Digitizing Healthcare Payments

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Digitizing Healthcare Payments
Digitizing Healthcare Payments
Payment processing platforms for healthcare payment and insurance management
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SectorMost major industry classification systems use sources of revenue as their basis for classifying companies into specific sectors, subsectors and industries. In order to group like companies based on their sustainability-related risks and opportunities, SASB created the Sustainable Industry Classification System® (SICS®) and the classification of sectors, subsectors and industries in the SDG Investor Platform is based on SICS.
Health Care
Medical Technology
Business Model Description

Invest in B2B payment processing platform solutions which will streamline payment processing and expedite reimbursements from both private and government-owned insurance companies. This digital solution includes claims management, automated payment posting, and electronic remittance advice (ERA) processing.

Revenue can be generated from transaction charges from hospitals, health care providers, and insurance companies including PhilHealth.

PhilHealth IT Transformation Project - The PhilHealth IT Transformation Project involves the design and development of an IT system that aims to streamline Philhealth's scope of work. This was submitted by Aboitiz InfraCapiital (AIC)– the infrastructure arm of one of the country's largest conglomerates, the Aboitiz Group– and Unisys Public Sector Services. (10) By the end of 2021, PhilHealth earned the net income of P32.84 billion (590 million USD), which is higher by P2.8 billion (5.01 million USD) from the previous year. This is after the Corporation has recognized a total of P140 billion (2.5 billion USD) in members’ benefit claims expense. Consequently, its total assets also rose by 27% with a total of P347.48 billion (6.22 billion USD) in 2021.

Specifically, AIC and Unisys are proposing to design and develop an end-to-end system to digitalize and optimize Philheallth's claims, contributions, membership, and accreditation processes. Moreover, it will provide data capture and reporting services in support of the National Health Data Reporting Repository. (10)

Expected Impact

Improve overall health care delivery capability by providing key IT solutions to ease processing and sharing of medical information of stakeholders.

How is this information gathered?
Updated: 17 Mar, 2024
Philippines
Indicative ReturnDescribes the rate of growth an investment is expected to generate within the IOA. The indicative return is identified for the IOA by establishing its Internal Rate of Return (IRR), Return of Investment (ROI) or Gross Profit Margin (GPM).
15% - 20% (in ROI)
Investment TimeframeDescribes the time period in which the IOA will pay-back the invested resources. The estimate is based on asset expected lifetime as the IOA will start generating accumulated positive cash-flows.
Medium Term (5–10 years)
Market SizeDescribes the value of potential addressable market of the IOA. The market size is identified for the IOA by establishing the value in USD, identifying the Compound Annual Growth Rate (CAGR) or providing a numeric unit critical to the IOA.
> USD 1 billion
Average Ticket Size (USD)Describes the USD amount for a typical investment required in the IOA.
> USD 10 million
Direct ImpactDescribes the primary SDG(s) the IOA addresses.
Good health and well-being (SDG 3)
Indirect ImpactDescribes the secondary SDG(s) the IOA addresses.
Industry, Innovation and Infrastructure (SDG 9) Sustainable Cities and Communities (SDG 11) Gender Equality (SDG 5)

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Sector Sources
  • 1) Official Gazette. (2019). Universal Health Care Act. https://www.officialgazette.gov.ph/downloads/2019/02feb/20190220-RA-11223-RRD.pdf 2) Department of Health (DOH). (2021). The New Normal for Health. https://doh.gov.ph/sites/default/files/publications/The-New-Normal-for-Health.pdf 3) DOH. (2014). Philippine e-Health Strategy Framework and Plan. http://ehealth.doh.gov.ph/images/PDF/PeHSFP20132017.pdf 4) PhilHealth. (2022). Stats & Charts: 2022 (First Semester). https://www.philhealth.gov.ph/about_us/statsncharts/snc2022_1stSem.pdf https://www.philhealth.gov.ph/news/2022/fund_strong.pdf "
IOA Sources
  • 5) DOH & PhilHealth. (2021). Guidelines on the Implementation and Maintenance of an Integrated Health Information System. https://law.upd.edu.ph/wp-content/uploads/2021/06/DOH-PHIC-JAO-No-2021-001.pdf 6) PhilHealth and DICT sign pact. (2023, March 20). Manila Bulletin. https://mb.com.ph/2023/3/20/phil-health-and-dict-sign-pact-to-further-boost-health-insurance-services-through-digitalization 7) Philippine Health Insurance Corporation (PhilHealth). (2013). Implementing Rules and Regulations of the National Health Insurance Act. https://www.philhealth.gov.ph/about_us/IRR_NHIAct_2013.pdf 8) Official Gazette. (2012). Data Privacy Act of 2012. https://www.officialgazette.gov.ph/2012/08/15/republic-act-no-10173/ 9) Official Gazette. (2017). Ease of Doing Business and Efficient Government Service Delivery Act. ihttps://www.officialgazette.gov.ph/2018/05/28/republic-act-no-11032/ 10) PPP Center. https://ppp.gov.ph/ppp_projects/philhealth-it-transformation/ 11) Grand View Research/ https://www.grandviewresearch.com/industry-analysis/asia-pacific-digital-health-market-report 12) Mordor Intelligence. https://www.mordorintelligence.com/industry-reports/asia-pacific-healthcare-it-market 13) Data Bridge Market Research. https://www.databridgemarketresearch.com/reports/asia-pacific-healthcare-it-market 14) Graphical Research. https://www.graphicalresearch.com/industry-insights/1499/asia-pacific-healthcare-information-technology-it-market 15) Dumlao-Abadilla, (2022). Aboitiz Group submits P 1-B offer to digitize PhilHealth claims process. https://business.inquirer.net/370540/aboitiz-group-submits-p-1-b-offerto-digitize-philhealth-claims-process 16) Philhealth, (2022). https://www.philhealth.gov.ph/about_us/statsncharts/snc2022_1stSem.pdf 17) PPPC, (2022). Sample computation on determining the reasonable rate of return (RROR) for the toll road industry. https://neda.gov.ph/wp-content/uploads/2022/12/PPP-Guidelines-Annex-C-Sample-computation-on-determining-the-reasonable-rate-of-return-RROR-toll-road-industry.pdf 18) Zalke, S. (2023). Philippines Telemedicine Market Analysis. Retrieved from https://www.insights10.com/report/philippines-telemedicine-market-analysis/ 19) Marasigan, L. (2022). KonsultaMD, HealthNow post strong growth in 2021. Retrieved from https://businessmirror.com.ph/2022/02/17/konsultamd-healthnowpost-strong-growth-in-2021/ 20) Statista (n.d.). Digital Health-Philippines. Retrieved from https://www.statista.com/outlook/dmo/digital-health/philippines 21) APAC Healthcare IT (2021) https://www.graphicalresearch.com/industry-insights/1499/asia-pacific-healthcare-information-technology-it-market#:~:text=How%20big%20is%20Asia%20Pacific,16.5%25%20between%202022%2D2028.