Insurance Commission wants review of HMO jurisdiction

MANILA, Philippines — The Insurance Commission (IC) is pushing for the review of the health maintenance organization (HMO) sector’s jurisdiction, nearly 10 years after it was placed under its care.

IC commissioner Reynaldo Regalado said he is meeting with officials of the Philippine Health Insurance Corp. (PhilHealth) to discuss several health matters, one of which is the issue on HMOs.

“I have yet to see where PhilHealth is heading. Right now, it’s like everything is up for review. I think there’s something that we can do to check,” Regalado said, referring to new PhilHealth head Edwin Mercado.

“This is the best time to review everything. But I want to first get a clear direction from PhilHealth. We have to know as a group where we’re supposed to be getting in. I’m open to any arrangement that can help the bottom line, which is self-protection,” he said.

Last November, Regalado already floated the idea of transferring the jurisdiction of HMOs amid difficulties in handling the industry given its complexities.

In November 2015, then president Benigno Aquino III transferred the jurisdiction of HMOs from the Department of Health (DOH) to the IC.

At the time, the Aquino administration saw the need to streamline and consolidate functions related to the regulation of HMOs to eliminate redundancy, simplify the organizational structure, improve accessibility and accountability, provide efficient use of specialized expertise and realize savings in administrative costs.

Even after the transfer, all issues relating to medical matters including, but not limited to, practice of the medical profession, medical procedures and standards and health programs, policies, services and facilities were still referred to the DOH.

“I want to know the thrust of PhilHealth and how we manage the health sector. If you can see, PhilHealth is improving its services, and that will have an effect on HMOs,” Regalado said.

“It will have a positive effect on the first part, but later on, we need to be able to adjust. It might lead to better services and better offerings for HMOs,” he said.

Regalado emphasized that HMOs need to be properly regulated. As such, the IC is working with Congress for a new HMO Code which would also determine the best agency to handle the sector.

The IC chief also plans to discuss the proposed amendments to the Universal Health Care Act, a priority measure under the Legislative-Executive Development Advisory Council.

For now, Regalado said he would take up HMO issues and concerns to PhilHealth to know how the health insurer plans to go about the sector.

Last year, the HMO industry finally returned to profitability after two consecutive years of losses as membership fees increased.