Shirley B. Domingo, MD, MPH Philippine Health Insurance Corporation

1. PhilHealth Vision and Strategies for Health Care Financing Reforms for Better Coverage of Essential Medicines Shirley B. Domingo, MD, MPH Philippine Health Insurance Corporation OIC, Office of the Senior VP, Health Finance Policy Sector Group VP, Quality Assurance Group

2. Goal of NHIP • “Provide all citizens with the mechanism to gain financial access to health services” • Repiblic Act 7875

3. Social Insurance: highest growth rate at 24.9 percent or around P4.0 billion increase in 2005. SOURCE: NSCB, 2005 Philippine National Health Accounts

4. Source: 2005 Philippine National Health Accounts

5. Trends of Health Expenditure by Source of Funds Source: Philippine National Health Accounts

6. SITUATIONER

7. In billions Source: Financial Statement

9. Drug Reimbursement based on PNDF Reimbursement limits are dependent on: MDRP Case type Level of hospital Rational drug use Provider Payment Mechanism: Fee for Service (Inpatient Care) D&M Limit depending on case type and hospital level (2,700 - 40,000) Case Payment (Selected In and Out Patient Care) Payment for D&M incorporated into the payment Capitation (Out Patient Package) Situationer

10. STRATEGIES

11. Patient Care Drugs are selected and procured based on organization's usual case mix and according to policies and procedures consistent with scientific evidence and government policies Leadership and Management Terms of reference, membership and procedures for meetings of all committees within the organization. Minutes of meetings are recorded and approved (e.g. Therapeutics Committee) Safe Practice and Environment Policies on rational antimicrobial use based on the hospital antibiogram in coordination with Microbiology Laboratory and Pharmacy Therapeutics Committee (evidence) Improving Performance Conduct of utilization review of drugs, procedures or diagnostic tests based on CPG (evidence) PhilHealth BenchBook Standards

12. PhilHealth Strategies Toward Financial Protection • Shifting to New Payment Mechanism • Contracting or Preferred Provider Service Agreements • Investing in Health Care Providers • Expanding Outpatient Benefits

13. Shifting to New Payment Mechanism From FFS to DRGs • Share risk with providers • Provide a rational, equitable, and quality care • DPRI as reference to reimbursement cost of drugs Pay for Performance • Provide incentive for good performance among providers which includes rational drug use

14. Contracting or Preferred Provider Service Agreements • Use financial leverage to buy quality services and cost-effective care • Use this to control out of pocket • Ensure Access to Essential Drugs Accreditation of Pharmacies • Promote quality practices and systems in pharmacies

15. Investing in Health Care Providers • Provide support/assistance to providers to improve their facilities and efficiency in health care delivery • Ensure access to Essential Drugs

16. Expanding Outpatient Benefits • Limited to Sponsored Members – expanded to include other member groups • Expand coverage to include outpatient drugs e.g. P100 for take home meds (sponsored members) • Accreditation for Pharmacies - promote quality practices and systems in drug outlets

17. Good Day!

18. Per capita health Expenditure from all sources of funds SI: Increased by 22.4 % SOURCE: NSCB, 2005 Philippine National Health Accounts

19. In million pesos