HMO Plans: How Do They Empower Philippine Workforce’s Financial Security?

It is true. Many Filipinos are only one illness away from poverty.

One of the biggest sources of financial insecurity among Filipinos is healthcare. With over half of medical expenses financed through out-of-pocket household payments and 60% of an average Filipino’s income spent primarily on food, Filipinos simply cannot afford to get ill.1 For the past two years, the COVID-19 pandemic has worsened this problem by making it more difficult to receive proper care due to the overdemand for medical services and increased medical bills.2 Now, Filipinos are financially unprepared for critical illnesses more than ever.

The EY 2021 Global Insurance Consumer Survey also revealed that emerging economies, the Philippines included, suffered greater financial blows than the developed countries during the pandemic.3 The layoffs and sudden changes to people’s work arrangements have caused financial constraints, forcing them to use part of their savings to stay afloat. The global survey also showed that among the most impacted segments in the Philippines, 87% of them listed the sudden loss of a loved one as one of their primary concerns during the pandemic3. Overall, the harsh truth that finances play a crucial role in safeguarding their families, whether for day-to-day needs or healthcare costs, has encouraged them to save more instead as preparation. Ultimately, the pandemic has led to an increase in Filipinos’ desire for greater financial security. However, savings alone is not enough to achieve the sense of financial security Filipinos are yearning for. Although about 99 million Filipinos, members and dependents included, are covered by the country’s national health insurance program4, having a supplementary HMO (Health Maintenance Organization) in addition to the PhilHealth coverage is the best fit. This will provide them with three important things: 1) a sense of security in times of medical emergencies; 2) ease of burden from whopping medical expenses, and 3) value for money.

Sense of Security

As a frontline organization during the pandemic, the HMO industry is proven to be a dependable partner in safeguarding workers’ health by providing plan members with hospitalization, whether for inpatient or outpatient consultations, emergency services, laboratory services, and other services, included in the coverage. While having a vast network of healthcare providers fitting for various medical needs, HMO companies, with their more organized and managed healthcare delivery process that fundamentally consider the interests and wellbeing of their stakeholders,5 allow their members to feel secure in times of hardships and unforeseen illnesses or injuries.

Easing of Financial Burden

Not only do HMO companies help in conveniently providing quality medical care, but they also help in making it easier for healthcare to be in the palm of its members without breaking their pockets. To put into perspective, some of the most common health hurdles that Filipinos currently face are dengue and pneumonia.

As dengue cases continue to be on a rise,6 there has been more attention given to the dismaying average cost for dengue treatment amounting to PHP 10,500,7 which is a sizable chunk of one’s monthly income. Meanwhile, as pneumonia continues to affect a large number of the Filipino population,8 it is equally dismaying that the average cost for basic pneumonia treatment averages at PHP 8,047,9 but can go over PHP 100,000 in severe cases.10 Especially for an average Filipino, these numbers can be daunting.

Fortunately, HMO plans substantially cover the expenses for these diseases. As a result, more members, dependents, and people of the workforce go to the hospital to be treated for dengue and pneumonia. Moreover, hefty expenses for other life-threatening diseases such as stroke, heart disease, cancer, etc.,11 are among the top cases financed through HMO plans. Considering that some of these health conditions are among the top causes of mortality in the Philippines,12 these are clear indications that HMO plans emboldened more Filipinos to be treated by specialists regardless of how grave or expensive the treatment of their condition is.

Value for Money

Usually offered as part of an employer's benefits package in private companies, HMO plans are comprehensive and customizable, with the option of extending coverage to families. There is no doubt that the managed delivery of medical care through HMO plans is deemed very convenient with its extensive array of assisted services. While staying economical, you are already equipping yourself with an extra layer of protection for both your physical and financial health.13

In this age where health is increasingly becoming more relevant, nobody must be excluded from the list of those getting the care they need. It is, therefore, imperative that healthcare is within reach of the population regardless of the number of one's income. It has long been the HMO industry’s mission to secure affordable quality healthcare for our people. But it is when employers also prioritize their employees’ health through the provision of comprehensive health benefits, and employees properly utilize the privileges their workplaces offer, that Filipinos can finally escape the position where we are just one illness away from poverty.

References:

1 World Health Organization. (2018, June 8). Health for all is key for a safer , fairer, more prosperous Philippines. Retrieved from https://www.who.int/philippines/news/commentaries/detail/health-for-all-is-key-for-a-safer-fairer-more-prosperous-philippines.

2 Chanco, B. (2021, January 20). Surprise hospital bills. PhilStar Global. Retrieved from https://www.philstar.com/business/2021/01/20/2071588/surprise-hospital-bills.

3 Cruz, C. (2021, December 9). Why insurers must adapt to meet the changing Philippine landscape under COVID 19. SGV. Retrieved from https://www.ey.com/en_ph/insurance/why-insurers-must-adapt-to-meet-the-changing-philippine-landscap.

4 PhilHealth. (2022). Stats and Charts 2022 (First Semester). Retrieved from https://www.philhealth.gov.ph/about_us/statsncharts/snc2022_1stSem.pdf.

5 Da Silva, C. (n.d.). Counting on the HMO industry in the time of COVID-19. The Philippine Star. Retrieved from https://star34.philstarlife.com/article/162357-counting-on-the-hmo-industry-in-the-time-of-covid-19.

6 Philippine Information Agency. (2022, August 22). PH dengue cases continue to rise -DOH. Retrieved from https://pia.gov.ph/news/2022/08/22/ph-dengue-cases-continue-to-rise-doh

7 Cheng, K. J. G., Lam, H. Y., Rivera, A. S., Tumanan-Mendoza, B. A., Alejandria, M. M., & Wu, D. B. (2018). Estimating the Burden of Dengue in the Philippines Using a Dynamic Transmission Model . Acta Medica Philippina, 52(2). https://doi.org/10.47895/amp.v52i2.427

8 Casta?eda, J. (2022, October 25). Jab well done! Getting vaccinated against pneumonia. PhilStar. Retrieved from https://www.philstar.com/lifestyle/health-and-family/2022/10/25/2219185/jab-well-done-getting-vaccinated-against-pneumonia

9 Tsilaajav, T. (2009, March). Costing study for selected hospitals in the Philippines. Department of Health. Retrieved from https://doh.gov.ph/sites/default/files/publications/CostingStudySelectedHospitalsPhilippines.pdf.

10 Tumanan-Mendoza, B. A., Mendoza, V. L., Frias, M. V., &amp; Bonzon, D. D. (2017). Economic Burden of Community-Acquired Pneumonia Among Pediatric Patients (Aged 3 Months to < 19 Years) in the Philippines. Value in Health Regional Issues, 12, 115–122. https://doi.org/https://doi.org/10.1016/j.vhri.2017.04.003

11 Department of Health. (n.d.). What are the leading cases of mortality in the Philippines? Retrieved from https://doh.gov.ph/node/1058.

12 Philippine Statistics Authority. (2022). Causes of Deaths in the Philippines (Preliminary): January to December 2021 | Philippine Statistics Authority. Psa.gov.ph. https://psa.gov.ph/content/causes-deaths-philippines-preliminary-january-december-2021

13 Beltran, B. B. (2019, May 24). What you should know about HMOs - BusinessWorld Online. BusinessWorld Online. https://www.bworldonline.com/features/2019/05/24/232671/what-you-should-know-about-hmos/

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