Happy Hour received an email from Association of Health Maintenance Organizations of the Philippines executive director Carlos Da Silva in reaction to out January 6 column, “Batting for Seniors,” where we wrote about Pasig Rep. Roman Romulo’s proposed Anti-Healthcare Age Discrimination Act (House Bill 6348).
According to Mr. Da Silva, most health maintenance organizations or HMOs would likely have only one or two major products in the marketplace which are the traditional “individual” or “family” plan, while the other one is the traditional “corporate” plan (or a variation thereof under an “Administrative Services Only” or ASO program). As explained by Da Silva, some HMOs only cater to corporate accounts and do not offer individual plans. There are, however, HMOs that offer a variety of products for various target markets.
“Many factors are taken into consideration by HMOs in pricing their products or services, e.g., the prevailing medical costs in the industry, the attained age of an individual applicant or the median age for a corporate account, risk assumptions on existing health profile/s of the individual or group, occupational or environmental hazards of the applicants, industry classification they belong to, past history of program utilization (for renewing accounts), medical or lay underwriting results, if any, marketing and selling expenses, if any, competition in the marketplace, the company’s administrative loading, the many benefits of the program including latest modalities of treatment, tailor-fitted benefit inclusions per client requests, medical network including specialists, point-of-service privileges, etc. All these are taken into consideration in order to price correctly the risks involved and the cost of doing business with a particular client,” explained Da Silva.
Only a very few HMOs have taken the risk on geriatric care plans for senior citizens as a target HMO market mainly because geriatric care encompasses a more holistic approach to cope with aging and its effects, not to mention the onset of the inevitable failing of mental and physical health—health risk conditions some HMOs may not be organized to assume nor prepared to undertake, the HMO group executive director continues.
Of course, we have to remember that HMOs are business organizations and not charitable institutions. And just like any business, a health maintenance company packages its products and services according to its capacity to assume risks based on risk-based capitalization, as well as the HMO’s expertise and technical know-how in terms of service delivery.
“To be forced to provide healthcare packages to a market it is not prepared to undertake would be against their rights as corporate citizen of the Philippines, not to mention the possibility of a failed business venture that will not only affect the ‘seniors’ amongst their planholders, but all their planholders in general, not to mention leaving a lot of unpaid bills with affiliated hospitals and accredited doctors in case of their closure,” Da Silva maintained.
“We fully agree with you that HMOs should not discriminate against senior citizens especially in the light of increased benefits for our senior citizens—in particular, in the area of healthcare. But let it be the decision of the HMOs concerned to offer plans for senior citizens and if ever they do, at a price equitable to both parties,” he concludes.
One of the things that we Filipinos are most proud of is the respect we pay our elders. Unlike other cultures whose children, more often than not, see their elderly parents as an unwanted burden whose needs (health and other aspects) can cramp their lifestyle, we see to it (or try our best) that parents are given the comfort and care that they deserve as they approach the twilight of their years.
This is the reason why many see the proposal of Romulo—who is running for senator by the way—as timely and appropriate. Why we agree that HMOs should not be compelled to go into a product or service that they are not prepared to handle financially, organizationally and other aspects, there has to be a way for the state and the private sector to work together to provide better healthcare options for senior citizens. In the first place, HMOs provide ceilings for the coverage of planholders (both for individual and corporate) regarding certain illnesses (including pre-existing), so they could probably do the same for seniors instead of just totally excluding them from their “target market.”
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