CAGAYAN DE ORO CITY (PIA) – The Philippine Health Insurance Corporation (PhilHealth) has introduced a comprehensive benefit enhancement program to meet Filipinos’ healthcare needs.
The program, which started last year, focuses on expanding coverage for critical health conditions and providing essential healthcare services, strongly emphasizing conditions that impose a high financial burden on Filipino families.
During the latest episode of Kapihan sa Bagong Pilipinas, PhilHealth-10 Regional Vice President Delio Aseron II shared that in line with the agency’s commitment to delivering healthcare benefits to all Filipinos, some benefit packages increased to help members better cope with various healthcare challenges.
“In line with President Ferdinand Marcos Jr.’s aspiration for a robust healthcare system that can withstand another pandemic, and under the guidance of the PhilHealth Board led by Health Secretary Teodoro Herboza, PhilHealth has embarked on an aggressive benefit enhancement program starting last year,” Aseron explained.
One of the first steps in this program was expanding the coverage of the hemodialysis package from 90 to 156 sessions annually. This change ensures that patients with Chronic Kidney Disease (CKD) Stage 5 receive the life-saving treatment without interruption, covering the standard three times per week sessions.
Additionally, PhilHealth increased the coverage per session by 54 percent, from P2,600 to P4,000, starting in July 2024. As a result, the total annual coverage for CKD Stage 5 patients increased from P405,600 to P624,000 per patient.
“To rationalize benefit packages that truly matter to our Kababayans, we focused on conditions with high financial burdens that could lead to catastrophic spending for patients and their families,” Aseron said.
He reported that PhilHealth has more than doubled the coverage for hemorrhagic stroke from P38,000 to P80,000, ischemic stroke from P28,000 to P76,000, and high-risk pneumonia from P32,000 to P90,100.
Aseron emphasized that this increased support reduces out-of-pocket expenses for patients facing these life-threatening conditions. Enhancements have also been made to packages for colon and rectal cancers and selected orthopedic implants, providing patients with financial protection and access to essential medical procedures.
“Recognizing the importance of mental health, PhilHealth has introduced a mental healthcare package that offers general and specialty mental health services. We are also partnering with more providers to make this service accessible to Filipinos struggling with mental health issues. There has also been an increase in the Konsultasyong Sulit at Tama (Konsulta) package. The primary care benefit expanded to include 32 more essential drugs and medicines in addition to the existing 21. These medications address common conditions like asthma, diabetes, and hypertension,” Aseron explained.
The program also provides free medical check-ups, maintenance medicines, and doctor-prescribed laboratory tests.
The budget per patient increased from P500 to P1,700 and now covers mammograms and breast, upper abdominal, and pelvic ultrasounds, aiding early breast cancer detection and improving outcomes.
“As our PCO, Mandy Ledesma Jr., announced, another round of increases is expected before the year ends. Studies are underway for this round, which would serve as PhilHealth’s early Christmas gift to Filipinos,” Aseron added.
He also underscored PhilHealth’s one of the most significant milestones—the Z-benefit package for breast cancer, which saw a remarkable 1,300 percent increase on March 30, 2024. Coverage for breast cancer treatment has surged from P100,000 to P1.4 million per case, significantly easing the financial burden on patients and their families.
Substantial enhancements were also made for neonatal sepsis and bronchial asthma, effective May 1, 2024. Coverage for neonatal sepsis increased from P11,700 to P25,793, while bronchial asthma coverage jumped from P9,000 to P22,488, representing a 150 percent increase.
Last month, he said, PhilHealth introduced outpatient therapeutic care benefit packages for severe acute malnutrition in children under five years old, supporting families to prevent malnutrition and growth stunting among Filipino children.
With the current benefit increases, PhilHealth is still studying the potential for further expansions, including COVID-19 inpatient enhancement and an adjustment in the hemodialysis rate.
The agency is optimistic about finalizing guidelines for increased coverage for physical and medical rehabilitation services, severe dengue hemorrhagic fever, and chemotherapy for lung, liver, ovary, and prostate cancers. Other areas considered for enhancements include emergency care, cataract extraction, prostate cancer, cervical cancer, open-heart surgeries, peritoneal dialysis, and a 30 percent increase in case rates for various conditions.
PhilHealth’s aggressive benefit enhancement program marks a significant step forward for the Philippine healthcare system. By expanding coverage for critical conditions, improving access to primary care, and addressing the financial burden of high-cost treatments, PhilHealth is making strides toward providing affordable and accessible healthcare for all Filipinos.
With further enhancements, the agency remains committed to its vision: “Bawat Filipino–miyembro, protektado; at kalusugan ng lahat-sigurado.” (JAKA/PIA-10)
