Interview with 1 Coop Health CEO Roy S. Miclat

In 2014, thirteen leading cooperatives, federations and organisations from the Philippines joined forces to create Cooperative Health Management Federation. In this interview, Roy S. Miclat, CEO of the Federation for the last three years, explains its structure and goals, as well as the nature of its relationship with the public health system in the country.

What is the origin of 1 Coop Health? What are its main objectives?
Also known as the Cooperative Health Management Federation, 1 CoopHealth is the first cooperative health maintenance organization (HMO) created in the Philippines. It was founded on 8 July 2014 by 13 leading cooperatives, federations and organizations with the main objective being to provide quality and affordable healthcare service to its member cooperatives.

CHMF or 1 Coop Health embodies the collective pioneering vision of the country’s leading cooperatives. To leverage community, institutional know-how, technical expertise, good governance, data & networks and technology into building a private health care platform that is progressive, responsive and inclusive.

CHMF’s founders took on the challenge in providing and managing health care for the welfare of their individual members. They made this possible by contributing on a common fund and building a competitive management.

1 Coop Health is a federation gathering several cooperatives, could you explain to us what is the federation’s structure and how it works?
This Federation is composed of duly registered cooperatives with various line of businesses that are willing to patronize the services of this Federation, and possess all the qualifications and none of the disqualifications provided for in the By-laws.

More than just a platform for sustainable private health care, it is also an area for ideas and innovation. Founded on timeless humane values but adaptive to the changing human condition, aware of the individual rationale for health care but responsive to communal aims as a social and business enterprise.

CHMF believes in the cooperative principles. Thus, it promotes affordable mass health care access as a first principle for economic growth and social prosperity. The purposes for which this Federation is organized are to: in the first place provide affordable primary, secondary, and tertiary health care to individual members of member-cooperatives; the second provide support, enhancement, development and assistance in the modernization of the facilities, equipment and services of MMG and Health Services Cooperative Hospitals. Finally, we provide affordable health care to the ageing population of member-cooperatives.

What are the advantages and services offered by 1 Coop Health to cooperative members?
The product and business model of CHMF offers «win-win» benefits to its cooperative members. First, it adds value to the traditional reimbursement-type hospital income benefit which is common in Microinsurance. 1 Coop Health provides a pre-paid or cashless package for treatment and preventive care. Its investment in business relationships with healthcare networks is an initiative to ease the burden of clients initially paying for their health emergency needs. On the other hand, the healthcare facilities gain business from servicing the low-income and marginalized sector whose capacity to pay for healthcare is enhanced by its entitlement in insurance.

Second, CHMF contributes to the financial stability of its coop members. It continues to attract more primary cooperatives to join and pool its in-house health assistance programs to 1Coop Health; thereby strengthening the viability of the model.

Lastly, 1 Coop Health is working on partnerships with social insurance organizations. Some coop-owners of CHMF have formal arrangements with PhilHealth’s local offices in terms of facilitating enrolment and collection of premiums. We want to create more relationships with organizations who aim to make healthcare affordable and accessible.

Do health cooperatives and the Philippine public health system maintain any line of collaboration?
Healthcare financial risk protection in the country is mainly provided by the government through the Philippine Health Insurance Corporation (PhilHealth) which is managed by the Philippine Health Insurance Corporation (PHIC).

PhilHealth is the health insurance provider run by the Philippine government. It is an affordable and progressive insurance program that extends financial assistance to all citizens seeking medical help, whether employed or unemployed. Membership is compulsory for all employees and half of the monthly contribution is covered by the employer while the other half is deducted from the employees’ salary.

The hybrid health system, and the limitations of PhilHealth – which offers a defined set of services at predetermined rates and does not cover items such as dental check-ups – has helped fuel the development of health maintenance organisations (HMOs), with about 28 HMOs now registered across the country. Now regulated by the Insurance Commission, after regulatory control was transferred from the DoH in 2015, the country’s HMOs provide access to a wide range of health care services to their members, depending on the fees paid and the package bought. HMO plans for corporate accounts are always integrated with PhilHealth benefits because employers pay 50% of their employees’ PhilHealth premiums.

Members may use their HMO membership along with their PhilHealth plan. The amount of financial assistance that PhilHealth extends to its members will vary according to the disease. The remaining balance will then be paid by the HMO plan.

As I have mentioned above, 1 Coop Health is working on partnerships with social insurance organizations. Some coop-members of CHMF have formal arrangements with PhilHealth’s local offices in terms of facilitating enrolment and collection of premiums.

What do you think is the main challenge of the cooperative movement in the Philippines?
The main challenge of the cooperative movement in the Philippines is basically the low level of acceptance due to the misconception that HMO memberships are only for the rich.

In view of the government initiatives to insure that all Filipinos have health coverage, 1 Coop Health offers micro-health plans that target the low-income sector, in which members are mainly fishermen, drivers, farmers and laborers.

Apart from the fact that PhilHealth benefits are government-mandated, at least 95% of the country’s 6 Million HMO members are on corporate plans but these are almost always integrated into the National Health Insurance Programme (PhilHealth). It is therefore apparent that the number of Filipino individuals who avail HMO services are considerably low compared to those who utilize PhilHealth services.