Good health for everyone
BECAUSE HEALTH continues to be among the top priorities of many people, a lot also give great importance to health insurance, especially during days when diseases become prevalent and uncertainties take place. With this, the local health maintenance organization ( HMO) industry is constantly striving to meet the Filipinos’ growing need for quality and innovative yet affordable health care services.
Norman P. Amora, Intellicare vicepresident for marketing and sales, said in e-mail to BusinessWorld that the HMO industry has matured and consumers have played a big factor in this process. According to him, the importance of HMOs, which “provides ‘peace of mind’ for members in terms of medical needs and access to reputable medical facilities and practitioners through a ‘cashless’ transaction,” is now recognized.
For MediCard Philippines, Inc. president Dr. Nicky S. Montoya, the significant growth of the industry over the years is credited to the improved economy and the country’s rising BPO ( business process outsourcing) sector.
“According to the Asian Development Bank, the Philippines’ GDP growth accelerated from 5.9% in 2015 to 6.8% in 2016,” Dr. Montoya explained in an e-mail to BusinessWorld.
Although the benefits of getting an HMO insurance have been acknowledged by the consumers, there are still challenges and opportunities that need to be addressed.
Maxicare President and Chief Executive Officer Christian S. Argos told BusinessWorld in an e-mail that health care is everyone’s prime priority but investing on personal health programs, such as what HMOs offer, has taken a back seat for some consumers. “The cost of health care continues to rise… It’s already at levels that a bigger portion of our population cannot afford. The only way to bring more HMO services to more people is to bring the cost down. The industry is looking at opportunities to transform the business, the relationship between HMOs and providers, so we can deliver more services to more members. It’s a chicken-and-egg situation. We need to make it more affordable so more people can come in and the cost can decrease further.
He explained that people should not measure the value of an HMO by its
cost-impact and purchase, but rather than the value of its coverage at the possible time of usage.
“It is understandable that many see an HMO plan as ‘expensive’; however, one must realize that it is far more costly once you get sick and avail of all necessary health treatments. HMO should be a lifestyle, a part of an individual as it entails security — financially and physically-wise,” Mr. Argos added.
One way to address the problem, according to Dr. Montoya, is through patient empowerment. He said that making people feel that they are in charge of their own health may inspire them to consider getting an HMO coverage.
At present, the HMOs are adapting innovations in technology to deliver more quality health care services for everyone. From traditional manual processes, it is now leveraging on the use of computers and mobile applications to connect with its consumers, making everything easier and faster.
Dr. Montoya stated that as consumers have become more mobile, the HMO industry has become more open to the advantages of technology. For instance, telemedicine offers both consumers and health care providers easy access to each other. It also helps the patients save time and money as it eliminates long waiting time at the doctor’s office.
Mr. Argos said that it is necessary that key players in the HMO industry have responsive portals to ensure consumers’ convenience in availing health care services. He explained that the industry is now into heavy automation to accelerate processes and to facilitate the flow of information from eligibility check to actual availment of services in the hospital or clinic.
Changes in the industry from a regulatory perspective are also taking place. The HMOs are now under the purview of the Insurance Commission ( IC), which was cited by Mr. Argos as a positive change since it strengthens the industry.
“We have a lot to learn from what the IC has done for the insurance industry. A lot of the best practices there can be directly imported to the HMO industry. On the other hand, we also have the opportunity to inform the IC the differences in our industry compared to insurance and the challenges in the HMO industry, and how we can engage the IC and the government to improve the regulatory environment, taxation, and other rules and regulations for the benefit of our members and the HMOs,” Mr. Argos said.
He added, “The state of the HMO industry right now is at a very, very transitional phase. This transition will lead to a stronger industry, better products and services for our members, expanded coverage (we’ll cover more people), and people will hopefully have healthier lives. And if they get sick, the HMO industry will be able to help even more members.” —