PhilHealth 16: Financial Engineering to Subsidize NCDs Treatment

In a presentation during the MeTA Forum last April 10, 2013 at the Asian Institute of Management (AIM) in Makati, Dr. Rizza Herrera and Dr. Liezel Lagrada of PhilHealth showed some 50 slides about the Primary Care Benefit (PCB) packages, showing only some of those slides here. PCB are outpatient services for the poor, a form of preventive healthcare to minimize incidence of the poor going to hospitals more often. I support more preventive healthcare, but I do not support the view that it's the government that should provide it for all.

PCB1 is one year old now, started in April 2012.

These packages are the equivalent of annual medical check up for clients of private health insurance or health maintenance organizations (HMOs). They even include X-ray. The hypertensive are entitled to once a month check up even though their annual premium is the same (or slightly higher?) than those who have no hypertension and are entitled to only once a year BP measurement.

PhilHealth says they have veered away from rebate mentality to capitation as payment service.  The number of participating local government units (LGUs) have been rising.

PCB1 is not portable, each family is assigned to a specific PCB1 provider, extending it to other member sectors would entail a good tracking system, both from Philhealth and from the providers.

Despite the increase in the number of PCB1 providers, there is still a big gap in the patient : health personnel ratio which greatly affects the realization of quality health care.

Intermission -- some photos that afternoon, speakers and audience....

Then the expansion to PCB 2, mainly addressed to control NCDs. My earlier discussion on PhilHealth claims for NCDs is posted below, PhilHealth Watch 15.

I like the chart on diabetes mellitus, global view. Non-smoking is the single biggest healthcare promotion act to lower the risk of getting that disease as people age.

More data and program plan for PCB2...

And more. The social and financial engineering to expand subsidized outpatient services is getting more complicated. Admittedly, I have difficulty comprehending fully these schemes.

My beef is that government efforts – by PhilHealth, DOH, WHO, UN, other foreign aid -- to further nationalize and centralize healthcare is not wise. People own their body. Those who take care more of their body and their households should not be penalized by subsidizing by force and coercion the healthcare of those who are less responsible about their own body.

There should be more allowance for more personal responsibility in dealing with NCDs for adults. Government helping NCDs for children like childhood cancer, vaccination against common tropical and infectious diseases, is fine with me. Also controlling infectious diseases that also affect adults.

But extending the healthcare subsidy against NCDs for adults is not wise. It can (a) bankrupt the government health insurance system if done well, or (b) escape bankruptcy but raise the monthly or annual premium to high and rising levels, or (c) have lousy and limited services to patients even if premium payment and direct tax subsidy are rising.

If people have money to over-eat and over-sit, or over-drink and over-smoke, they should have money to buy private health insurance to augment their PhilHealth insurance and other government (DOH, other agencies and LGUs) health spending. If they are poor to get private health insurance, then they should reduce those vices, or ask funding support from private charities, well-off individuals and friends, and so on.
--------------

See also:
PhilHealth Watch 12: Assistance to Leptospirosis Patients, September 03, 2012
PhilHealth Watch 13: SHInES on Social Solidarity, November 26, 2012 

PhilHealth Watch 14: Not Yet 85 Percent Coverage, January 10, 2013 

PhilHealth Watch 15: Rising Claims for NCDs, April 15, 2013