MAILBOX: Setting the record straight

MANILA, Philippines - This is with reference to an article which appeared in the Business Section of your Sept. 14 issue of The Philippine STAR – “Money-Go-Round” by Victor C. Agustin entitled “Chinese General Row Splits HMOs.”

Allow us to set the record straight and for the information of not only the estimated four million HMO planholders in the country today, but our entire citizenry – a lot of which will soon be HMO planholders when the industry goes into Microhealth initiatives in support of government’s thrusts to provide the Filipino people with quality yet affordable health care programs.

The Association of Health Maintenance Organizations of the Philippines, Inc. (AHMOPI) is the recognized trade organization of HMOs in the country today. Established and registered with the Securities and Exchange Commission in November 1987, it undertakes to protect the interest of the industry, its  planholders  and its members, strictly adhering to sound business ethics to achieve far greater performance standards and operational efficiencies.

While AHMOPI  used to have 15 members, this was reduced to 11 in early July this year. Current AHMOPI members are Avega Managed Care, Inc.; Blue Cross Health Care, Inc.; Caritas Health Shield, Inc.; Cocolife Health Care; Health Maintenance, Inc.; Health Plan Philippines, Inc.; Insular Health Care, Inc.; Intellicare;  Medicard Philippines, Inc.; Medocare Health Systems, Inc.; and  Star Healthcare Systems, Inc.

For the longest time, the Association has had a “no-bond” policy for its members to gain or retain affiliation with any institutional healthcare provider. This is on account of the “shared responsibility” between the HMOs and their accredited institutional healthcare providers – the principle being that our planholders are “ours”, not the hospitals.  It is only when we send our planholders to our affiliated hospitals that they become our “mutual” clients.  HMOs assume the risks of all coverable health profiles/circumstances of their planholders – up to the policy’s maximum benefit limit per illness or injury per year, or the aggregate benefit limit per year.  It is understood that for every patient we send to our affiliated hospitals, they earn from the business we give them, and therefore, should  be  willing to take the risk of the business.  

For the longest time, too, Chinese General Hospital (CGH) has requested some AHMOPI members to post cash bonds of varying amounts to gain or retain affiliation. The Association has been able to stave off any action from  them  over  the  non-posting of cash bonds by our members.  

However, of late, the hospital has stepped up anew its bond requirements for some of our members prompting them to again refer the matter to the Association for negotiations, just as we have always done in the past, (with success) involving others institutional healthcare providers. We firmly believe that requiring the posting of cash bonds does not guarantee payment of contractual obligations as there are a lot of other initiatives both the hospitals and the HMOs may undertake to ensure better compliance to contractual obligations. The AHMOPI has always been willing to step into the picture and assist both parties settle issues.

All our efforts to negotiate with CGH over its bond requirements for some of our members have been in vain prompting the Association to disaffiliate from them effective June 22, after the usual 30-day advance written notice.  In keeping with sound business practice, this unfortunate parting of ways with CGH was undertaken with utmost sensibility, decorum, and legal documentation. 

While all 15 of our members independently submitted their disaffiliation letters to CGH, five eventually retracted the same on account of “pressures from all over.” Faced with serious consequences for their actions as provided for in the Association’s Code of Conduct, four AHMOPI members have so far voluntarily resigned from the Association.

It may interest you to know that in 2014, 15 AHMOPI members paid affiliated hospitals, clinics and laboratories nationwide (inclusive of out-in/patient availments) a total of P17.935 billion. 

In terms of payments to accredited physicians (an average of 12,000 per HMO), figures show that AHMOPI members paid a total of P4.365 billion in 2014, or a combined total of  P22.300 billion – for a membership base of about 3.672 million. If we add the planholders of non-AHMOPI members which is estimated at .328 million, this should give us a total of an estimated four million HMO planholders nationwide.

As an integral part of the country’s health delivery systems, the AHMOPI is glad to partner with institutional healthcare providers, clinics and laboratories nationwide. We currently have four existing Memorandums of Agreement with major medical specialty societies, i.e., the Philippine College of Surgeons (PCS), the Philippine College of Physicians (PCP), the Philippine Society of Anesthesiologists (PSA), and the Philippine Obstetrical & Gynecological Society (POGS). We likewise have Unified Service Agreements with all participating Diplomates and Fellows of these specialty societies including their sub-specialty organizations who have joined and are part of MOA undertakings. All these initiatives are based on terms mutually beneficial to both our organizations and all stakeholders of the business.

We hope to have set the record straight and clarified matters for the various publics we serve, our planholders in particular, and look forward to having this letter published in its entirety.

Thank you and kindest regards.

Very truly yours,

Carlos D. Da Silva

Executive Director