Policy analysis on financing roles for Population- and Individual-based health services in light of the Universal Health Care Act

Leonardo Jr R Estacio; Christine Mae S Avila; Ma-ann M Zarsuelo; Ma Esmeralda C Silva; Michael Antonio F Mendoza; Carmencita D Padilla

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Policy analysis on financing roles for Population- and Individual-based health services in light of the Universal Health Care Act

Author: Leonardo Jr. R. Estacio ^{1
,

2} ; Christine Mae S. Avila ³ ; Ma-Ann M. Zarsuelo ^{3
,

4} ; Ma. Esmeralda C. Silva ^{3
,

5} ; Michael Antonio F. Mendoza ^{3
,

6} ; Carmencita D. Padilla ⁷
Author Information

1. University of the Philippines Manila Health Policy Development
2. College of Arts and Sciences, University of the Philippines ManilaHub
3. University of the Philippines Manila Health Policy Development Hub
4. Institute of Health Policy and Development Studies, National Institutes of Health, University of the Philippines Manila
5. College of Public Health, University of the Philippines Manila
6. College of Dentistry, University of the Philippines Manila
7. University of the Philippines Manila
Publication Type:Journal Article
Keywords: Health Insurance
MeSH: Healthcare Financing; Universal Health Insurance; Insurance, Health
From: Acta Medica Philippina 2020;54(6):686-691
CountryPhilippines
Language:English
Abstract: Objectives:The health financing scheme brought by the Universal Health Care Act has a significant change in the landscape of allocating funds for health services, as well as in the delineation of roles among the key actors. Consistent with the law, the protection from the health financial risks of Filipinos must be guaranteed. This study aimed to determine the roles of the government and other key agencies in financing population-based and individual-based health services in the Philippines.
Methods:A systematic review of literature was done to generate evidence for the policy brief and proposed policy alternatives. The UP Manila Health Policy Development Hub organized a roundtable discussion in collaboration with the Department of Health participated by key stakeholders from various sectors involved in the policy issue. Systematic review and insights from the discussion were analyzed to produce consensus policy recommendations.
Results:Given the current procurement and financing, the DOH should fund population-based services while PhilHealth, with the assistance of Health Maintenance Organizations (HMO) for premium holders, should fund individual-based services. Health programs with grey areas (i.e. with both individual- and population-based service) need further technical discussions. It is imperative to have clear-cut specific guidelines on the managerial and financial roles of the provincial health board and the scope of financing service delivery.
Conclusion:Delineating the roles of DOH, PhilHealth, and HMOs in financing health services is not without risks. The utilization of the special health fund at the provincial level should be carefully implemented and monitored to minimize inefficiencies and fraud.
Full text:2605-Article Text-14188-1-10-20201226 (1).pdf