The Universal Health Care program for Filipinos, a priority measure of the Aquino administration, moved one step closer to its enactment into a law as the House of Representatives approved House Bill (HB) 6048 or the Pinoy Health Insurance Act on second reading.
The Pinoy Health Insurance Act mandates automatic and mandatory enrollments in the Philippine Health Insurance Program of all Filipino citizens and qualified foreigners and mandatory covers workers in the formal and informal sectors, enrolled indigents and lifetime members.
Workers in the formal economy are members of the labor force who are already enrolled in the Government Service Insurance System and the Social Security System, while informal workers refer to hawkers, market vendors, pedicab and tricycle drivers, small construction workers as well as those who manage home-based industries and services.
HB 6048 also mandates compulsory health insurance in all local government units (LGUs) through the National Health Insurance Program, notwithstanding the existence of an LGU-based health insurance programs.
“This social insurance program will serve as the means for the healthy to help pay for the care of the sick and for those who can afford medical care to subsidize those who cannot,” part of the measure read.
The coverage of the Pinoy Insurance Act has also been extended to househelpers whose employers will pay for their premiums.
Aside from fee-for-service scheme, those enrolled under the Pinoy Insurance Act have the option to avail of case-based payment, capitation of health care professionals and facilities or a combination of payment schemes.
To maximize the resources, HB 6048 allows the Philippine Health Insurance Corporation (PhilHealth) to set aside a portion of its accumulated revenues not needed to meet the cost of the current year’s expenditures as reserve fund to be used for increase in benefit or decrease of members’ contributions, augmentation of Health Facilities Enhancement Program of the Department of Health and development and maintenance of electronic data bank of members.
Likewise, Philhealth has been enabled to secure copies of medical and financial records not only of the health care providers and employers but also of their patients and employees, as well as conduct post-audit on the quality of services rendered by health care providers.
The bill also addressed fraud because it obligates Philhealth to mandate the national agencies and local governments to require proof of Philhealth membership before transacting with private individuals or groups and grants them the power to accredit independent pharmacies and other retail outlets.
In cases of any delay in remittance of contributions, the measure metes a 3-percent interest per month on hospitals committing the violation. –LLANESCA T. PANTI, Manila Times
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