By Romsanne R. Ortiguero
According to Oxford Business Group (OBG), health maintenance organizations (HMO) first became prominent in the US in the 1970s as a middleman between doctor and patient, providing access to medical services through pre-paid health plans and a network of doctors, clinics and hospitals.
In the Philippines, HMOs began in the 1980s, where those employed were the ones mostly covered by health plans. Typically, as described by OBG, HMOs often have primary care facilities at their central offices, while affiliated hospitals will have an HMO-affiliated medical coordinator, usually a doctor, to provide primary care and handle referrals to specialists.
Throughout time, an individual’s affiliation to HMOs is becoming more relevant than ever as Filipinos, in recent years according to surveys, continue to consider health as a top personal concern. OBG stated in a 2017 report, “HMOs are becoming an increasingly important part of the health care system in the Philippines, providing insurance plans to help people, particularly those employed in the private sector, to cover health-related costs.”
Echoing this, Dr. Nicky S. Montoya, MediCard president and chief executive officer, told BusinessWorld in an interview that HMOs are helping Filipinos have better access to health care, which can be quite expensive.
“If you think about it, before, when HMOs or health insurance are not yet prominent, there are a lot of individuals who cannot afford to go see a doctor or are afraid of what they are going to do, so they totally avoid seeking health care until the last minute,” Dr. Montoya shared.
“HMO, or actually managed care, is really more to make sure that you will be able to afford and access health care when you need it. When you need to see a doctor, there is a way (through an HMO), and you can afford it. HMOs will help you find the right doctor, will refer you to that right doctor. You will be able to see that doctor and get a prescription or even procedures and tests that are necessary to make sure that your health concern will be addressed,” he continued.
With the assurance that medical attention will be given in times of need, health insurance brings peace of mind to the ones covered.
For Maxicare, “HMO entails security — financially and physically-wise. It is not merely a benefit, rather a necessity, especially with the fact that diseases have been prevalent, accidents often occur, and uncertainties always exist.”
This sense of security, according to Dr. Montoya, even extends to the family or dependents of the individual covered. “When HMOs started, it was a benefit mainly for those who are employed. The sense of security could not be enough if it’s just the employee; of course they would think of their families. So once they’re given that benefit, where their families get covered as well, they feel more secured in life.”
Apart from helping provide access to costly health care in the country, the local HMO industry also enhances the accessibility to medical attention regardless of location.
“It is our capability to provide accessible, affordable health care in such a widely dispersed territory/archipelago like the Philippines and the varying densities of providers in these areas. The availability or providers are disparate (i.e. they are more focused in the centers of the cities and metropolis), therefore the level by which health care can be accessed by everyone is limited,” Mario M. Silos, Intellicare chairman and president, told BusinessWorld in an e-mail.
“HMOs democratize the benefits to give you access to a health care provider wherever you are in the country via telemedicine for example. Therefore, the function of the HMOs is to make these available resources and providers accessible via the product that we provide,” he continued.
On the other hand, while having a health plan from HMOs becomes a growing necessity, some Filipinos still find it challenging to afford one.
“It is understandable that many see an HMO plan as ‘expensive’; however, one must realize that it is far more costly once you get sick and avail of all necessary health treatments,” Maxicare said in an e-mail to BusinessWorld.
To illustrate as an example, Dr. Montoya said an average hospitalization bill for three to four days can sum up to P30,000, which to some, is already equivalent to a month’s worth of salary.
To respond to this challenge, the HMO industry strives to find ways to provide a more inclusive set of services that suit the financial capacity and health care needs of different Filipinos.
“Health care is everyone’s prime priority, but investing on personal health programs, such as what HMOs offer, has taken a back seat for some consumers,” Maxicare shared.
This is a gap in which HMOs are trying to bridge through variations on its product offerings.
“We have developed an array of product offerings that can be customized to the needs of specific corporations or groups, given the budget that they have. It gives you an alternative by having a range of choices and selections,” Mr. Silos shared.
“We are able to sustain and continuously increase our roster of valued clients through thorough product development and design. We have varied plans tailored fit to the needs of the market, whether on a corporate level or individual-wise,” Maxicare noted, and added that they have programs designed for corporate requirements, small and medium enterprises, as well as for individual and family accounts.
For MediCard, Dr. Montoya shared that they also have different packages, one of which is as affordable as P500 in a bid to reach more Filipinos.
With these flexible offerings tailored-fit to cater to different market segments, the local HMO industry enables investing in one’s health more approachable and attainable.
“Getting a sound body is one of the greatest investments that we can give ourselves. While health insurance has been one of the options to invest to in the past, it has become a must-have today. When we work hard to prepare for our future, we should also ensure that taking care of ourselves now is a big decision that we should make to enjoy what we have worked hard for,” Maxicare shared.