ACTIVITY 4

8 TASKS FOR
POLICY ADVOCACY
Kristine Joy A. Gacutno, MD, DPSP
Charlotte Anne V. Tiu, MD, DPBEM
Trisha Mae Casuga, LPT
Christine Baldevia, MD
Steve Aldrich Guias, MD
Ianne June M. Evans, RN

Dr. Gina Pardilla

SCENARIO 9.4 ADVOCACY
TO HELP UNINSURED
CONSUMERS TO OBTAIN
MEDICAL SERVICES

(IN PHILIPPINE SETTING)

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DECIDE WHETHER
TO PROCEED
Yes, as an advocate in policy making, we would like the
policy makers to have a different view with the uninsured
consumers to obtain medical services here in the Philippines.
 
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DECIDING WHERE
TO FOCUS
Here in the Philippines, we already have the Universal Health Care (UHC)
Act wherein unemployed, uninsured, and indigent consumers will have their
free enrollment and free availment of medical services without spending
money in the hospital. The only problem is that in the insurance that we
have here in the Philippines which is the Philhealth, they only have limited
packages wherein many cases are non-compensable.
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SECURING
ATTENTION OF
DECISION MAKERS
We should have a data gathering team wherein they will
present the prevalence of non-compensable cases where a lot
of consumers cannot maximize their insurance benefits.
 DEVELOPING A BASE
6

OF SUPPORT
• with the implementation of Universal Health Care (UHC) in the Philippines, all indigent
patients who come to the hospital are automatically enrolled.
• our LGU also supports healthcare needs of their constituents by providing free
consultations, free medicines, and free laboratory exams in our hospital and city health
office.
• we are also partnering with DOH who provides funds for indigent patients thru their MAIP
(medical assistance for indigent patients)
• Office of the President thru the MALASAKIT funds
• the Office of the Vice President, and the Tingog Partylist also provides funds to the hospital
for the indigent patients
• also need to partner with TESDA to provide free training to develop skills and provide
greater chances of good and permanent employment.
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DEVELOPING A BASE
OF SUPPORT
• we could also tap the DSWD, and help them improve their listing of 4Ps deserving clients.
• DSWD also provides financial support for indigent patients. (maximum of 5,000 pesos per
patient per admission), they also give cash assistance for special laboratory exams that are
not available in our hospital (almost full amount of laboratory exam cost )
• We may also include as support to the advocacy, the individual companies/employers and
probably suggest tax credits if they include free medical assistance to their employees,
either contractual, job-order, or permanent.
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DEVELOPING
PROPOSALS
• Implementation of Universal Healthcare
• Memorandum of Agreement with DOH for MAIP funding
• MOA with DSWD for financial assistance for indigent patients
• MOA with Office of the President for MALASAKIT funds
• MOA with Office of the Vice Prsident for financial assistance for indigent patients
• MOA with Tingog Partylist for financial assistance for indigent patients
• Propose for tax credits of small businesses to help them provide insurance benefits for their
employees
 
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SECURING APPROVAL OR
ENACTMENT OF PROPOSAL
Conduct a consultation inviting Health Insurance Companies, LGU
representatives (Chief Executive, MSWDO, SB on Health, Liga ng Brgy.
President and MHO) Private Hospitals representative to discuss with proposals
to enhance any existing programs in obtaining medical services to uninsured
consumers.
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SECURE IMPLEMENTATION
OF A POLICY REFORM
Obtaining a Memorandum of Agreement between various stakeholders as to the
proposed programs resulted from previous consultation to identify roles and
responsibilities of the parties involved, and allocation funds to support programs
for the implementation.
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ASSESSING IMPLEMENTED
POLICIES
Assessment of implementation is necessary to ensure the efficiency of health
programs. It could be done through interviews or survey questionnaires from
uninsured consumers catered in various medical institutions involved in the
MOA.
SCENARIO 9.5.
ADVOCACY TO HELP
CONSUMERS GAIN
ACCESS TO MEDICAID
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DECIDE WHETHER
TO PROCEED
Yes. A policy like Medicaid funding can be a major source of support for hospitals and
physicians, and jobs in the health care sector. The guarantee of matching government
funds on an open-ended basis allows flexibility. The financing structure also provides
support for our country to allow a Health care policy like Medicaid to operate as safety
net when there is economic shifts.
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DECIDING WHERE
TO FOCUS
Currently in the Philippines, Under the UHC Law, all citizens are automatically entitled to
PhilHealth benefits, including comprehensive outpatient services. PhilHealth will be
responsible for purchasing all individual-based services, including supplies, medicines,
and commodities, as well as maintenance and operating expense of health facilities.
Membership into the Program shall be simplified into two (2) types, direct contributors
and indirect contributors.

An entitlement program like Medicaid can also vary like in the United states, there is a
possibility that programs can offer more flexibility in terms of the following.
• determine covered populations (lower the eligibility criteria)
• covered services
• health care delivery models, and methods for paying physicians and hospitals.
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SECURING
ATTENTION OF
DECISION MAKERS
Through an array of health system amendments, along with this is a planned paradigm
shift to primary care, which is the core and center of all health reforms. Monitoring
progress should take into account the epidemiological and demographic profile, health
system, level of economic development, and the population's demands and expectations.
By this health reform is feasible and law makers will focus more on a health financing
perspective and expanding health insurance in the Philippines.
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DEVELOPING A BASE
OF SUPPORT
To build a s strong foundation of support the government should prioritize more on health
(billions of funds). And supported with government laws and policies to have a substantial impact
on the amount the government spends for an entitlement program like Medicaid. The government
is also entitled to have a broad discretion to determine who is eligible, what services they will
cover, and what they will pay for covered services.
 DEVELOPING
17

PROPOSALS
An entitlement program like Medicaid can be implemented in the Philippines, and just like other health insurances
this means that anyone who meets eligibility rules has a right to enroll in Medicaid coverage.
It also means that the government can guarantee financial support for part of the cost of their Medicaid programs.
In order to receive federal funding, states must cover certain “mandatory” populations:

• children through age 18 in families with income below a certain poverty line
• people who are pregnant and have income below a certain percent of the poverty line;
• certain parents or caretakers with very low income; and
• most seniors and people with disabilities who receive cash assistance

A policy that can offer a more important role in insuring low-income Filipinos due to a more Affordable Care Act
and more health care coverage. An entitlement program in our country that aims to cover MANDATORY services,
such as hospital and physician care, laboratory and X-ray services, home health services, and nursing facility
services for adults. And a proposal to provide a more comprehensive set of services, known as the Early and
Periodic Screening for Cancer Patient, Diagnostic, and Treatment.
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SECURING APPROVAL OR
ENACTMENT OF PROPOSAL
The enactment of proposal must describe the program administration, eligibility categories,
and services provided. The enactment plan must identify the required and optional health care
services available. It also must describe how beneficiaries and advocates can review and
obtain copies of the approve policies and rules governing program operation. For Monitoring
of the Proposal and Advisory Committee can be developed to participate in both policy
development and program administration
 SECURE IMPLEMENTATION
19

OF A POLICY REFORM
An entitlement program like Medicaid is a health program to provide health coverage to millions of
Americans, especially for the poor. Each state has its own application procedures for its Medicaid program
and often change according to the elected officials or state budget deficits. Periodic updating of eligibility
with different required documents to provide depending on the states policy, and policies for the elderly,
blind and disabled that a lien may be placed on their home if they reside in the home rather than in a nursing
home.

With these policies, if this will be applied in the Philippines, many Filipinos will not be able to apply for
eligibility for this health coverage and benefits. Periodic updating of eligibility with required documents
every 3 months will lessen the compliance of the consumers, especially the poor. Application procedure
policies should be at a national level rather than state level to encourage compliance of the consumers.

Each policy should be discussed by different sectors before a policy reform to be applied. To effectively
secure implementation of a policy reform for Medicaid, stakeholders should be consulted to ensure that the
policies and procedures are realistic and actionable, tailored to the needs of the consumers, and
comprehensible to the consumers – especially the poor.
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ASSESSING IMPLEMENTED
POLICIES
With the different issues with implementation of policies and procedures of Medicaid, policy
implementation evaluation should be considered. Stakeholders should be engaged with the
evaluation. Assessing policies should begin with problem identification, analysis of the issues with
the policies, developing a strategy that is tailored to benefit both the consumer and the government.
With thorough assessment of these implemented policies, a policy reform may be implemented.
THANK YOU