PhilHealth TB DOTS Out-patient Benefit Package - TB DOTS Out-patient Benefit Package ......

Click here to load reader

download PhilHealth TB DOTS Out-patient Benefit Package - TB DOTS Out-patient Benefit Package ... –Focus on MCP, NCP, TB DOTS . PhilHealth Financing TB Preventive: BCG vaccine for Newborns

of 23

  • date post

    08-Mar-2018
  • Category

    Documents

  • view

    222
  • download

    3

Embed Size (px)

Transcript of PhilHealth TB DOTS Out-patient Benefit Package - TB DOTS Out-patient Benefit Package ......

  • PhilHealth TB DOTS Out-patient Benefit Package

    WHO Consultation

    Eliminating the Catastrophic Economic Burden of TB: Universal Health Coverage and Social Protection Opportunities

    April 29, 2013

    Sao Paulo, Brazil

    Dr. Mary Antonette Yason Remonte

    MDG Benefit Products Team Head

    Philippine Health Insurance Corporation

  • Outline

    Overview of Health System And Health Care Financing

    Current Efforts

    Challenges

    Future Directions

  • Health Care In the Philippines

    Large informal sector

    Highly decentralized

    Free market

    Large private sector

    Cost of services unregulated

    Out of Pocket expense remains high

  • 11%

    15%

    9% 53%

    10%

    2%

    National Government

    Local Government

    Social Insurance

    Out of Pocket

    Private Sector

    Foreign Funding

    Health Care Expenditure 2010

    Source:NCSB

  • Health Care Financing Flow

  • Current Status of TB in the Philippines

    15th high burden countries in the world (Global TB Report 2012)

    Prevalence 4.7/1000 (NTPS 2007)

    MDRTB 3.9/1000 (NTPS 2007)

    8th leading cause of morbidity (FHSIS 2009)

    25% with TB did not consult any provider (FHS 2011)

  • Treatment Success Rate 2011

    Source: NTP

  • 2010-2016 Philippine Plan of Action to Control Tubeculosis

    Localized implementation of TB Control

    Monitor health system performance

    Engaged both public and private providers

    Promote positive behavior of commmunities

    Address MDR TB, TB-HIV, and vulnerable populations

    Regulate and make available diagnostic tests and drugs

    Certify and accredit TB care providers

    Secure adequate funding and improve allocation and efficiency of fund utilization

  • Universal Health Care

    Financial

    Risk

    Protection

    Improving

    Access to

    Quality

    Health

    Facilities

    Attainment of

    MDGmax

    Better health

    outcomes

    Responsive health

    system

    Equitable &

    sustainable health

    financing

    Health

    Financing

    Service

    Delivery

    Policy,

    Standards and

    Regulation

    Health

    Human

    Resource

    Health

    Information

    Governance

    for Health

  • Universal Health Care Financial Risk Protection

    Enrollment of the poor to SHI by the National Government (5 million thru NHTS-PR)

    Coverage of catastrophic cases (Z benefits)

    No balance billing policy for the poor

    Access to quality health services

    Health facilities enhancement

    1,178 RHUs upgraded

    Attainment of health related MDG goals

    Focus on MCP, NCP, TB DOTS

  • PhilHealth Financing TB

    Preventive: BCG

    vaccine for Newborns

    TB Screening

    and Diagnosis

    TB DOTS Treatment

    Screening and

    Diagnosis for DRTB

    Treatment for DR TB

    In-patient Admission

    PCB 1 Package

    (Capitation)

    TB DOTS Out-patient

    Package (new Cases)

    (Case Rate)

    In-Patient Benefit (Fee for Service )

    Newborn Care

    Package (Case Rate)

    Vaccine thru EPI

    Supplies thru NTP

    Meds and supplies thru NTP

    Supplies/ capital outlay

    thru NTP

    Meds and Supplies thru NTP

    DOH owned

    hospitals

    PhilHealth

    DOH

  • Qualified dependents of members

    No limit as to number of births

    Who can avail

    Non-hospital facilities

    Maternity and Lying-in Clinics

    Hospitals Who provides

    Newborn care

    Screening tests newborn screening and hearing

    Vaccination hepatitis B and BCG EINC protocol

    What services

    P 1,750

    No balance billing

    Important Features

    Newborn Care Package

  • Sponsored Program NHTS and LGU Sponsored

    Organized Group

    Overseas Workers Program

    Who can avail

    Rural Health Centers

    Health Centers

    Out Patient Department of Government Hospitals

    Who provides

    Primary Preventive Services-

    Diagnostic Examinations including sputum examination Medicines for Common diseases

    What services

    Assignment and enlistment of PhilHealth member to Primary Care Provider

    Individual Health Profile including symptoms suggestive of TB Electronic reporting with additional incentives

    Important Features

    Primary Care Benefit 1 Package

  • Members and qualified dependents Who can avail

    TB DOTS Centers (RHUs, private clinics, OPDs of hospitals) Who provides

    Service fee

    Drugs and medicines

    Follow up sputum smear What services

    P 4,000 Important Features

    TB DOTS Package

  • Members and qualified dependents Who can avail

    hospitals Who provides

    Room and board

    Professional fees

    Medicines and supplies

    Laboratory and other diagnostics

    What services

    For admissions only

    Case rate and fee for service

    Important Features

    In Patient Benefits

  • Challenges

    53% of towns and cities have accredited TB DOTS facilities

    Low utilization

    Incomplete claims defaulters?

  • Number of PhilHealth Engaged TB DOTS Providers

    8 29108

    385474

    627709

    813

    1090

    1201

    0

    200

    400

    600

    800

    1000

    1200

    1400

    2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

    PCB Providers 2138

    Source: PhilHealth AD

  • 0 0.291.55

    6.57.17

    20.2

    25.50

    28.3929.39

    12.15

    0

    5

    10

    15

    20

    25

    30

    2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

    In m

    illio

    ns o

    f p

    eso

    s

    Year

    TB DOTS Package Reimbursement

    Note: partial data for 2012

    Source; PhilHealth TFI

  • Source: PhilHealth TFI

  • Future Directions Simplified accreditation approach

    PhilHealth Engagement thru Accreditation & Contracting of Health Services

    Automatic Accreditation, decentralization

    Increased coverage of the poor Sin Tax Law premium for next quintile

    Increase coverage for the TB conditions Category II to be included in TB DOTS Package

    MDRTB for study

    Improved quality of care payment upon completion of treatment

    Quality standards for out-patient facilities on the works

  • Health Care Financing Flow

  • Health Care Financing Flow