On HMOs’ insurance for seniors
This refers to Rina Jimenez-David’s column titled “The old still matter” (Opinion, 12/29/15), which talked on House Bill No. 6348, also referred to as “Anti-Healthcare Age Discrimination Act” authored by Rep. Roman Romulo.
Most health maintenance organizations (HMOs) would likely have only one or two major products in the marketplace—the traditional “individual” or “family” plan; and the traditional “corporate” plan (or a variation thereof under an “Administrative Services Only” or ASO program). Some HMOs do not have individual plans; they cater to corporate accounts only. However, others offer a variety of products for different target markets.
Many factors are taken into consideration by the HMOs in pricing their products or services—among them, the prevailing medical costs in the industry; the 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 and the 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 the latest modalities of treatment; tailor-fitted benefit inclusions per client requests; medical network including specialists; point-of-service privileges. All these are taken into consideration in order to price correctly the risks involved and the cost of doing business with a particular client.
Admittedly only a very few HMOs have taken the risk on geriatric care plans for senior citizens as a target HMO market primarily on account of the fact that 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 or prepared to undertake. Just like any business organization, the HMOs package their products and services according to their capacity to assume risks based on their risk-based capitalization, not to mention expertise and technical knowhow in 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 citizens of the Philippines. This is not to mention the possibility of a failed business venture that could affect not only the “seniors” among their planholders but also all their planholders, and, of course, the affiliated hospitals and accredited doctors left with enormous unpaid bills in case of the HMOs’ closures.
We fully agree with David that “the old still matter” 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.
—CARLOS D. DA SILVA, executive director, Association of Health Maintenance Organizations of the Philippines Inc.
