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 (Phil Health) and other national government agencies (NGAs) such as DIG, D SWD, DAR, DOH. The Enhanced PCSO GMA Program is a realization of the common goals of PCSO, Phil Health, 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 P 1.5 billion as assistance for the payment of the local government unit (LGU) premium counterpart to Phil Health for 2004, initially utilized the P 1 billion "Stand By Fund" approved by the PCSO Board.
DBM, on the other hand, assured the release of P 1.5 billion to Phil Health 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 V. 5. To be able to identify the number of claims from the enrolled members. 6. To determine the controversies behind the card CHAPTER.
SCOPE AND LIMITATION The study is confined only to Region V 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 Phil Health. In the secondary data, the researcher used the information from Phil Health, news clippings from the newspapers and the Internet. CHAPTER V. DATA ANALYSIS Table I. Number of Indigents Enrolled In Eastern Samar Municipality No. The lowest number of enrollees came from the Municipality of Maslog with only 40 enrollees and only 0.11% of the total enrollees.
Table II. Number of Indigents Enrolled in Leyte Municipality No. Fe 1,653 1.38%Tanauan 3,801 3.18%Tol osa 1,057 0.89%Tunga 622 0.52%Cont... Municipality No. Of Indigents Enrolled PercentageTacloban 12,456 10.43%Albuera 2,820 2.36%Bay bay 6,801 5.70%Isabel 1,572 1.32%Kananga 3,977 3.33%Mata g-ob 1,317 1.10%Merida 2,398 2.01%Or moc 11,889 9.96%Palompon 3,162 2.65%San Isidro 2,838 2.38%TOTAL 119,419 100.00% In the Province of Leyte, the highest number of indigents enrolled was the Municipality of Tacloban with a total of 12,456 or 10.43% of the total enrollees of 119,419. The lowest number of enrollees came from the Municipality of Tunga with only 622 enrollees and only 0.52% of the total enrollees.
Table. Number of Indigents Enrolled in Northern Samar Municipality No. The lowest number of enrollees came from the Municipality of Silvino Lobos with only 207 enrollees and only 0.49% of the total enrollees. Table IV. Number of Indigents Enrolled in Southern Leyte Municipality No. The Municipality of Limasawa had the smallest enrollees with only 313 or.
80%. Table V. Number of Indigents Enrolled in Biliran Municipality No. Of Indigents Enrolled Percentage Almeria 859 9.26%Biliran 819 8.83%Cabucgayan 1,345 14.50%Caibiran 1,811 19.52%Colaba 682 7.35%Kawa yan 905 9.76%Maripipi 274 2.95%Naval 2,582 27.83%Total 9,277 100.00%In the Province of Biliran, the highest number of indigents enrolled was the Municipality of Naval with a total of 2,582 or 27.83% of the total enrollees of 9,277. The lowest number of enrollees came from the Municipality of Maripipi with only 274 enrollees and only 0.2. 95% of the total enrollees. Table VI.
Number of Indigents Enrolled in Western Samar Municipality No. Margarita 2,107 3.45%Sta. The lowest number of enrollees came from the Municipality of San Sebastian with only 304 enrollees and only 0.50% of the total enrollees Table VII. 30%.
The Province of Leyte's enrollment on the other hand went down, with a target of 121,155 or 42.03%, the program was able to enroll only 119,419 or 39.06%, where there is a decrease by 1,736 or 2.97%. Northern Samar's target was 46,467 or 16.12% but had only 41,943 or 13.72% of actual enrollees. There was a decrease of 4,524 or 2.4%. The target of Southern Leyte was 18,568 or 6.44% but had an actual enrollment of 39,121 or 12.80%.
An increase of 20,553 or 6.36%. The Biliran Province had a target of 5,558 or 1.93% enrollees but was able to enroll 9,277 or 3.03%, an increase of 3,719 or 1.1%. In Western Samar, its target was 62,761 or 21.77%. The program was only able to enroll 61,064 or 19.97%, which is a decrease of 1,697 or 1.80% from its target.
All in all, the total target enrollment was 288,292 families but had an actual enrollment of 305,738. There was an increase by 17,446. The biggest increase from its target was the Province of Southern Leyte with 20,553 while Northern Samar deviated from its target with a decrease of 4,524. Claims of the Members The Claims Processing Division and the Management Information System of the Philippine Health Insurance Corporation reported that for the months of June, July, August and September, 160,950,512, and 1010 claims were received respectively. Controversies behind this Program Since the Enhanced PCSO GMA Program was implemented on the hype of the election period, number of controversies were soon heard in the news and read on the daily newspapers. The opposition accused President Gloria Macapagal-Arroyo of using the government resources for her campaign.
A group of young lawyers filed a criminal suit before the Commission on Elections against the top officials of the Philippine Health Insurance Corporation and the Philippine Charity Sweepstakes Office, whom they accused of violating several election laws. The complainant, Ramon Rana of the PRO-CON, said that PCSO chief Maria Livia "Honey girl" de Leon and Phil Health President Francisco T. Duque violated election laws in carrying out the "5 million = 25 million" program. The program seeks to enroll 5 million families, or 25 million individuals, in the Medicare program not later than April 6, the birthday of President Arroyo. Duque and de Leon were charged with vote buying, intervention of a public officer, using public funds for election purposes and banned election propaganda. They said that the public funds were spent to influence voters by enrolling families in Phil Health for one year. The premium cost of P 1,200 for each family member was chargeable to Phil Health and the PCSO.
Ernesto Maced a said that the least Arroyo could do was order Phil Health and the PCSO to scrap their card- distribution extravaganzas with her in attendance and to remove her photo from the cards "to prove that PCSO and Phil Health have not been squandering billions of pesos on what obviously are cleverly designed election paraphernalia". The President said that she was only doing what is stated under the Health Insurance Law that all Filipinos must have a health insurance and that the cards are a great help to the poor. Phil Health President Francisco Duque dismissed the allegations saying that the reason why Arroyo's photo appears on the card is because she is the President nothing more and nothing else, just like the photo of former President Joseph Estrada on the Metro Rail Transit when he was still president. CHAPTER VI. CONCLUSION The Philippines is one of the Third-World Countries. Almost two-thirds of the population in the country composes the less privileged.
The Enhanced PCSO Greater Medicare Access Program is a great help for the underprivileged Filipinos. Instead of paying every quarter of P 300 or P 1,200 per month where individual paying members normal do for the membership, the Program offered it for free. It was able to enroll a total of 305,378 indigents in Region V. Even though it exceeded the supposedly target enrollees, still the 17,446 enrollees that exceeded were still accepted The card is valid for a year and can be renewed through the Local Government Units (LGUs). These newly enrolled members were able to avail the benefits since as of June, July, August and September 2004, Phil Health's Claims and Processing Division and the Management Information System reported of 2,632 claims received.
The Program doesn't exactly pay all the hospital bills but lessens the burden on the expenses of the member. Even though there were a lot of controversies surrounding this Program, it is still of help to the poor for as the National Health Insurance Act of 1995 states that all people be provided access to quality health services through an enhanced Medicare program. CHAPTER VII. RECOMMENDATION Since the Enhanced PCSO Greater Medicare Access (GMA) Program is only valid for one year, the expiration date would be February, March, April or May 2005 depending on the month these new members were encoded in the database. So that their membership would continue, Phil Health should see to it that these members would have a new sponsor when time comes that the cards would expire.
Phil Health could coordinate with the Local Government Units (LGUs) for continuing the membership of these members and jointly assume payment of premiums for these indigents. The main consideration, however, lies in the budgetary limitations of the LGU, which will make them unable to renew all indigents under the Program in their respective area. To address this, the Corporation should encourage other possible partners and stakeholders such as the National Government Agencies (Philippine Charity Sweepstakes Office, Department of Health), Legislators and the Private Sectors (pharmaceutical companies) to help in the payment of premium contributions and help these indigents get their cards renewed so that they may be able to avail these benefits in case they " ll get sick in the future. Such donations from private entities / individuals are fully deductible from taxable income. CHAPTER V.
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OW WA Fund Transfer to Phil Health Exposed". The Manila Times. March 12, 2004.