Level of satisfaction with the national health insurance program in 2006 among PhilHealth accredited service providers from four medical societies

ABSTRACT

OBJECTIVES: To determine the level of satisfaction with the National Health Insurance Program (NHIP) among PhilHealth-accredited members of the four different medical societies (PCP, PPS, PCS and PSA) and identify areas for improvement of the NHIP. METHODS: In 2006, UPM-NIH conducted satisfaction surveys among PhilHealth-accredited members of the Philippine College of Physicians (PCP), Philippine Pediatric Society (PPS), Philippine College of Surgeons (PCS), and Philippine Society of Anesthesiologists (PSA) during their respective national conventions. The survey questionnaire used a Leikert scale to measure level of satisfaction and was based on the key performance areas of the NHIP identified in the validation framework of the InterAgency Validation Team and key informant interviews (KIIs) of selected medical doctors. Data analysis was done using SPSS ver 14. RESULTS AND CONCLUSION: Respondents from the PCS (surgeons) were only slightly satisfied with PhilHealth in general, while the respondents of the other three societies (PCP - Internists, PPS - Pediatricians, and PSA - Anesthesiologists) were slightly dissatisfied with PhilHealth. Respondents of the four societies were satisfied with the accreditation process. Respondents were most dissatisfied with the length of time to be reimbursed and the amount reimbursed for their professional services. The respondents from the PCS tended to be more satisfied than the respondents of the PCP, PPS and PSA. Respondents expressed some dissatisfaction with the PhilHealth benefit package formulation. A significant percentage of respondents (about 27%) were neither satisfied nor dissatisfied with PhilHealth. These respondents could swing PhilHealth satisfaction either way and PhilHealth should make efforts to make them satisfied. The design of the survey tool precluded a qualitative analysis of the reasons for satisfaction/dissatisfaction. But the areas of most dissatisfaction identified by the respondents have to do with reimbursement length of time and amount. In subsequent small group discussions with different physician service providers, it was observed that there was a general low level of awareness about the principles of social health insurance, benefit design and payment mechanisms. PhilHealth should address this with regular information and service improvement campaigns to engender a more proactive role for the service providers in achieving greater financial access to needed quality health services for all Filipinos. Respondents had recommendations to improve PhilHealth performance in the following areas accreditation, reimbursement, SPECIAL ARTICLE benefit package formulation, administrative process, and coverage and enrollment. Many of the recommendations had to do with increasing PhilHealth efficiency, unifying the Department of Health (DOH), the Philippine Regulatory Commission (PRC) and PhilHealth standards, simplifying and decreasing requirements for the different processes and improving PHIC's information system. They also recommended revising the relative value scale (PhilHealth's system of assigning a value to a certain procedure which serves as the basis for determining the amount for reimbursement), improving coverage, formulating comprehensive benefit packages focused on the poor, and effective identification of the poor for the Sponsored Program, (PhilHealth's program for enrolling the poor).