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 (PhilHealth) and other national government agencies (NGAs) such as DILG, DSWD, DAR, DOH.
The Enhanced PCSO GMA Program is a realization of the common goals of PCSO, PhilHealth, 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 P1.5 billion as assistance for the payment of the local government unit (LGU) premium counterpart to PhilHealth for 2004, initially utilized the P1 billion “Stand By Fund” approved by the PCSO Board. DBM, on the other hand, assured the release of P1.5 billion to PhilHealth 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 VIII.
5. To be able to identify the number of claims from the enrolled members.
6. To determine the controversies behind the card
CHAPTER III. SCOPE AND LIMITATION
The study is confined only to Region VIII 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 PhilHealth.
In the secondary data, the researcher used the information from PhilHealth, news clippings from the newspapers and the Internet.
CHAPTER V. DATA ANALYSIS
Table I. Number of Indigents Enrolled In Eastern Samar
Municipality No. Of Indigents Enrolled Percentage
Arteche 1,142 3.27%
Balangiga 686 1.96%
Balangkayan 991 2.84%
Borongan 5,398 15.46%
Can-avid 1,909 5.47%
Dolores 3,575 10.24%
Gen. Macarthur 505 1.45%
Giporlos 1,092 3.13%
Guiuan 2,933 8.40%
Hernani 869 2.49%
Jipapad 315 0.90%
Lawaan 953 2.73%
Llorente 1,309 3.75%
Maslog 40 0.11%
Maydolong 1,154 3.31%
Mercedes 459 1.31%
Oras 3,121 8.94%
Quinapondan 1,489 4.26%
Salcedo 1,015 2.91%
San Julian 1,220 3.49%
San Policarpo 1,888 5.41%
Sulat 1,311 3.75%
Taft 1,540 4.41%
TOTAL 34,914 100.00%
In Eastern Samar, the highest number of indigents enrolled was the Municipality of Borongan with a total of 5, 398 or 15.
The IPPS or the inpatient prospective payment system refers to a system of payment which includes the diagnosis-related groups’ cases as acute care hospital inpatients. This system is based on resources which are utilized when treating Medicare recipients belonging to these groups. Each diagnosis-related group (DRG) comprise of a payment weight. The IPPS serves an integral role when it comes to deciding the overall hospital costs of all the devices used to treat the patient in within a specific inpatient stay.
Kaiser Permanente’s mission is to provide care assistance to those in need. As a health maintenance organization, Kaiser Permanente provides preventive care such as prenatal care, immunizations, diagnostics, hospital medical and pharmacy services. Also, they take responsibility and provide exceptional training for their future health professionals for better clinical performance and treatment for the patients. The organization is to ensure fair and proper treatment towards their employees for a pleasant working environment in hospital and to provide medical services especially in a growing population in suburban communities, such as Tracy and Stockton in California.
To collect my information I used a variety of sources and methods. These consisted of:
For the first component of the Session Long Project, your task is to write a 2-3 page essay about a health care organization with which you are involved, or are familiar. Specifically, your tasks are to select an organization and describe it. Then, discuss the main challenges in marketing that organization.
GMFC is concerned about PPACA new benefits and age limit requirements. The Affordable Care Act comes with a lot of regulations and rules and GMFC considers such regulations cumbersome. ACA considers health insurance a minimum essential coverage when the coverage adheres to ACA new regulations and rules for health insurance. Additionally, the health insurance must entail new rights (Buchmueller et al., 2013). ACA rules stipulates that health insurance companies should obtain a minimum essential coverage and maintain the coverage for a whole year to avoid the fee for not obtaining the health , protection, and benefits offered by the law. GMFC considers these rules difficult and binding. Consequently, GMFC raises concerns that the above regulations and law will raise cost to the company. In other words, the ACA will lead to increased health care cost to many employers in this case GMFC. The cost will rise because employers will incorporate advanced IT infrastructures and take hours of labor to gather extensive amount of data. Additionally, the employers are thinking of offsetting the cost by providing lower health care costs. In other words, GMFC is considering cutting health care coverage and offer each employee a stipend to cut on the rising
The PPACA has turned to healthcare field upside-down. This is due to the new laws and regulations that were put in place. Some of the changes occurring due to the PPACA include increasing access to care, a revised pay structure, increasing technologies, and creating a healthcare system that is safer for Americans (Harrington, 2010). These requirement and new laws made Centura Health look at their policies and the way they are providing care. Centura Health used these requirements and laws to create a new strategy they labeled the 2020 Centura Health Strategy. This strategy is creating major changes throughout every one of Centura Health’s facilities.
...n of the research method or methods used to gather and interpret them are included. The method used to collect data is normally outlined in the article is appropriate to the topic, and allows the study to be duplicated for purposes of verification. The document relies on other sources that are listed in a bibliography or includes links to the documents themselves. The document names people and/or sources that provided non- published data used in the preparation of the topic of study.
Furthermore, in the case of comparing the Patient Centered Medical Homes against Obamacare services the odd speak for combining some of the techniques that are used in the PCMH to build a more stable health care system. “Maria Vezina (2013) reports knowledge about the Patient Protection and Affordable Care Act (PPACA) passed in March 2010 and upheld by the Supreme Court in June 2012, is key in understanding the varied regulatory changes that have been made to our U.S. health care system. PPACA is the most significant regulatory overhaul of U.S. health care since Medicare and Medicaid in 1965. The entire health care team needs to be prepared for initiatives introduced to better manage the care for a greater population of people with improved
“KP is the largest non-profit health care delivery system in the United States, and operates in 8 states and the District of Columbia. KP is made up of 3 entities: the Kaiser Foundation Health Plan (KFHP), Kaiser Foundation Hospitals (KFH), and the regional Permanente Medical Groups,” (Selevan, Kindermann, Pines, and Fields (2015). Selevan al et (2015) state that the members of Kaiser Permanente can be compared to other insurance companies in regards to age, race, and employment status, although the members are known to have lower income levels. Additionally, they found that Kaiser Permanente’s model of care focuses on improving the health of patients, promoting population
The data gave me insight into my research question because I got information from the
While the purpose of The Patient Protections and Affordable Care Act is to improve the costs and quality of healthcare for all U.S. citizens and legal immigrants, the PPACA will accomplish this foremost by extending insurance coverage to millions of Americans who are currently without health insurance, as stated in Title I: Quality, Affordable Health Care for All Americans (The Health Foundation of Greater Cincinnati). By having everyone participate in the same health insurance pool, we can ensure a health insurance market that is more affordable for everyone. One of the problems with our health insurance market has been that people have a hard time getting insurance coverage on their own and its very costly and often does not cover a lot. The health refo...
In addition to costly outliers, both the IPPS and HH PPS share other similar payment adjustments in order to ensure that all eligible beneficiaries have access to the appropriate services. They include adjusting the payment rate for partial episodes, and low-utilization of services. The outlier adjustment is made in order to pay for beneficiaries whose cost of care exceeds the threshold amount for their assigned group, just as for the IPPS 3. Under the HH PPS, the low-utilization adjustment can be made for beneficiaries whose episodes consist of four or fewer visits. When this is the case, workers will be paid based on the services they provide per visit multiplied by the number of visits provided during the episode 3, 4. One additional payment adjustment made under the HH PPS, the partial episode payment adjustment (PEP) can be made for patients who change HHAs or are discharged and readmitted within a 60-day episode. When this happens, a new episode will begin for that patient and they would now required a new plan of care and assessment. The adjustment to the original 60-day episode proportionately reflects the length of time the patient remained under the agency’s care
When promoting primary health care services, there are many factors that must be considered when developing an effective marketing plan. Primary care providers are the gatekeepers of health care in the United States; many patients have to visit them before being referred to specialist providers (Bodenheimer, 2003). They are also being tasked with ensuring patients are receiving preventative services and managing more complex chronic diseases (Akinci & Healey, 2004). Recruitment of primary care physicians is challenging because they are expected to do more and are not being reimbursed proportionally for the added workload (Bodenheimer, 2003). In this paper, a group of primary care physicians in Washington D.C. is looking to research their consumer population base in order to provide them better services and recruit new primary care physicians to their practice (Colorado State University-Global Campus, 2013). A successful primary care marketing plan will recruit quality health care providers while improving consumer accessibility to their services, customer satisfaction rates, and patients’ continuity of care with their health care provider.
In this unit, we will be discussing real-life healthcare organizations, the 5 P’s of healthcare marketing, and evaluation strategies that may be used to determine marketing potential. Select and provide a general overview of three (3) healthcare organizations that interest you. Discuss the 5 P’s of healthcare marketing to each healthcare organization. Elaborate how the 5 P’s of healthcare marketing may impact the marketing potential of a healthcare organization. Discuss an assessment or evaluation strategy which may be used to help determine the marketing potential of an organization.
Unfortunately, this era also witnessed tumor in the medical community as the American Medical Association (AMA) greatly opposed the prepaid plans of the early 1900s while favoring the indemnity- type insurance that reimbursed policyholders. Therefore with the pioneers of prepaid services encountering daring degrees of oppositions, a strategy to discourage such opposition led to the development of the early Independent practice associations (IPA) model HMO (Fox & Kongstvedt, 2015; Kongstvedt, 2009).