U.S. Health Care reform and the Philippine Nurse Workforce

by JEFF WILLIAMS, MediCalll

Recent health care–reform bills in the United States are requiring the health care insurance industry to revisit and retool many of its existing practices in an effort to improve overall patient care quality.

Under the Affordable Care Act (a comprehensive health care–reform law enacted in the United States in March 2010), the U.S. National Association of Insurance Commissioners has defined allowable medical loss ratios (MLRs) according to plan size. These regulations require health insurers to spend 80% to 85% of consumers' premiums on direct care for patients and efforts to improve care quality. Currently, many insurance companies spend a substantial portion of consumers' premium dollars on administrative costs and profits, including executive salaries, overhead, and marketing.

The U.S. National Association of Insurance Commissioners has defined approved qualityimprovement expenses (those that fall within the 80%–85%) as expenses that:
• Improve health outcomes, including increasing the likelihood of desired outcomes compared with a baseline and reducing health disparities among specified populations;
• Prevent hospital readmissions;
• Improve patient safety and reduce medical, errors, lower infection and mortality rates;
• Increase wellness and promote health, activities; and
• Enhance the use of health care data to improve quality, transparency, and outcomes.

Improving quality may include:
• Making/Verifying appointments;
• Obtaining feedback from the insured to effectively monitor compliance to treatment;
• Educating and participating in selfmanagement programs;
• Determining drug interaction;
• Assessing wellness;
• Providing lifestyle coaching;
• Personalizing post-discharge counseling;
• Implementing medication and carecompliance initiatives; and
• Arranging and managing transitions from one setting to another (i.e., hospital to rehab).

Some of these approved expenses are currently being done in the United States, but some are not. In an effort to keep costs down, they are often performed by a part-time, workfrom- home medically certified workforce (such as U.S. registered nurses or licensed vocational nurses), or they use a non-medically certified but program-specific medically trained workforce.

Response to the 'reduced' demand

It is well known that the Philippines is a major supplier of medical professionals, primarily nurses, to the health care industry throughout the world, with the United States being the largest market for Filipino medical professionals. Over 48% of all non–U.S. educated nurses emigrate from the Philippines, totaling almost 6% of the U.S. registered nurse workforce.*

Recent economic challenges have temporarily slowed the demand for nursing positions in the United States, leaving the Philippines with a short-term oversupply of medically educated, career focused, caring individuals in need of gainful employment. The current "retrogression" of nurse placement will eventually lift as the aging populations in major world economies again increase the demand for health care professionals throughout the world. The Philippines has a highly skilled, ready workforce and extensive knowledge of the BPO and KPO industry. This combination will allow the country to capitalize on the opportunities in health care services that have recently presented themselves.

With the myriad of opportunities that are already being realized in this country due to the ongoing electronic health record mobilization (coding, transcription, data analysis, etc), the Philippines is in a unique position to claim the title of unrivaled health care outsourcing destination as no other nation currently possesses the combination of talent and outsourcing industry expertise on the same scale.

* U.S. Department of Health and Human Services 2008 National Sample Survey