Community-based health care organizations : prospects and potentials in the national health insurance program / Ruben N. Caragay

The Community-Based Health Care Organizations (CBHCO) have long been providing health services especially in areas where the government service mechanisms are absent or inadequate. Many of them have health financing schemes for greater efffectiveness and sustainability. Wihin the context of the National Health Insurance Program (NHIP), they are recognized as health care providers and lately, as financial intermediaries. The research was done in order to rationalize their participation in the NHIP. Qualititative (focus group and roundtable discussions) and quantitative (survey using questionnaire) methods were utilized to obtain data from the CBHCOs, stakeholders, and policy makers in order to identify their possible roles and mechanisms for participation in the implementation of the health insurance law. Important roles such as vision of promotive and preventive health services aside from curative services and as financial intermediaries (e.g., planning/budgeting, collecting and disbursing insurance funds) were identified. They can also be advocates of social health insurance, monitors in NHIP implentation, and coordinators between the Philippine Health Insurance Corporation (PhilHealth), the local government units (LGUs), and the communities. Various mechanisms for phasing-in between the CBHCOs and the PhilHealth were also determined ranging from retention of a autonomy and flexibility to complete integration of he CBHCOs. There are three main recommendations: (1) the operationalization of the CBHCO role as health service provider prior to exploring the other roles; (2) the conduct of pilot testing using various models/mechanisms of CBHCO-PhilHealth interphrasing; and (3) strenghtening of the CBHCOs for self-regulation and for a more meaningful relationship with the Department of Health (DOH), and the PhilHealth.

Nursing.