PhilHealth to set up benchmarks on professional fees of physicians

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Friday, April 1, 2011


THE Department of Health (DOH) is studying the real cost of services by physicians to guide PhilHealth in establishing benchmarks with regard the professional fees of doctors.

“This is to arrest the ballooning cost of health care,” DOH Secretary Enrique Ona told municipal mayors during the 4th national directorate meeting and health summit of the League of Municipalities of the Philippines in Boracay Island, Aklan early this week.

PhilHealth reportedly lost P4-billion to fraudulent reimbursements through various unnecessary and overpriced procedures since 1995 when Republic Act 7875 or the National Health Insurance Program was enacted.

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“As we expand PhilHealth coverage to the very poor and not so poor, I also ask your help in compelling your constituents who can pay the minimal premium of P100 per month to enroll in PhilHealth for their own protection as well as to increase the pooled fund for paying out benefits,” he added.

“For instance, PhilHealth membership can be made a prerequisite for certain municipal permits. This is in keeping with the PhilHealth law’s mandate for mandatory coverage for all Filipinos.”

Ona admitted that in his dialogues with various local chief executives (LCEs), “horror stories of the difficulties in accessing PhilHealth benefits abound. Some even question the wisdom of enrolling their constituents to PhilHealth when its benefits are scant in often out of reach.”

But he stressed that LCEs need not worry as measures are being instituted to improve the benefit availment and its support value. “We are modernizing the information system of PhilHealth to facilitate claims processing and reduce the disincentives associated with PhilHealth benefits such as delays in payment.”

Aside from establishing standards in the doctors’ professional fees, the support value of PhilHealth is also being increased. “Our target is for PhilHealth to have 70-percent support value and to drastically lower out-of-pocket spending.”

“There shall be no balance billing for the identified poorest of the poor in government hospitals. Both inpatient and outpatient benefits are now being improved. Case payment, wherein each medical and surgical case has a predetermined cost to be paid out by PhilHealth, is being introduced,” Ona disclosed in his speech, adding that PhilHealth already approved an initial 11 medical and 11 surgical cases for case payment.

“Case payment holds the promise of lowering health care costs by encouraging efficiency among health care providers,” he explained as he urged LCEs to coordinate and work with their respective DOH Center for Health Development and the PhilHealth regional office to increase PhilHealth enrollment.

“Let us ensure that your rural health units (RHUs) and local government hospitals are accredited to PhilHealth for improved health services among members and increased revenues for your health facilities. Ensure that the PhilHealth Capitation Fund paid to you for enrolling your indigents is used to improve the outpatient services of your RHUs, increase the supply of medicines and other essential medical supplies, and augment the benefits of your health workers,” he added. (CGC)

Published in the Sun.Star Bacolod newspaper on April 01, 2011.

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