PhilamCare low-cost health plan (Philippines) : final evaluation report, May 1994-December 1996

The subproject was implemented by PhilamCare, a local health maintenance organization (HMO), and targeted lower-income families, particularly those in the informal sector not covered by social security benefits. The subproject also included family planning (FP) benefits, which existing health insurance plans in the Philippines did not. PROFIT assisted PhilamCare in designing a health insurance plan and provided funds to underwrite the risks associated with launching the plan on a pilot basis in the cities of Manila and Cebu. PhilamCare managed the day-to-day operations of the plan and offered TA to the contracting hospitals in managed care principles and in providing FP services. Constraints to implementation during the first year included difficulties in identifying a hospital in Manila willing to participate in the plan, retaining a sales staff, and marketing to a new client base (the informal sector), and the fact that an unexpectedly high number of enrollees allowed their coverage to lapse, resulting in sales reaching only 1,403 members, far below projections. Day-to-day operations of the plan improved in the second year with the hiring of a full-time manager and the signing of agreements with new participating hospitals. However, PhilamCare was still unable to meet its sales targets. Therefore, in 12/96, with only 2,000 enrollees (vs. the targeted 4,000) and PROFIT"S inability to continue underwriting the plan, the PhilamCare Board decided to discontinue it. However, PhilamCare is considering ways to re-launch a plan targeting lower-income families. This subproject confirmed the existence of a demand for health insurance among low-income individuals in the informal sector. To succeed, future projects of this kind will need to control recruitment costs, target client groups rather than individuals, and reduce drop-outs. Moreover, motivating consumers to use the FP benefits under a health plan requires education and an understanding of the reasons why some consumers use government facilities and how to motivate them to shift to designated private providers. (Author abstract, modified)