Managed care
Began in the late 1970s as a spill over from a successful run in the
United States.
PIONEERS WERE:
Philam Care
Medicard
Fortune Care
Goals:
government.
Self regulation by AHMOPI
> Medicard
website: https://www.intellicare.com.ph/
website: http://www.carehealthplus.com/
hotline: 09228447644
website: https://www.facebook.com/Carewell-Health-Systems-Inc-130500297034459/
hotline: 4344868/3555771
website: http://www.caritashealthshield.com.ph/
website: http://www.fortunecare.com.ph/
website: http://www.hmi.com.ph/
website: http://mainsite2.hppi.com.ph/home
website: https://www.insularhealthcare.com.ph/
website: http://www.kaiserhealthgroup.com/contact.php
hotline: (02) 274 8202 / (02) 274 8203 / (02) 274 8205 / 0917 5642 398 / 0998 9591 088
10. Life & Health HMP, Inc.
website: http://lifeandhealthhmp.com/
website: none
website: http://www.pacificcross.com.ph/
website: https://www.philcare.com.ph/
website: http://www.valucare.com.ph/
The health care provider receives a set amount of money each month
based on the number of individuals covered by the plan.
The provider may or may not serve that many people in one month.
Capitation systems provide a steady, reliable cash flow, but involve some
economic risk because the services provided may exceed the dollar
amount allotted.
The amount of money reflects the estimated service costs to treat the
individual patient's condition.
The provider takes the risk that unanticipated services will be required
Regulation of Health Maintenance Organizations (HMOs)
In the Philippines there is a small group of Health Maintenance
Organizations (HMOs) devoted to providing or arranging for the provision
of pre-agreed or designated health care services to its enrolled members
for a xed prepaid fee for a speci c period of time (Da Silva, 2012-I).
There are three different types of HMOs:
1. The investor-based HMO which is organized to operate at a profit. In
2011 there were 20 issued clearances to operate in Philippines.
2. An outpatient clinic with basic diagnostic facilities for ECG, chest and extremity X-
rays, CBC, urinalysis and fecalysis
5. A statement describing the differences, if any, in the standard benefits and fees of
PhilHealth against non-members
6. A copy of the agreement between the applicant HMO and the providers who shall
furnish the pre-agreed or designated health care services to the HMOs prospective
member
7. A statement of the HMO capitalization duly certified and attested by the Securities
and Exchange Commission (SEC) or Cooperative Development Agency (CDA), as the
case may be
8. A listing of the names and locations of the providers and other persons or facilities
either owned or controlled by the applicant HMO or with whom it has contracted to
furnish designated health care services to its prospective members
For community-based or cooperative HMO,
the minimum facilities required are:
1. One af liated general hospital
2. One af liated outpatient clinic
3. A copy of the standard bene t packages to
be offered to prospective members 4. Schedule
of fees to be charged for the standard
packages
According to information given by the Association of Health
Maintenance Organizations of the Philippines (AHMOPI)
HMOs covers mostly those in the employed sector.
Payment of premium depends on the agreement among the
employee and the employers.
In 2011, there were around 3.3 million of HMO plan holders,
mainly located in Metro Manila. Usually, the payment
mechanism is per service, but there are some cases of
capitation (Da Silva, 2012-I)6.
Difference Of HMO, Health Insurance And Medical
Insurance
If there are more patient visits, he still gets paid the same.