Philhealth’s Indigent Program

CHAPTER I. RATIONALE

Introduction

The Philippine Health Insurance Corporation was created by Republic Act No. 7875 to administer the National Health Insurance Program which is designed to provide health insurance coverage and ensure affordable, acceptable and health services for all Filipinos.

The Enhanced “PCSO Greater Medicare Access (GMA) Program” is a partnership forged by four important agencies of the government: the Philippine Charity Sweepstakes Office (PCSO), the Local Government Unit (LGU), Department of Budget and Management (DBM), the Philippine Health Insurance Corporation (PhilHealth) and other national government agencies (NGAs) such as DILG, DSWD, DAR, DOH.

The Enhanced PCSO GMA Program is a realization of the common goals of PCSO, PhilHealth, DBM and the LGUs of the intention to enroll 5 million indigent families nationwide institutionalizing an integrated health care financing and delivery mechanism that ensures accessible, affordable and quality health care to all underprivileged Filipinos. The Program started its enrollment on February 2004 and ended on May 2004. The validity of this card is for a year and can be renewed through the Local Government Units (LGUs).

For the implementation of the Program, PCSO allocated P1.5 billion as assistance for the payment of the local government unit (LGU) premium counterpart to PhilHealth for 2004, initially utilized the P1 billion “Stand By Fund” approved by the PCSO Board. DBM, on the other hand, assured the release of P1.5 billion to PhilHealth for the national government (NG) premium counterpart for the would be indigent.

CHAPTER II. OBEJCTIVES

1. To be able to identify the qualified members

2. To be able to know the membership process

3. To be able to identify the program benefits

4. To be able know the number of indigents enrolled in Region VIII.

5. To be able to identify the number of claims from the enrolled members.

6. To determine the controversies behind the card

CHAPTER III. SCOPE AND LIMITATION

The study is confined only to Region VIII which composes the provinces of: Biliran, Eastern Samar, Leyte, Northern Samar, Southern Leyte and Western Samar.

Chapter IV. Methodology

The primary data were gathered through interviews with the Membership & Marketing Division, Finance Division, Claims Division and Management Information System of PhilHealth.

In the secondary data, the researcher used the information from PhilHealth, news clippings from the newspapers and the Internet.

CHAPTER V. DATA ANALYSIS

Table I. Number of Indigents Enrolled In Eastern Samar

Municipality No. Of Indigents Enrolled Percentage

Arteche 1,142 3.27%

Balangiga 686 1.96%

Balangkayan 991 2.84%

Borongan 5,398 15.46%

Can-avid 1,909 5.47%

Dolores 3,575 10.24%

Gen. Macarthur 505 1.45%

Giporlos 1,092 3.13%

Guiuan 2,933 8.40%

Hernani 869 2.49%

Jipapad 315 0.90%

Lawaan 953 2.73%

Llorente 1,309 3.75%

Maslog 40 0.11%

Maydolong 1,154 3.31%

Mercedes 459 1.31%

Oras 3,121 8.94%

Quinapondan 1,489 4.26%

Salcedo 1,015 2.91%

San Julian 1,220 3.49%

San Policarpo 1,888 5.41%

Sulat 1,311 3.75%

Taft 1,540 4.41%

TOTAL 34,914 100.00%

In Eastern Samar, the highest number of indigents enrolled was the Municipality of Borongan with a total of 5, 398 or 15.46% of the total enrollees which is 34, 914. The lowest number of enrollees came from the Municipality of Maslog with only 40 enrollees and only 0.11%