Defining the ROLL out Strategy for UHC Benefits: Philhealth's Benefit Development PLAN
Author(s)
Panelo CI1, Stein D2, Dutta A2, Santillan M3, Tan C4, Moreno A4, David Reyes MR3, Caampued M5
1USAID's ProtectHealth/Palladium, Manila, Philippines, 2Palladium LLC, Washington DC, DC, USA, 3Philippine Health Insurance Corporation, Pasig City, Philippines, 4USAID's ProtectHealth/Palladium, Mandaluyong, Philippines, 5Alliance for Improving Health Outcomes, Quezon City, Philippines
The Philippine Health Insurance Corporation is developing its Benefit Development Plan (BDP) that describes the strategic roll out of various benefits for universal health coverage (UHC). The BDP also defines the process and sets the criteria for the review and introduction of social health insurance benefits. OBJECTIVES. Develop the BDP through a technically sound and broadly consultative process. METHODS. The process of developing the BDP was started with the drafting of a technical note discussing the rationale, contents and proposed approach for its development. This was followed by a broad consultation of stakeholders representing PhilHealth members, providers, the Department of Health, members from the academe and research community, and development partners. RESULTS. There was consensus that the introduction of benefits under UHC will use criteria such as legal mandates, burden of disease, advances in technology, value for money and fund viability, among others. Appropriate decision rules will have to be developed to make use of these criteria in decision-making. In addition, the stakeholders agreed on a formal and explicit process in benefit development. Making the process explicit improves transparency in the benefit development process where interests of various stakeholders can be managed and operational considerations can be flagged. Both members and providers expressed strong preference to be involved in the benefit development process at its various stages. The role of the Health Technology Assessment Council (HTAC) also needs to be defined as new benefits can only be introduced if there is positive recommendation. CONCLUSIONS. PhilHealth is expected to complete its BDP soon. Other countries in similar stages of implementing UHC may want to study how an explicit benefit development process can be developed and implemented.
Conference/Value in Health Info
2020-09, ISPOR Asia Pacific 2020, Seoul, South Korea
Value in Health Regional, Volume 22S (September 2020)
Code
PMU13
Topic
Clinical Outcomes, Economic Evaluation, Health Policy & Regulatory
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis, Insurance Systems & National Health Care, Performance-based Outcomes, Public Spending & National Health Expenditures
Disease
Multiple Diseases