Securing Health

Medicard CEO and UP College of Medicine alumnus Dr. Nicky Montoya shares his insights why planning for one’s health is essential

By Gelyka Ruth R. Dumaraos

In a country where health is considered one of the leading priorities, it is surprising to know that only a small percentage of the population gives importance to having health plans and insurances

Based on available data, out of 105 million Filipinos, only six million have Health Maintenance Organizations (HMOs) plans.

Securing Health 2

Of this six million, majority of those enrolled are because they were given as benefits from the companies they work with.

The big majority of the population only rely on the health insurance the government provides through PhilHealth. It is truly laudable that PhilHealth is aiming for universal health care, or what was previously dubbed as Kalusugang Pangkalahatan.

Though PhilHealth and having HMO plans are similar in nature, the former’s coverage is limited. PhilHealth only covers around 20 to 30 percent of hospital bills. Coverage for outpatient care is limited, too. PhilHealth is mandatory for all employees but HMO coverage is optional or voluntary.

However, the two can actually be complementary, according to Dr. Nicky Montoya, president and CEO of Medicard Philippines, one of the leading HMO plan providers in the country.

PhilHealth and HMOs—complementary

The limited coverage of PhilHealth can be partially filled in by HMOs, such that the remaining balance of the hospitalization expenses and costs of outpatient consultations could be covered. depending on the plan.

This is why having HMO plans is highly encouraged.

“Outpatient consults are covered by HMOs and in fact, are encouraged, says Dr. Montoya. He explains that regular outpatient consults can detect medical problems at an early stage, and can prevent more serious complications that will require one to be rushed to the ER (emergency room). However, he laments that getting an HMO plan is not a top priority for Filipinos, probably due to different preferences.

People tend to put their money on other things than invest on their health, says Dr. Montoya. When no one is sick, people will spend their money on basic necessities like food, clothing, shelter, and other household expenses.

The Medicard CEO explains that since income is not that high in most households, allocating a budget for healthcare expense is only considered when someone is actually already sick.

Having an HMO is like protecting your health for any unforeseen eventuality. “We all get sick, some more than others,” Dr. Montoya says. “We all will eventually have some major health issue.”

This was what the people behind Medicard had in mind when the HMO was established in 1987.

‘Prescribed by doctors’

Medicard prides itself with the fact that it was founded by doctors.

“That’s why we are ‘prescribed by doctors’, because we were started and continue to be ran by doctors. My parents were doctors and their friends, Drs. Martesio Perez, Augusto Litonjua, Rafael Recto, Belen Pe, and many others saw that by providing a more affordable financing to health care, they can provide access to healthcare to more Filipinos,” shares Dr. Montoya. He adds that most of Medicard’s departments have doctors. Card holders are assured that the plan they avail is recommended and approved by physicians.

With a reasonable premium, one can avail of regular check-ups and consults, annual physical exam, access to the ER for emergencies, and access to telemedicine by way of MyPocket Doctor and even inpatient care.

HMO innovations

Innovation is also Medicard’s continuous goals. They started the Liaison officers for in-patient as well as express payment for doctors to facilitate processing of professional fees (PFs) of doctors. Medicard also has its own network of clinics located in Makati (2 branches), McKinley, Centris, Fairview, Ortigas, Sta. Lucia Mall, Festival Mall, SM Clark, Imus, Sta. Rosa, Calamba, Lipa, Batangas and Cebu offering multispecialty consults, laboratory, x-ray, ultrasound, dental and other ancillary services. They also use technology to help guide the attending physicians diagnose and manage a patient’s health issues.

Moreover, Medicard is one of the first to offer occupational health services and corporate staffing for onsite clinics. To date, it has seven Department of Health (DOH) DOH licensed X-ray vans that go to companies for their annual physical exams. Medicard is also accepted in the widest network of fully accredited and certified health facilities by DOH and PHIC nationwide. Customer service is likewise a top priority as they have their own call center with over 120 agents in three locations on duty 24/7 to answer all calls. Its IT system is backed up by a virtual server that is disaster proof and certified 4.5/5. Medicard is also the first to introduce a telemedicine solution in the market, My Pocket Doctor, to all members. This gives them the access for a consultation with a doctor right in the comforts of their own home, office or anywhere using any phone or smart phone or computer. With Medicard, clients also have other non-medical benefits like discounts from a lot of restaurants, gyms, resorts and spas to take care of yourself emotionally and mentally.

Top priority

In the years to come, Dr. Montoya hopes that more and more people will look into healthcare in a different perspective. Maintaining health security should be a top priority for all.

As with Medicard, he commits that it will continue its mandate to provide better quality healthcare for all.

“It is our vision to provide access to the best healthcare quality to as many Filipinos as we can,” Dr. Montoya says with conviction. “We will continue to innovate and provide the latest in healthcare and provide more access to quality health providers.”