OPINION
Ed Javier
PhilHealth's Urgent Mission: Simplify Access, Educate Members, And Lead With Empathy
Photo credit: PhilHealth
A few columns ago, we explored the controversy surrounding PhilHealth and the rider provision in the 2024 budget that allowed the Department of Finance (DoF) to access excess PhilHealth funds. With this issue now before the Supreme Court, it’s time to shift focus.
We suggest that PhilHealth prioritize educating its members about their benefits, how to access them, and ensuring the integrity of the system.
Equally important is simplifying procedures to ensure members can efficiently avail themselves of these benefits.
PhilHealth provides essential services, including coverage for inpatient care, outpatient services, maternity care, and catastrophic illnesses through its Z Benefits package.
However, many members face challenges due to complex procedures, reimbursement delays, and insufficient information about their coverage. PhilHealth must address these issues effectively by prioritizing ongoing education and communication.
Issuing a few press releases and advertisements will not suffice; a comprehensive and continuous approach is necessary, particularly in regions with high poverty rates.
PhilHealth should not rest until most Filipinos, especially the indigents, persons with disabilities, and indigenous people, are enrolled as members.
Access to benefits must be easily obtainable, and payments to member hospitals and doctors should be prompt to ensure they can continue providing services to the people.
Streamlining the claims process is crucial. Simplifying procedures while maintaining due diligence to prevent fraud can reduce paperwork and bureaucratic obstacles, making it easier for members to access their benefits.
Transparency about coverage details, including limitations or exclusions, is essential. PhilHealth must ensure that members are well-informed about what is covered and how to access these benefits effectively.
With "excess funds" available, PhilHealth should enhance its technological infrastructure and organizational efficiency. Upgrading computer programs and applications, boosting technical staff support, and improving organizational skills will help manage data more effectively and enhance service delivery.
Once most members are enrolled, liabilities are settled, and the organizational structure is optimized with proper budgets and technology support, only then can PhilHealth legitimately claim to have "excess funds."
Expanding outreach efforts is vital, especially in underserved areas. Increased community outreach and education will ensure that all members, particularly those in marginalized communities, receive the necessary information to fully utilize their benefits.
There must also be certainty of punishment for those who attempt to defraud the government through fake claims.
PhilHealth must strengthen its legal unit to file cases and prosecute offenders and their government cohorts. Demonstrating that the government means business by holding wrongdoers accountable is crucial.
The lack of successful prosecutions in the past has led to a lack of fear among those who attempt to deceive the government. It’s essential to show that fraudulent actions will have serious consequences to deter future attempts.
Finally, PhilHealth President Emmanuel Ledesma must shed the privileges of his rich-kid upbringing, living in posh, exclusive gated subdivisions, and step away from his luxury suits lifestyle.
Born into comfort and luxury, Ledesma has likely never experienced the struggles faced by the majority of PhilHealth members—many of whom live in poverty and rely on the system for essential healthcare.
His insulated lifestyle, living in gated communities far removed from the everyday Filipino, stands in stark contrast to the harsh realities of those seeking care in underfunded public hospitals, especially in areas like Cordillera, Bicol, Eastern Visayas, and Mindanao.
As the CEO of a government corporation that impacts millions of lives, especially the poor, Ledesma needs to immerse himself in these conditions and understand the urgency of their needs.
His role is not akin to running a private corporation where he can remain insulated in his air-conditioned office from the problems at hand.
By experiencing these challenges firsthand, Ledesma can better grasp the struggles of members and drive meaningful change to improve the organization’s effectiveness in serving its most vulnerable constituents.
Managing PhilHealth is not solely about financials, actuarial data, or corporate services. It is about understanding and empathizing with its members, especially the poor ones.
Even the best financial strategies are meaningless if they do not address the actual needs and wants of members.
To deliver the best services, Ledesma must first deeply understand what members are experiencing. Without this empathy and understanding, the organization is bound to fail in its mission to effectively serve its people.
If you lack the ability to empathize with the very people you serve, then there is only one honorable course of action left – Resign!
We suggest that PhilHealth prioritize educating its members about their benefits, how to access them, and ensuring the integrity of the system.
Equally important is simplifying procedures to ensure members can efficiently avail themselves of these benefits.
PhilHealth provides essential services, including coverage for inpatient care, outpatient services, maternity care, and catastrophic illnesses through its Z Benefits package.
However, many members face challenges due to complex procedures, reimbursement delays, and insufficient information about their coverage. PhilHealth must address these issues effectively by prioritizing ongoing education and communication.
Issuing a few press releases and advertisements will not suffice; a comprehensive and continuous approach is necessary, particularly in regions with high poverty rates.
PhilHealth should not rest until most Filipinos, especially the indigents, persons with disabilities, and indigenous people, are enrolled as members.
Access to benefits must be easily obtainable, and payments to member hospitals and doctors should be prompt to ensure they can continue providing services to the people.
Streamlining the claims process is crucial. Simplifying procedures while maintaining due diligence to prevent fraud can reduce paperwork and bureaucratic obstacles, making it easier for members to access their benefits.
Transparency about coverage details, including limitations or exclusions, is essential. PhilHealth must ensure that members are well-informed about what is covered and how to access these benefits effectively.
With "excess funds" available, PhilHealth should enhance its technological infrastructure and organizational efficiency. Upgrading computer programs and applications, boosting technical staff support, and improving organizational skills will help manage data more effectively and enhance service delivery.
Once most members are enrolled, liabilities are settled, and the organizational structure is optimized with proper budgets and technology support, only then can PhilHealth legitimately claim to have "excess funds."
Expanding outreach efforts is vital, especially in underserved areas. Increased community outreach and education will ensure that all members, particularly those in marginalized communities, receive the necessary information to fully utilize their benefits.
There must also be certainty of punishment for those who attempt to defraud the government through fake claims.
PhilHealth must strengthen its legal unit to file cases and prosecute offenders and their government cohorts. Demonstrating that the government means business by holding wrongdoers accountable is crucial.
The lack of successful prosecutions in the past has led to a lack of fear among those who attempt to deceive the government. It’s essential to show that fraudulent actions will have serious consequences to deter future attempts.
Finally, PhilHealth President Emmanuel Ledesma must shed the privileges of his rich-kid upbringing, living in posh, exclusive gated subdivisions, and step away from his luxury suits lifestyle.
Born into comfort and luxury, Ledesma has likely never experienced the struggles faced by the majority of PhilHealth members—many of whom live in poverty and rely on the system for essential healthcare.
His insulated lifestyle, living in gated communities far removed from the everyday Filipino, stands in stark contrast to the harsh realities of those seeking care in underfunded public hospitals, especially in areas like Cordillera, Bicol, Eastern Visayas, and Mindanao.
As the CEO of a government corporation that impacts millions of lives, especially the poor, Ledesma needs to immerse himself in these conditions and understand the urgency of their needs.
His role is not akin to running a private corporation where he can remain insulated in his air-conditioned office from the problems at hand.
By experiencing these challenges firsthand, Ledesma can better grasp the struggles of members and drive meaningful change to improve the organization’s effectiveness in serving its most vulnerable constituents.
Managing PhilHealth is not solely about financials, actuarial data, or corporate services. It is about understanding and empathizing with its members, especially the poor ones.
Even the best financial strategies are meaningless if they do not address the actual needs and wants of members.
To deliver the best services, Ledesma must first deeply understand what members are experiencing. Without this empathy and understanding, the organization is bound to fail in its mission to effectively serve its people.
If you lack the ability to empathize with the very people you serve, then there is only one honorable course of action left – Resign!
Sep 16, 2024
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