Center for Health Market Innovations (CHMI)

Programs

PhilHealth Link

last updated Sep 21, 2012

Overview

Implementing organization: 
PhilHealth Regional Office, Region VIII, Provincial Government of Leyte
Legal Status: 
State/government
Year Launched: 
2010
Stage: 
Existing/expansion stage
Income Level of Target Population: 
All income levels

Funding

Primary Source of Funding: 
Government

Technology

Technology Used: 
Phones › Voice
Technology Purpose: 
Improving Data Management

Scale

Number of Clients Served: 
51,680 inquiries
Summary: 

PhilHealth LINK is a call center for PHilHealthmembers, a collaborative enterprise supported by provincial local government units (LGUs) who want to maximize reimbursement from PhilHealth so that LGU health facilities can have a steady revenue stream.

Program goals/rationale: 

A major problem of the National Health Insurance Program is the low availment of benefits by members. In the 2008 Benefit Delivery Review, only a small percent of PhilHealth members actually utilized health services. This problem has been traced to many factors. The cost of information, education, and communication (IEC) campaigns to reach each and every member is quite prohibitive. In the past, many members (such as poor families whose premiums are subsidized under the Sponsored Program) were handed out cards with little information given on how the cards are going to be used. Members themselves often misplace their membership card, or find it difficult to prove they are members due to their inability to produce the needed administrative requirements, such as birth certificates.

Key program components: 

PhilHealth LINK is particularly useful for households whose premiums are subsidized by LGUs under the Sponsored Program, and who may not be fully aware of the benefits they are entitled to, and how they may be availed of.

At present, there are 14 call-center agents at PhilHealth LINK, which is physically located at the Region 8 Tacloban City Office. They are fed questions by coordinators in hospitals (called PhilHealth HELP), who interview all patients on the documentation that they need to produce to prove that they are a PhilHealth member. The call-center agents, in turn, facilitate the production of the needed documents (e.g., birth certificates, PHIC membership eligibility, PHIC number).

Staffs that assist in making sure that eligible patients use their PHIC cards are paid incentives to raise the quality of their work. The payments are as follows: Php 10/claim for PhilLink employee; Php 30/claim paid to PhilHELP employee; and Php 20/claim paid to the provincial processor.

Program history: 

PhilHealth LINK was launched by PhilHealth Region VIII in 2010.

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