Jl. Raya lenteng Agung No. 4E Tlp: (021) 788 865 12 Email: yaslisinstitute@gmail.com Website: http://yaslisinstitute.

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Sosial Health Insurance Training In PhilHealth, Manila, Philipine Yaslis Institute

INTRODUCTION
The Philippine Health Insurance Corporation () was created in 1995 to create a universal health coverage for the Philippines. It is a tax-exempt, government-owned and governmentcontrolled corporation (GOCC) of the Philippines, and is attached to the Department of Health. It states its goal as insuring a sustainable national health insurance program for all.In 2010, it claimed to have achieved "universal" coverage with 86% of the population.This social insurance program provides a means for the healthy to pay for the care of the sick and for those who can afford medical care to subsidize those who cannot. Both local and national government allocate funds to subsidize the indigent. In 2000 and 2005, reform efforts were outlined to make decentralization and health insurance work more effectively, including an expanded government subsidy for the enrollment of the poor, the creation of local health service delivery/planning units to reduce fragmentation, and a stronger DOH role in regulation. Since 1995, the benefits package and delivery system have improved. For example, now has an Outpatient and Diagnostic Package limited to indigent enrollees. This addition creates nearly comprehensive coverage for indigents. All other beneficiaries have access to nearly comprehensive services, excluding some outpatient care. Inpatient care includes room and board, medicines, diagnostic and other services, professional fees and operating room services. These benefits are subject to some limits, which differ based on the level of the health facility/hospital (level 1 to 4 hospitals and the Ambulatory surgical centers equivalent to level 2 hospitals) and the severity of the cause of admission (case-type A, B, C and D). Catastrophic conditions, ambulatory surgeries including ambulatory dialysis, deliveries and outpatient malaria and TB-DOTS care. Longterm process development of Philhealth contents many lesson learnts and experiences which could be explored and learned by professionals of health insurancence of Indonesia. The Yaslis Institute coop with the PhilHealth will provide the on job training in Social Health Insurance for the officers and managers of health insurance companies, in Manila, Philipine.

Objective of the Training

1. General review of the Philhealth such as : the history, vission, mission, objective, structure and management of the PhilHealth. 2. How the PhilHealth coop with stakeholders such as: central, province, and district government and the providers. 3. How the PhilHealth manage the membership, providers, logistic and collect the premium. 4. How the PhilHealth manage the personnel, finance and medical claim. 5. How the PhilHealth control the abuse and fraud in health care utilization and other critical issues relate to on managing the Philhealth.

Activity of Training

Day 1 8:30 a.m. Registration Opening Ceremony - Indonesia National Anthem - Philippine National Anthem - Words of Welcome - Introductions 9:00 a.m. Group picture with PhilHealth Officials 9:20a.m. COFFEE BREAK 9:30 a.m. A Situationer on Indonesias health system and health financing status 10:30 a.m. The National Health Insurance Program of the Philippines: History and Evolution legal framework 12:00 a.m. LUNCH BREAK 1:00 p.m. Governance structure of the national health insurance program of the Philippines Board of Directors Central Office Regional Offices Local Health Insurance Offices

2:30 p.m. Actuarial foundations of a national health insurance program 3:20 p.m. COFFEE BREAK 3:30 p.m How much to collect? The PhilHealth Premiums 6:30 p.m. WELCOME DINNER Day 2 8:30 a.m. Recapitulation of Day 1/ key messages 9:00 a.m. Designing benefits Basic benefits Preventive care benefits Drugs and medicines Benefits for catastrophic illnesses 10:15 a.m. COFFEE BREAK 10:30 a.m. Giving what is due: Benefits of a PhilHealth Member 12:00 a.m. LUNCH BREAK 1:00 p.m. Membership Making PhilHealth Inclusive: Universal Coverage of All Filipinos Seeking out Filipinos for PhilHealth Membership 1. Campaign for membership 2. Registration Procedure Membership in the Formal Sector Covering Filipinos overseas Retirees 2:00 p.m. 3:00 p.m. COFFEE BREAK 3:15 p.m. Membership in the Informal Sector Individually paying program Sponsored Program Indigent Program

Day 3 8:30 a.m. Recapitulation of Day 1/ key messages 9:00 a.m. PhilHealths Quality Assurance Program Dealing with Healthcare Providers 10:15 a.m. COFFEE BREAK 10:30 a.m. Accreditation Program (individual and institutional health care provider) 12:00 a.m. LUNCH BREAK 1:00 p.m. Standard-setting and Monitoring (Benchbook Program) 2:30 p.m. Visit to Bangkal (Makati City) Health Center and Lying-In Clinic

Day 4 FIELD VISIT The NHIP at the regional, provincial and local level and visits to accredited healthcare facilities 6:30 a.m. Travel from Hotel to Tarlac City(2.5 hours) 9:00 a.m. Social health insurance at the provincial level (Tarlac province) 9:30 a.m. Visit to Tarlac Provincial Hospital and Tarlac Eye Center Tour of the facility Orientation by the Chief of Hospital 10:00 a.m. Travel from Angeles City to Mexico, Pampanga (45 mins) 11:00 a.m. Visit to Mexico Community Hospital Tour of the facility Meeting with the Mayor 12:30 p.m. LUNCH BREAK

1:30 p.m. Travel to PhilHealth regional office in the City of San Fernando, Pampanga (45 mins) 2:30 p.m. Briefing on PhilHealth Regional Operations PhilHealth regional operations including various business processes 4:00 p.m. Leave for Manila 6:00 p.m. Arrive Hotel Day 5 8:30 a.m. Impressions on the previous days visit 9:00 a.m. Money Matters: Making collections happen Schedule of premium contributions premium collection methodologies (banks, online, mobile phone) 10:15 a.m. COFFEE BREAK 10:30 a.m. Fund Management 1. Creation of the NHI fund 2. Components of the NHI fund 3. Financial Management / Investment Program 4. Reserve fund 12:30 p.m. LUNCH BREAK 1:30 p.m. Claims and Reimbursements Case Payments 2:45 p.m. COFFEE BREAK 3:00 Summary of learnings 2:30 p.m. Closing Ceremony Day 6 Departure for Indonesia

Length and Cost of Training

Duration of training is 5 days that include some visit to regional offices and city tour. The entire cost of the program will be US$1.300 per participant. This includes: Training Fee Training kits Lunch + Coffee Break Welcome Dinner Airfare (Cebu Air) Jakarta Manila (Round Trip) Hotel for 5 nights (Share for 2 persons) City tour

Contact person:
Dhita Anggita : 0821 2268 3389 Tlp : (021) 788 865 12 Email: yaslisinstitute@gmail.com Web: http://yaslisinstitute.org