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7 PhilHealth partners to form PCNs

June 19, 2023 Arlene Rivera 184 views

FIVE local government units (LGUs) and two private sector groups of clinics and doctors formally agreed recently with the Philippine Health Insurance Corporation (PhilHealth) to form the first seven primary care networks (PCNs) in the country.

Doctors and clinics within these PCNs will start networking with each other to share resources with the patient’s welfare in mind.

The Republic Act (RA) No. 11223 or the Universal Health Care (UHC) Act defines “primary care” to be first-contact, accessible, continuous, comprehensive and coordinated; accessible at the time of need; with a range of services for all presenting conditions; and able to coordinate referrals to other doctors, clinics and hospitals in the health care delivery system, when needed.

The UHC Act makes it the main responsibility of the DOH and LGUs to make sure that the health care delivery system will make a primary care doctor, assisted by other health workers, available to each and every Filipino.

Meanwhile, Filipinos have the right to choose primary care doctors, either from public or private clinics.

“Primary care and essential public health services, integrated with a broader health care network of hospitals and other facilities, is a key element needed for universal health care to happen. Dapat ramdam ng bawat Pilipino ang UHC,” said Department of Health (DOH) Secretary and PhilHealth Chairperson of the Board Dr. Teodoro J. Herbosa.

Around two million Filipinos spread out across the provinces of Bataan, Guimaras, Quezon, South Cotabato, as well as Baguio City will benefit from the PCN innovation allowed under the Universal Health Care (UHC) Act. Another 300,000 Filipinos under the care of the LiFE group as well as QualiMed, will also be subjected to improvements in primary care financing.

The current PhilHealth Konsultasyong Sulit at Tama (Konsulta) primary care benefit package covers patient consultations, any of 13 laboratory and diagnostic tests as ordered by the doctor, and 21 common medications that can be prescribed according to medical needs. PhilHealth pays its Konsulta Package Providers an amount ranging from P500-750 per patient per year on a reimbursement basis after services have been rendered.

The Konsulta PCPN innovates this arrangement on a “sandbox” or testing basis in pre-selected areas by allowing advanced payments or frontloading of funds even before services have been rendered.

Konsulta PCPN (primary care provider network) will also only pay networks of primary care doctors and clinics instead of the individual clinics like the regular Konsulta benefit. These innovations are enabled by new Commission on Audit (COA) accounting guidelines. The seven Konsulta PCPNs caring for 2.3 million Filipinos are projected to be paid a total of P1.2 billion, which may be used to improve infrastructure, equipment, and staff compensation even before the first patient starts using services.
“Layunin ng PhilHealth na ang bawat Filipino, dapat rehistrado. Ang bawat miyembro natin, dapat protektado, para ang kalusugan ng lahat, segurado. This groundbreaking approach to primary care financing, through network contracting and close-ended, prepaid capitation, is a gamechanger,” said PhilHealth Acting President and Chief Executive Officer (CEO) Emmanuel R. Ledesma, Jr.

“The DOH and the many LGUs and our partner hospitals and clinics look forward to the lessons and gains to be gathered from the implementation of primary care networks. Para magkaroon ng UHC, hindi dapat tayo kanya-kanya. Sa pagbigay ng kalusugan, unity ang kailangan. Sa isang Healthy Pilipinas, ang bawat buhay ay mahalaga,” Herbosa concluded.

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