PhilHealth President Edwin M. Mercado aims to reduce the out-of-pocket medical expenses of members to less than 30 percent by addressing inefficiencies within the state health insurer. Mercado plans to achieve this goal through standardizing financial reporting and completing the digitization initiatives.
Newly-appointed Philippine Health Insurance Corporation (PhilHealth) President and chief executive officer Edwin M. Mercado is aiming to decrease the out-of-pocket (OOP) expenses of its members to less than 30 percent by addressing the issues plaguing the state health insurer. These issues include inefficiencies in its financial reporting and service delivery.
\In a press briefing in Malacañang on Wednesday, Mercado stated that the average OOP medical expenditure for households in the country’s “mature” healthcare system is 45 to 47 percent. This expenditure, he believes, should be reduced to 25 to 27 percent to prevent catastrophic spending among households, where more than 10 percent of their income net of food expenditures are spent on healthcare. \“Actually, it is included in the medium-term plan, which has an acronym, which I cannot remember. But it states it should be reduced to 30 percent in the medium term and that is set up like a general roadmap for the Philippine economy. So, that is our initial goal, but if we will be able to exceed that, the better,” Mercado said in Filipino. “So the marching order of our President is to expand the benefits,” he added. Under the Philippine Development Plan (PDP) 2023-2028, the Marcos administration is targeting to bring down the OOP to 28.1 percent by 2028. Mercado plans to achieve this reduction and improve member benefits by eliminating waste in PhilHealth’s operations through standardizing financial reporting and completing their digitization initiatives. \“We will standardize financial reports so we will not keep on changing. It is hard to analyze financial reports if they have different definitions. There are standard accounting definitions for that. So, we will define that so that the reporting will be clean and transparent,” he said. As for digitalization, he said, PhilHealth can utilize it to decrease the screening and processing times for the release of claims from hospitals, which currently averages 25 days. Citing his experience as a hospital administrator, he mentioned that PhilHealth continues to face thousands of pesos worth of claims, which they are forced to return to hospitals due to faulty claims applications. \“Once we implement the digitization, we will be able to flag the claims, which are excessive or contain suspiciously high amounts,” Mercado explained. “The savings, which we will collect from the wastage, will be used to expand the benefits,” he added.
PHILHEALTH OUT-OF-POCKET EXPENSES DIGITALIZATION FINANCIAL REPORTING HEALTHCARE
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