Recorded presentation

Marilyn Gorra, PhD, Philippine Tuberculosis Initiatives for the Private Sector (Philippine TIPS)/Chemonics International Inc., 1608 West Tower, Philippine Stock Exchange Center, Ortigas Center, Pasig, 1605, Philippines, +63 2 687-7135, mgorra@philtips.com

In 1999, the government-owned Philippine Health Insurance Corporation (PhilHealth) began conceptualizing a TB benefit package using the DOTS protocol. This package became feasible in mid-2003 when the Philippine TIPS project, in cooperation with the Philippine Coalition Against Tuberculosis (PhilCAT), completed the detailed plan and operating manual for an efficient certification system for DOTS centers. The certification system plays an important role in assuring PhilHealth that it will be purchasing quality DOTS services. It also safeguards PhilHealth's financial releases, even though the benefit is an outpatient package. PhilHealth traditionally does not fund OPD benefits because these are subject to fraudulent claims. However, under the system, claims for payment are made on behalf of TB patients by the DOTS centers. Funds are channeled not to individual patients or doctors but to DOTS centers. This gave PhilHealth the confidence to approve the TB OPD package. The detailed plan for the certification system includes supporting procedures, forms, flowcharts and templates necessary for the certification. The plan covers six key components: the certification process; marketing and communications; organization and staffing; data and information requirements; costs and financing; and quality assurance. Philippine TIPS employed an evidenced-based, consultative approach to develop the certification plan. With knowledge of the Philippine health care system and international certification programs, Philippine TIPS experts informed themselves about the needs and aspirations of key stakeholders. Every effort was also made to ensure that the analyses and recommendations were consistent with the overall directions of the Philippine Department of Health, PhilHealth and PhilCAT.

Learning Objectives:

• At the end of the session, the participant will learn the issues, processes and value to a social health financing institution of a certification system for DOTS centers.

Keywords: Tuberculosis, Quality Improvement

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation