By Bjorn Biel M. BeltranSpecial Features Writer

When the concept of health maintenance organization (HMO) became popular in the United States in the early 1970s, Filipinos mostly received their medical care through the local practices of doctors in clinics and hospitals, in addition to what the government can offer them. The idea of holistic medical insurance was an expensive one, an idea that was not widely accessible.

Luis S. Montoya, senior vice-president at MediCard Philippines, Inc., recalled that when his father, along with a group of doctors and medical professionals, founded the organization in 1987, there was a significant backlash among medical practitioners in the country.

“There was some opposition from certain doctors, because not all of them agreed to accept HMO members,” he told BusinessWorld in an interview. “The main thing that they didn’t like was professional fees were somewhat negotiated down from what they were used to.”

He pointed out that because the whole concept of HMO was to offer health insurance coverage to a bigger population base, part of the deal HMOs had with medical practitioners was paying them modest fees in exchange of bringing in more patients. Some doctors, he said, disagreed with the business model, but times were changing.

“Since they were used to their private practice, they were setting their professional fees at a certain level [higher than what we offered],” he said.

“Slowly, over the years, they came to see that it was really to their advantage. Now, more Filipinos get access to health care. Eventually, they came around,” he added.

Dr. Nicky S. Montoya, MediCard president and chief executive officer, said that the duty of organizations like MediCard is to serve its customers efficiently and reliably, and that duty extends to the medical community that they partner with.

“We were the first to come up with the idea at that time to pay the doctors faster,” he said in the same interview.

Professional fees for doctors at that time, he pointed out, varied greatly, some practitioners used that fact to get away with billing patients much more than some and less with others. In a way, it added to the fear of seeking medical consult — the unknown of what it would cost.

“Some doctors want to bill certain patients more. To this day, some of them still try to get away with that,” he said. “Unfortunately, it doesn’t make sense for a business to work with unpredictable fees. So we set a schedule of fees that we think are fair. What we did was, sure, we cannot pay your high fees, but we can promise you that we will pay you correctly and efficiently.”

MediCard, he added, is very conscious about its customers, and it takes efficiency very seriously.

As MediCard grew, it began offering new, cheaper options for families and individual members in the hope of making efficient and adequate health insurance more accessible to more Filipinos.

To improve on this commitment, the organization is currently making significant investments in its digital capabilities, starting with a mobile app that will be launched this year.

“We’re launching [an app] where your card will be in your smartphone,” Dr. Nicky Montoya said. “And we deployed our own terminals in the hospitals. Eventually, that’s all you’ll need: your smartphone with a terminal from MediCard at the hospital and you will be able to transact. You don’t need to have physical paper anymore.”

It is through innovations like this that MediCard looks to the future. As digital transformation overtakes a bigger part of the health care industry, there is a demand for HMOs to adapt and change to provide services more apt to modern challenges.

“I think our biggest investment is really in IT [information technology], both hardware and systems programming software,” Mr. Luis Montoya said.

“The challenge is innovation, especially in IT. It is very difficult to translate what you envision into reality. We’re talking to a lot of IT professionals, consultants, even outside groups, to make our systems good for the future.”

Though the present is very different from what it was like over 30 years ago, the problem of changing with the times to solve future problems is nothing new. And MediCard has been through this before.

“Ultimately, the one thing about MediCard is we want to make sure that everything is fair and transparent, that you will be able to access health care in the appropriate place and the appropriate time,” Dr. Nicky Montoya said.

For people to receive appropriate health care is the goal, he emphasized. It has been and always will be. And moving towards the future, he hopes that more people will be able to, with the help of MediCard.