MANILA – The
Philippine Health Insurance Corporation (PhilHealth) is set to adjust the
rates of most of its benefit
packages starting 2024.
PhilHealth must
adjusts its rates in order for
members to cope with the
increasing cost of medical
care, PhilHealth president
and chief executive officer
Emmanuel Ledesma Jr.
said in a statement on Friday.
“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
(Our fellowmen must be
able to feel their benefits
from PhilHealth),” he added.
The state health
insurer first implemented
the case rate payment
system in 2013, wherein it
reimbursed a fixed amount
for a specific medical condition or surgical case.
With the set adjustment, the case rates
are likely to increase to a
maximum of 30 percent
across all cases, resulting to lower out-of-pocket
expenses during hospitalization and even during
outpatient care.
To minimize untoward inflationary effects
after rate adjustments,
PhilHealth will prescribe a
cost-sharing mechanism
wherein health facilities
and the members will have
fixed co-payment rates on
top of what is being paid
for by PhilHealth.
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 availed of 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.
“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 said.
The 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 percent.
Ledesma said
the upward adjustment in
case rates is on top of the
ongoing benefit expansion
and rationalization that
was already approved by
the PhilHealth Board.
For 2023, PhilHealth has implemented
the expansion of dialysis
coverage to 156 sessions
from the previous 90 sessions, and rationalized the
rates for conditions mostly
availed of among Filipinos.
Through Circular
2023-0021, it increased
the coverage for ischemic
stroke from PHP28,000
to PHP76,000, and hemorrhagic stroke from
PHP38,000 to PHP80,000.
It is set to release a circular before
yearend to widen its coverage for pneumonia highrisk from PHP32,000 to
PHP90,100.
In 2024, Z Benefits for breast cancer shall
likewise be expanded,
which will include coverage of targeted therapy
of up to PHP1 million per
patient per year.
Z Benefits cover
20 catastrophic illnesses
and health conditions re-
quiring expensive treatments and hospitalizations: acute
lymphocytic leukemia, early breast cancer, prostate cancer, kidney transplant, standard risk coronary bypass
graft, tetralogy of Fallot, ventricular septal defect, cervical cancer, Z MORPH (Mobility, Orthosis, Rehabilitation and Prosthesis Help), selected orthopedic implants,
peritoneal dialysis, colon cancer, rectal cancer, expanded mobility orthosis rehabilitation help, premature and
small newborns, children with developmental disabilities, children with mobility impairment, children with visual impairment, children with hearing impairment, and
rheumatic heart disease. (PNA)
