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AUICK Second 2006 Workshop
City Report and Action Plan -
Olongapo
 Mr. Fernando Moselina Magrata Acting City Administrator and Hospital Administrator, Office of the city Administrator, Olongapo City, Philppines CONTENTS 2.1.
Introduction Olongapo has a distinctive history.
Until recently it was “Subic Bay,” the home of the
U.S. 7th fleet. Along with Clark Air Force Base, it is now a
Philippines city and part of an effort to develop a sea port and air
terminal hub for all Asia. The city now has a population of roughly
211,000. It
reflects the Philippines general position in the demographic
transition. Mortality has fallen and fertility is declining. The crude
death rate is only 5 per 1000 of the population and the crude birth
rate is at the moderate level of about 24. This implies a young
population (0-14) of about 35 percent of the population, and an aged
population of only 3 percent. “The Senior Citizens Act” which was enacted on 23 April 1992. It is the enabling law to carry-out the Constitutional provisions which state that: City Social Welfare and Development Office, a component Department of the City Government, serves as the lead agency in the development and implementation of programs on social services for the senior citizens. most outstanding (Region-wide) Senior Citizens Program in Central Luzon. Lest it be said that there is a bias against the younger population, the City was, likewise, been awarded consecutively as the “Most Child-Friendly City”, both Region-Wide and Nation-Wide in 2003, 2004 and 2005. Olongapo City Mayor James Gordon, Jr. Under the present dispensation, not only were the current programs sustained or enhanced, but other development programs were introduced such as the construction and operation of the Olongapo City Center for Women, the on-going construction for a new Olongapo Center for Assistance, Rehabilitation and Empowerment (OCARE) which shall be co-occupied by male senior citizens, financial support for the Office for Senior Citizens Affairs (OSCA) and the creation of the Council for the Welfare and Empowerment of the Elderly which is basically composed of private stakeholders to promote further community participation. There are other new initiatives in the offing which may, perhaps, include doable initiatives and specific measures learned from the AUICK experience. non-inclusive and insufficient health insurance for most of the senior citizens. 2.2.
Problem of Senior Citizens' Non-Inclusion
as Direct Members Of the various problems and challenges facing the development thrusts for senior citizens, it is the non-inclusion of the elderly, or those who are 60 years old and over, in the National Health Insurance Program (NHIP) which is the most compelling and that which requires immediate attention. Undoubtedly, senior citizens are often afflicted with sickness categorized as intensive cases which require extended confinement in hospital. Ironically, this sector, which should have been the priority target of public health insurance, was excluded from the coverage of the (NHIP), which is administered by the Philippine Health Insurance Corporation (Philhealth). Records at the City Planning and Development Office (CPDO) show that, as of the year 2003, there were Ten Thousand Seven Hundred Seventy Nine (10,779) citizens who were 60 years old or over. These elderly comprised a substantial 5% of the total population. On the other hand, records from the Office for Senior Citizens Affairs (OSCA) show that of the total elderly citizens, barely 4,145 (38.5%) are covered by the NHIP either as retirees or as dependents of their children who are Philhealth members. This shows that a huge 6,634 or 61.5% of the elderly citizens are left out and with no health insurance. The City of Olongapo ran and managed the James L. Gordon Memorial Hospital, a tertiary-training hospital with a 305-bed capacity. JLGMH is the primary source of diagnostic, curative and therapeutic resource in the City. While the hospital normally attains 100% occupancy rate in its private rooms, including Tricare patients, it is still highly subsidized by the City Government because of its public nature and the classification of its patients which is 70% service/charity and 30% private. One of the reasons for the hospital’s inability to attain financial sustainability is the confinement of senior citizens who are without health insurance coverage. Based on the data from the Census of the Philippine Hospital Association (PHA), a 4-day confinement for an ordinary case shall entail an average of P 7,500.00 per patient. Supposing that in a year, 25% or 1,660 of the 6,634 uninsured elderly were confined for ordinary cases at the hospital, JLGMH stands to lose or subsidize the amount of P 12,450,000.00 in terms of costs and services, as most of them are indigents or can ill afford the costs of hospitalization. The amount will be more staggering if these senior citizens are admitted for intensive cases which would entail an average of P20,000.00 per confinement. The NHIP automatically covers retirees and employees, regardless of the status of their appointments, in the public or private sectors. Payments of the corresponding insurance premiums, equivalent to 8.5% of their salaries, are automatically deducted from their monthly payrolls. The government or the private employers, on the other hand, contribute 11.5% of the employees’ monthly salary as government’s or employer’s share. Self-employed citizens, not beyond the age of 60, can likewise apply for NHIP coverage as self-paying members. Their spouses, children below the age of 21 and parents, who are at least 60 years of age, are covered by the health insurance as dependents. The NHIP has a special program termed as “Indigent Component Program” for citizens who are not gainfully employed or have no regular source of income, and those who are considered indigents. Under the Philhealth Indigent Program, an annual insurance premium of P1,200.00 is required, of which P 600.00 shall be paid and/or subsidized by Philhealth, and the remaining P 600.00 shall be paid either wholly by the local government unit (LGU), or under a costs-sharing scheme whereby P 300.00 shall be contributed by the LGU and the other P 300.00 shall be shared by the prospective member. But then again, beautiful as it may seem, the Philhealth Indigent Component has left out the elderly, they being beyond the reglamentary age of sixty. The Constitution mandates to adopt an integrated and comprehensive approach to health development and other social services to the elderly. However, it is sad to note that the enabling law which is supposed to provide this comprehensive health development has effectively excluded the very segment of the society which it is mandated to serve. Under these circumstances, it is now up, therefore, to the local government units to devise their own strategies and measures to alleviate the non-inclusion of the elderly in the national health insurance program. 2.3. Goals and Objectives The primary goal of this Action Plan is to establish a Senior Citizen Health Care Plan which would extend and/or expand health insurance coverage to senior citizens who are not dependents of their children’s Philhealth insurance and are not qualified for direct membership due to old age. During its initial stage, the Health Care Plan aspires to cover 3,500 of the uninsured elderly citizens, the number of which will be increased progressively until all senior citizens are covered. The attainment of these primary goals will bring about the achievement of peripheral, albeit, significant objectives which include the following:
2.4. Proposed Courses of Action The Health Care Plan calls for the establishment of a scheme patterned after that of the Health Maintenance Organization (HMO) focusing exclusively on the elderly citizens, those 60-years old and above. The City of Olongapo, as a Corporate Body, and using the facilities and resources of its various health facilities, including but not limited to the City-ran James L. Gordon Memorial Hospital and barangay health centers, shall sell and market this health care plan for the elderly.The Health Care Plan expects to provide benefits and services that will proximate those that are being provided by the NHIP to its members. The only difference is on the matter of financing. While the health premium will be similar as those of the NHIP which is P 1,200.00/annum, participation on the other hand will be between the City and the elderly members with a 50%-50% sharing of the annual costs. With both stakeholders sharing the costs of the annual premiums equally, the Health Care Plan stands to generate an initial capitalization of P4,200,000.00 which will be deposited as a Trust Fund under the City Treasury. A Board of Directors shall be organized for the purpose and this Body shall be responsible for the administration and operation of the Health Care Plan. The Board shall be composed of representatives from the city government, the City senior citizens’ federation and private organizations/non-government organizations (NGOs) to further private sector participation and transparency. It is, however, imperative that the President of the Federation of Senior Citizens Association of the Philippines (FSCAP), Olongapo Chapter shall be a signatory to any fund withdrawal from the Health Care Plan. The Health Care Plan, through the various stakeholders, shall devise its own By-Laws, and if at all necessary, the Senior Citizens Health Care Plan shall be registered with the Securities and Exchange Commission. The specific activities and actions leading to the establishment of the Senior Citizens Health Care Plan are as follows:
The City Government may tap various non-traditional sources to finance the Health Care Plan which may include, but not be limited to:
The monitoring works for the various activities heretofore stated shall be the responsibility of the following City Government agencies with the Office of the City Administrator as the Lead Agency:
The specific monitoring role of these agencies in relation with the aforestated activities are as follows: Specific Activity Agency/ Agencies Concerned
Upon its operation, the City Accounting Department shall prepare and provide the City Mayor and the Board of Directors monthly and quarterly reports of fund disbursements and financial transactions for monitoring on the status of the Health Care Funds.
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