QUEZON CITY, (PIA) — Filipinos can now access healthcare services with much lower out-of-pocket expenses through the help of the Philippine Health Insurance Corporation (PhilHealth).
This, as PhilHealth announced on Monday, November 20, that it will increase the financial coverage of most benefit packages under the National Health Insurance Program (NHIP) to further lessen the financial burden of Filipinos seeking medical care in hospitals.
“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,” said PhilHealth President and Chief Executive Officer (CEO) Emmanuel Ledesma Jr.
“Dapat ramdam ng mga kababayan natin ang benepisyo nila sa PhilHealth (Our fellow Filipinos should feel the benefits of their membership to PhilHealth),” he added, citing the need to keep pace with the state of the country’s inflation rate which impose a significant impact on healthcare costs.
It can be recalled that PhilHealth implemented a case rate payment system in 2013 which enabled a fixed compensation for a specific medical condition.
With the adjustment on the benefit packages, PhilHealth members can expect a maximum 30 percent increase in all case rates during hospitalization as well as outpatient care, particularly in higher-level facilities.
However, the corporation is set to prescribe a cost-sharing mechanism between its accredited health facilities and qualified members to ensure that they will have a fixed co-payment rates in addition to the expenses covered by PhilHealth benefit packages.
This will also allow health facilities to efficiently utilize resources on a need basis while members can transparently track their expenses for the use of amenities and other additional services on top of those provided in basic hospital admission.
“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,” Ledesma explained.
Meanwhile, the said increase in case rates is apart from the ongoing expansion and rationalization of benefit packages which already rendered the approval of the PhilHealth Board.
“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 (This is our response to the call of President Ferdinand Marcos Jr. as well as our stakeholders alongside the Congress and patient groups to further enhance the benefits of members wherever they are in the country),” the PhilHealth chief underscored.
In 2023, the corporation was able to implement the expansion of dialysis coverage from 90 to 156 sessions. It also increased the coverage for ischemic stroke from P28,000 to P76,000 and hemorrhagic stroke from P38,000 to P80,000.
Before the last semester of the year ends, PhilHealth will also expand the coverage for pneumonia high-risk from P32,000 to P90,100.
Further, in 2024, the state health insurer is eyeing to enhance the Z Benefits for breast cancer through integrating the coverage of targeted therapy which can be availed up to P1-M per member-patient/year. (PhilHealth/PIA-NCR)
