('m5C$

C'mo5C networ7


47/49

'e Ne;born Care Pa%PC no. 11 s. 2011?

D>N>RA+ RU+>2?

Providers?

Currentl$ a**redited as a Non6hospital fa*ilit$

Certified N2F #$ N2RC of the NIH or #$ 37H Reim#ursement s*heme? Case pa$ment

Appli*a#le to N4 of Eualified mothers ,ho *omplied ,ithPHIC reEuirements

N42 should #e performed after the &'th

hr of life #ut notlater than / da$s from #irth of non6pro#lemati* #a#ies or

,ithin da$s from #irth of N4 in the NICU

Ne;born Care Pa%


48/49

20SC>IPTI0 T0>MSP>:P:S0

2

Pro$ision of essential ne5born care to includethe follo5ingB cord clam-ing0 dr8ing of thene5born0 immediate s6in7to7s6in contact05ashing0 breast feeding0 5eighing of the

ne5born0 e8e -ro-h8laCis0 1it) Kadministration0 (!G $accination0 He-atitis (immunization /9st dose2

=


49/49

$+!8IC+$ N( D8+N )M(UN ( B+

7+7UC+7 F(!MC)$+ !)+

Ne,#orn 2*reening )est 9N42: P ""-

Ne,#orn Hearing 2*reening )est7nl$

P&--

4oth N42 and Ne,#orn hearing2*reening )est:

P"-

Ne;born Care Pa%

NHIP FP MCH

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