PhilHealth, the Philippines health insurance agency, is using data to track rising payouts and cut waiting times.
Benefit payments increased by 41% in 2014, its annual report says. This was followed by a 24% increase last year. These increases are driven largely by an expansion in the benefits offered by the government – with more citizens covered, larger payouts made and a wider range of hospitals included in the scheme.
Jovita Aragona joined PhilHealth in June 2015 as Senior Vice President and Chief Information Officer. Seconded to the agency by the Secretary of Health, she is using data to track these payments and ensure value for money.
Philhealth is introducing data dashboards to monitor trends on claims being made by patients. “The bottom line is for us to have information which we can use for our decision making,” Aragona says.
The data has helped PhilHealth make quicker payouts to citizens, she adds. When a patient is admitted, hospitals can now send their bill immediately to PhilHealth. It used to take a month, she says.
The dashboard can alert officials to potential fraud. If there is a spike in the number of claims from a particular clinic, for instance, “you can go and investigate if that is the real situation down at the facilities”, she says.
PhilHealth is also using analytics to evaluate whether its insurance schemes are effective. And Ii monitors new diseases registered in hospitals to decide whether new packages need to be introduced.
Hospitals have also moved to electronic patient records and send these directly to PhilHealth.
However, the Philippines is missing a basic element for digital reform – reliable internet access. “If you go to farflung areas, there are instances wherein connections are not good,” Aragona says.
Hospitals and local PhilHealth offices in remote areas are not able to send their data to the head office in Manila in real-time. Equally, citizens are unable to use the new online registration system.