Marikina lawmaker suggests using HMOs to serve PhilHealth beneficiaries
Marikina Rep. Stella Luz Quimbo FILE PHOTO / House of Representatives Facebook page
MANILA, Philippines – A lawmaker has proposed using health maintenance organizations (HMOs) to provide services to Philippine Health Insurance Corporation (PhilHealth) beneficiaries so that healthcare provision will be more competitive.
Marikina 2nd District Rep. Stella Quimbo, during Tuesday’s hearing of the House of Representatives committee on health, said that having HMOs or third-party healthcare providers may improve service delivery.
HMOs are providers of health insurance plans, which private companies often offer as incentives to their employees. Under this system, employees may pay a certain amount to cover hospitalization and other healthcare needs. In some cases, the company shoulders the entire health insurance fee of the employee.
Quimbo said this is contained in her House Bill No. 10382, which seeks to amend provisions of Republic Act No. 11223 or the Universal Health Care (UHC) Act.
In her sponsorship speech, she said, “To improve service delivery and cost-efficiency, I propose to include an amendment on allowing alternative supply arrangements, which would include the ability to engage public, private, or public and private consortia, or in other words, including HMOs.”
According to Quimbo, the provision of healthcare benefits in the Philippines is currently ‘very traditional’.
“So as of now our supply arrangements do not have other options, right? So right now the way we provide benefits is still very traditional, but why not open the menu of service delivery to include the possibility of engaging or outsourcing HMOs?” she asked.
“So that’s the second amendment I propose, allowing this possibility, or in other words, introducing this possibility of competitively selecting third-party providers including HMO so that we can introduce not only innovation but also competition so that we can actually lower the cost of providing benefits,” she added.
The health panel discussed different proposals to amend the UHC law, out of consideration to the high premiums imposed on PhilHealth beneficiaries in contrast to the low amount of benefits received by senior citizens, the elderly, and overseas Filipino workers.
Earlier, Quimbo suggested decreasing the PhilHealth premiums and finding a proper formula to compute the premium rate after noting that the state-run insurer’s gross margin of P173.4 billion in 2023 came from its social health insurance program alone.
This means allocations under the national budget and other investment revenues are not included.
Quimbo said around P80 billion is allocated for premium subsidies and P20 billion for benefit expansion. However, the services given to beneficiaries do not match the huge earnings, as evidenced by patients’ high out-of-pocket expenses.
Deputy Majority Leader and Tingog party-list Rep. Jude Acidre meanwhile said in a press briefing that he supports this move because there are instances where people spend more for PhilHealth than HMOs — but HMOs give more benefits to their insured members.
“What Cong. Quimbo says is correct, her observation that PhilHealth charges a huge premium to workers but if you will observe, they only cover a small amount for cases, it is not enough to compensate our contributions every month. In fact, I sometimes tell PhilHealth that they are more costly than HMOs, but HMOs give bigger benefits,” Acidre said.
READ: Herbosa: PhilHealth has enough money, premium hike delay won’t hurt
Last January, PhilHealth announced that the members’ premium contribution will increase from 4 percent to 5 percent in 2024, in line with the UHC Act. However, Malacañang said last February 24 that President Ferdinand Marcos Jr. is still studying proposals to suspend the rate increase — which was suggested by Health Secretary Teodoro Herbosa.
READ: PhilHealth members’ contribution hikes to 5% this 2024
According to Herbosa, he believes PhilHealth has enough funds “to actually continue to give benefits”
