2017 stats & charts · angeles university foundation medical center 2,975,000 6 baguio general...

2017 Stats & Charts

NHIP Dashboard Indicators

73%

Support

NHTS/SPClaims

NBB Claims

12%

Unique MemberClaims Reimbursed

Total CoveredMembers

Utilization

86%

Accreditation

Total LGUs

LGUs with PCB, MCP &

DOTS

Accreditation

Total LGUs

93%

Total Population

CoveredBeneficiaries

Coverage

as of December 31, 2017

Covered Members and Dependentsas of December 31, 2017

93%of 2017

Projected Population

Note:

- Indigent count of members and dependents was based on DSWD Listahan II database and are subject for further validation.

- 2017 Projected Population is 104,519,910 estimated from the August 2015 Census by PSA.

Sector Members Dependents Beneficiaries

Members in the Formal Economy

14,903,502 13,952,626 28,856,128 Private 12,646,606 10,361,739 23,008,345

Government 2,186,147 3,537,657 5,723,804 Household Help/Kasambahay 69,621 51,687 121,308

Enterprise Owner & Family Drivers

1,128 1,543 2,671

Members in the Informal Economy

11,077,951 11,821,151 22,899,102 Migrant Worker 536,094 779,640 1,315,734

Informal Sector 2,317,026 3,430,129 5,747,155

Self-Earning Individual 435,824 599,814 1,035,638

Organized Group and Others

15,109 21,040 36,149

Informal Economy Members w/o 3/6 contribution but Entitled to Point of Service (POS) excluding Foreign Nationals

7,773,898 6,990,528 14,764,426

Indigents 14,329,442 17,700,855 32,030,297 Sponsored Members 1,127,692 1,452,057 2,579,749 Senior Citizens 6,899,207 1,574,258 8,473,465 Lifetime Members 1,245,993 888,947 2,134,940

TOTAL 49,583,787 47,389,894 96,973,681

Covered Members (by Sector)

Formal Economy

30%

Informal Economy

22%

Indigents29%

Sponsored2%

Senior Citizens14%

Lifetime3%


Accreditation as of December 31, 2017

Gov't35%Private

65%

100% of DOH-licensed hospitals are accredited by PhilHealth.

Accreditation Institutional Health Care Providers (IHCP)

Type of Ownership Government Private Total

Accredited Facilities 763 1,150 1,913

Primary Care Benefit Package

MaternityCare Package

DOTS Package

Number of Accredited Outpatient Clinics

2,455 3,243 1,996

No. of cities &municipalities with Accredited OP Clinics*

1,541 1,493 1,410

% to total cities &municipalities 94% 91% 86%

A city or municipality may have more than one outpatient clinic accredited by PhilHealth to provide NHIP benefits and services.

Note : Includes all accredited Hospitals and Infirmaries

There are 1,634 LGUs nationwide.


Accreditation of Facilities(by Category)


Category of Facilities Government Private Total % to Total

LEVEL 1 336 466 802 42%

LEVEL 2 45 279 324 17%

LEVEL 3 51 64 115 6%

Infirmary 331 341 672 35%

Total 763 1,150 1,913 100%

Benefit Payment January 1 to December 31, 2017

Source: Financial Statements

Sector Total Amount of Claims Paid% Distribution of Total Benefit Amount Paid

Formal Economy 26,709.45 23%

Private 19,248.42 17%Government (including PCB1-DepEd)

7,461.03 7%

Informal Economy 24,460.49 21%

Migrant Worker including PCB 1,401.48 1%

Informal Sector/Self-Earning Individual 23,059.01 20%

Indigent-NHTS (including PCB1-NHTS) 21,282.93 19%

Sponsored 12,725.72 11%

NGAs 0.85 0%

LGUs (including PCB1-LGUs/PREVENTS) 9,168.48 8%

Others (Point of Care) 3,556.39 3%

Lifetime Member Program and Senior Citizens 29,481.53 26%

TOTAL 114,660.11 100%

(Number of Claims Paid Per Member Category)January 1 to December 31, 2017

Claims Processing

Number of claims paid were generated using Power BI Dashboard processed January 12, 2018 based on check date.

Member CategoryTotal Amount of Claims

PaidTotal No. of Claims Paid

Average Value Paid per Claim

% Distribution of Total No. of Claims Paid

GOVERNMENT 6,353,763,508 619,533 10,256 6%

PRIVATE 16,914,834,765 1,655,484 10,217 16%

IPP 20,521,755,437 2,333,373 8,795 23%

OWP 1,694,522,822 152,994 11,076 2%

SPONSORED 11,351,960,037 1,159,796 9,788 12%

INDIGENT 18,443,759,854 1,990,791 9,265 20%

SENIOR CITIZEN 18,200,816,403 1,594,494 11,415 16%

LIFETIME 5,947,374,810 569,596 10,441 6%

Grand Total 99,428,787,636 10,076,061 9,868 100%

Number and Amount of Claims Paid Per Type of FacilityJanuary 1 to December 31, 2017

Claims Processing

Type of FacilityTotal Amount of Claims

PaidTotal No. of Claims

PaidAverage Value Paid per

Claim% Distribution of Total No. of

Claims Paid

Level 1 29,037,369,814 2,851,421 10,183 28%

Level 2 28,235,571,622 2,664,025 10,599 26%

Level 3 29,540,697,669 2,511,739 11,761 25%

INFIRMARY 4,170,918,375 644,032 6,476 6%

MCP 3,209,205,351 654,156 4,906 6%

Primary Health Clinic 2,722,000 939 2,899 0%

Animal Bite Package Provider 168,274,500 55,829

3,014 1%

Ambulatory Surgical Clinic 1,456,633,094 111,377 13,078 1%

TB DOTS Provider 121,944,500 59,033 2,066 1%

Outpatient Malaria Provider 9,600 16 600 0%

Free Standing Dialysis Clinic 3,639,084,838 538,401 6,759 5%

Grand Total 99,582,431,362 10,090,968 9,868 100%


Top 10 Medical Case Rate January 1 to December 31, 2017

Claims Processing

ICD 10 Code DESCRIPTION Total Amount of Claims

Paid Total No. of Claims Paid

J18.92COMMUNITY-ACQUIRED PNEUMONIA III, MODERATE RISK 10,248,698,481 707,113

A09.9 ACUTE GASTROENTERITIS 1,825,667,511 323,044

N39.0 URINARY TRACT INFECTION, SITE NOT SPECIFIED 1,579,961,608 227,931

K29.1 OTHER ACUTE GASTRITIS 804,899,924 140,857

J45.90 BRONCHIAL ASTHMA IN ACUTE EXACERBATION 1,077,236,822 128,685

I10.9 ESSENTIAL HYPERTENSION; MALIGNANT HYPERTENSION 969,992,224 112,194

I10.1 HYPERTENSION, STAGE II 951,592,313 110,886

A91.1 DENGUE WITH WARNING SIGNS 1,064,731,209 108,555

P36.9 BACTERIAL SEPSIS OF NEWBORN, UNSPECIFIED 1,090,670,203 85,476

A90 DENGUE WITHOUT WARNING SIGNS 724,488,143 75,474


Top 10 Case Rate ProceduresJanuary 1 to December 31, 2017

Claims Processing

RVS Code ProcedureTotal Amount of

Claims PaidTotal No. of Claims

Paid

90935 HEMODIALYSIS PROCEDURE 8,375,307,755 1,653,491

99432 NORMAL NEWBORN CARE PACKAGE 1,322,801,660 818,078

NSD01NORMAL SPONTANEOUS DELIVERY PACKAGE FOR HOSPITALS

2,430,477,620 460,071

MCP01 MATERNITY CARE PACKAGE 2,727,008,500 343,503

59513 CAESARIAN SECTION, PRIMARY 3,281,981,429 167,859

59409 VAGINAL DELIVERY ONLY (W/ EPISIOTOMY) 1,394,529,594 142,162

96408 CHEMOTHERAPY ADMINISTRATION 972,496,040 132,677

59514 CESARIAN DELIVERY 2,276,769,700 113,650

66987EXTRACAPSULAR CATARACT REMOVAL W/ INSERTION OF INTRAOCULAR LENS

1,699,033,290 105,989

77401RADIATION TREATMENT DELIVERY (COBALT OR LINEAR ACCELERATOR)

654,893,058 99,735


Number and Amount of Claims Paid Per PackageJanuary 1 to December 31, 2017

Z-Benefit

Note : No. and amount of claims paid as reported by BDRD.

Z BENEFITSTotal Amount of Claims

PaidTotal No. of Claims

Paid

BREAST CANCER 20,725,000 253

CABG 136,950,000 250

CERVICAL CANCER HD 1,900,000 12

FIRST TRANCHE, COLON CANCER STAGE II-III (HIGH RISK) 3,000,000 16

FIRST TRANCHE, RECTUM CANCER CLINICAL STAGE I BUT POST-OPERATIVE STAGE II-III 600,000 4 FIRST TRANCHE, RECTUM CANCER CLINICAL STAGE II-III BUT POST-OPERATIVE STAGE II-III USING COBALT 5,460,000 33 FIRST TRANCHE, RECTUM CANCER CLINICAL STAGE II-III BUT POST-OPERATIVE STAGE II-III USING LINEAR ACCELERATOR 250,000 1

KIDNEY TRANSPLANTATION 114,550,000 196

LEUKEMIA 7,875,000 45

PARTIAL HIP PROSTHESIS, BIPOLAR 73,180 1

PD FIRST 50,344,375 789

PROSTATE CANCER 1,000,000 10

TOF 33,550,000 105

TOTAL HIP PROSTHESIS, CEMENTED 413,600 4

TOTAL HIP PROSTHESIS, CEMENTLESS 4,065,600 24

VSD 38,400,000 154

ZMORPH FOR THE FITTING OF EXTERNAL LOWER LIMB PROSTHESIS BELOW THE KNEE (BOTH) 60,000 2

ZMORPH FOR THE FITTING OF EXTERNAL LOWER LIMB PROSTHESIS BELOW THE KNEE (LEFT) 660,000 44

ZMORPH FOR THE FITTING OF EXTERNAL LOWER LIMB PROSTHESIS BELOW THE KNEE (RIGHT) 555,000 37 Grand Total 420,431,755 1,980

Number and Amount of Claims Paid Per FacilityJanuary 1 to December 31, 2017

Z-Benefit

Note : No. and amount of claims paid as reported by BDRD.

Z BENEFITSTotal Amount of

Claims PaidTotal No. of Claims Paid

ANGELES UNIVERSITY FOUNDATION MEDICAL CENTER 2,975,000 6

BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER 3,928,180 45

BATANGAS MEDICAL CENTER 3,075,000 33

BICOL MEDICAL CENTER 800,000 10

BICOL REGIONAL TRAINING AND TEACHING HOSPITAL 665,000 8

CAGAYAN VALLEY MEDICAL CENTER 325,000 4

CHINESE GENERAL HOSPITAL & MEDICAL CENTER 3,850,000 7

CORAZON LOCSIN MONTELIBANO MEM. REG'L HOSP. 7,300,092 66

DAVAO REGIONAL MEDICAL CENTER 1,125,000 15

DE LOS SANTOS MEDICAL CENTER 2,850,000 5

EAST AVENUE MEDICAL CENTER 400,000 5

ILOCOS TRAINING AND REGIONAL MEDICAL CENTER 75,000 1

KAPAMPANGAN DEVELOPMENT FOUNDATION, INC. 1,170,000 76

KIDNEY SOLUTIONS INC. 934,614 38

LORMA MEDICAL CENTER 1,150,000 2

MAKATI MEDICAL CENTER 436,153 13

MANILA DOCTORS HOSPITAL 4,950,000 9

MARY MEDIATRIX MEDICAL CENTER 7,950,000 15

NATIONAL KIDNEY AND TRANSPLANT INSTITUTE 114,597,857 789

NORTHERN MINDANAO MEDICAL CENTER 10,761,000 40

NOTRE DAME DE CHARTRES HOSPITAL 1,000,000 2

PHILIPPINE CHILDREN'S MEDICAL CENTER 3,710,000 19

PHILIPPINE HEART CENTER 140,980,000 362

SOUTHERN PHILIPPINES MEDICAL CENTER 34,730,000 91

ST. FRANCES CABRINI MEDICAL CENTER, INC. 1,025,000 12

ST. LUKE'S MEDICAL CENTER - GLOBAL CITY 14,400,000 25

ST. PAUL'S HOSPITAL OF ILOILO, INC. 3,048,458 20

UNIVERSITY OF THE EAST RAMON MAGSAYSAY MEMORIAL MEDICAL CENTER, INC. 90,000 6

UP-PHILIPPINE GENERAL HOSPITAL 33,260,000 163

VICENTE SOTTO MEMORIAL MEDICAL CENTER 17,425,400 78

WESTERN VISAYAS MEDICAL CENTER 1,445,000 15

Grand Total 420,431,755 1,980

(Number of Claims Paid)as of December 31, 2017

Indigent-NHTS/ Sponsored Program

No Balance Billing73.29%

not NBB26.71%

Note: Level of NBB Compliance per PROs based on Exit Survey Results from October to December 2017

January 1 to December 31, 2017

Support Value

Preliminary estimates using Average Value Paid per Claim (AVPC ) for claims paid January 1 to December 31, 2017 P 9,870 over

P 17,801 the estimated average cost of In-patient care based from the 2013 NDHS by PSA with 3.2 inflation rate in 2017.

2017 stats & charts · angeles university foundation medical center 2,975,000 6 baguio general...

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