Geriatric health plans still business choice – AHMOPI

Dear Mr. Torres:

Reference is in reference to your article in the Jan. 19, 2016 issue titled “HMOs Warned vs Discrimination on Senior Citizens” on House Bill 6348 entitled “Anti-Healthcare Age Discrimination Act” by Rep. Roman Romulo. 

Most health maintenance organizations (HMOs) would likely have only one or two major products in the marketplace – the traditional “Individual” or “Family” plan; and the traditional “corporate” plan (or a variation thereof under an “administrative services only” or ASO program).

Some HMOs do not have individual plans and only cater to corporate accounts.  However, others offer a variety of products for different target markets.

Many factors are taken into consideration by HMOs in pricing their products or services, e.g., the prevailing medical costs in the industry, the attained age of an individual applicant or the median age for a corporate account, risk assumptions on existing health profile/s of the individual or group, occupational or environmental hazards of the applicants, industry classification they belong to, past history of program utilization (for renewing accounts), medical or lay underwriting results, if  any, marketing  and  selling expenses, if any,  competition in the marketplace, the company’s administrative loading, the   many   benefits  of   the   program   including   latest  modalities of treatment, tailor-fitted benefit inclusions per client requests, medical network including specialists, point-of-service privileges, etc.

All these are taken into consideration in order to price correctly the risks involved and the cost of doing business with a particular client.

Admittedly only a very few HMOs have taken the risk on geriatric care plans for senior citizens as a target market primarily on account of the fact that geriatric care encompasses a more holistic approach to cope with aging and its effects, not to mention the onset of the inevitable failing of mental and physical health – health risk conditions some HMOs may not be organized to assume nor prepared to undertake.

Just like any business organization, HMOs package their products and services according to their capacity to assume risks based on their risk-based capitalization, not to mention expertise and technical know-how in service delivery.  

To be forced to provide healthcare packages to a market it is not prepared to undertake would be against their rights as corporate citizen of the Philippines, not to mention the possibility of a failed business venture that will not only affect the seniors among their planholders, but all their planholders in general, not to mention leaving a lot of unpaid bills with affiliated hospitals and accredited doctors in case of their closure. 

We fully agree with you that HMOs should not discriminate against senior citizens especially in the light of increased benefits for our senior citizens – in particular, in the area of healthcare. But let it be the decision of the HMOs concerned to offer plans for senior citizens and if ever they do, at a price equitable to both parties.

Carlos D. Da Silva

AHMOPI executive director