ZAMBOANGA CITY - The Philippine Health Insurance Corporation (PhilHealth) is set to adjust the rates of most of its benefit packages starting next year, which will result in increased financial coverage for Filipinos' hospitalization expenses.
The adjustment is prompted by the increasing
costs of healthcare in the country brought about by inflation. It was in 2013
when the state insurer first implemented the case rate payment system wherein
PhilHealth reimbursed a fixed amount for a specific medical condition or
surgical case.
“It is about time that PhilHealth adjusts its
rates in order for our members to cope with the increasing cost of medical
care. We want our members to feel the value of their benefits which translates
to meaningful financial risk protection. Dapat ramdam ng mga kababayan natin
ang benepisyo nila sa PhilHealth,” said Emmanuel Ledesma, Jr., PhilHealth
President and Chief Executive Officer.
The case rates are likely to increase to a
maximum of 30 percent across all cases. This is expected to lower out-of-pocket
expenses of patients during hospitalization and in the availment of PhilHealth
benefits for outpatient care, according to Ledesma.
However, to minimize untoward inflationary
effects after rate adjustments, he said PhilHealth will prescribe a
cost-sharing mechanism whereby health facilities and the members will have
fixed co-payment rates on top of what is being paid for by PhilHealth as the
insurer.
“This way, health facilities will be more
efficient in the use of resources to achieve desired health outcomes, while
members can predict how much they should pay for amenities and other extra
services available beyond those provided in basic or ward accommodations. Other
strategies to control the untoward effects of this adjustment include measures
to prevent insurance fraud and doctor moral hazard,” Ledesma said.
“This will be our way of controlling healthcare
costs, in making member’s expenses predictable, and in discouraging irrational
use of healthcare services among facilities,” he added.
PhilHealth shall adopt a variable inflation
adjustment across types of health facilities, which means that higher-level
facilities shall get higher adjustments in rates up to a maximum of 30%. The
upward adjustment in case rates is on top of the ongoing benefit expansion and
rationalization that was already approved by the PhilHealth Board.
“Ang malawakang increase sa case rates benefits
natin ay iba pa sa mga nauna at ilalabas pa nating benefits enhancements
ngayong taon. Tugon natin ito sa panawagan ni Pangulong Ferdinand Marcos Jr.
gayundin ng ating stakeholders kasama ang Kongreso at patient groups na gawin
pang lalong makabuluhan ang benepisyo para sa mga miyembro saan man sila sa
bansa” Ledesma said.
For 2023, PhilHealth implemented the expansion of
dialysis coverage to 156 sessions from the previous 90 sessions. It also
rationalized the rates for conditions mostly availed of among Filipinos.
Recently, it released its Circular 2023-0021
where it increased coverage for ischemic stroke from P28,000 to P76,000, and
hemorrhagic stroke from P38,000 to P80,000. It is set to release a circular
before year-end to widen its coverage for pneumonia high-risk from P32,000 to
90,100.
Ledesma said they also launched its Outpatient
Mental Health Package in mid-October, and will soon launch a package for Severe
Acute Malnutrition. It also started to enhance its various Z Benefits Packages.
In 2024, Z Benefits for breast cancer shall likewise be expanded which will
include coverage of targeted therapy of up to P1 million per patient per year.
“PhilHealth
will continue to respond to Filipinos’ needs in line with President Ferdinand
Marcos Jr.'s 10-point agenda, especially in the area of affordable and
universal health care for all Filipinos,” he said. (Mindanao Examiner)
