PhilHealth’s new case rate packages available next month

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Monday, August 22, 2011

NEW case rate packages will be available starting September 1 in various health care facilities accredited by the Philippine Health Insurance Corporation (PhilHealth).

The medical cases and their corresponding package rates are: dengue I (P8,000); dengue II (P16,000); pneumonia I (P15,000); pneumonia II (P32,000); essential hypertension (P9,000); cerebral infarction (CVA I, P28,000); cerebro-vascular accident with hemorrhage (CVA II, P38,000); acute gastroenteritis (P6,000); asthma (P9,000); typhoid fever (P14,000); and newborn care package in hospitals and lying-in clinics (P1,750).

For surgical procedures, the packages include radiotherapy (P3,000 per session); hemodialysis (P4,000 per session); maternity care package (MCP, P8,000) coupled with the normal spontaneous delivery (NSD) package in level 1 (P8,000) and levels 2-4 hospitals (P6,500); caesarian section (P19,000); appendectomy (P24,000); cholecystectomy (P31,000); dilatation and curettage (P11,000); thyroidectomy (P31,000); herniorrhaphy (P21,000); mastectomy (P22,000); hysterectomy (P30,000); and cataract surgery (P16,000).


“The new packages are available for all member-types admitted in any of the accredited institutional health care providers nationwide starting September 1,” PhilHealth said in an advisory over the weekend. “For our sponsored program members who are admitted in government hospitals, the ‘no balance billing (NBB)’ policy applies, meaning no other fees nor expenses shall be charged to or paid for by the patient-member above and beyond the package rate."

The NBB policy shall also apply to any other member type such as the employed, individually-paying and overseas workers, who will avail themselves of the MCP and NCP in all accredited MCP non-hospital providers such as maternity clinics and birthing homes, it added.

“The shift from fee-for-service to case rates for these medical and surgical cases was prompted by developments taking place in the health care industry, particularly on the need to provide optimal financial risk protection especially to the most vulnerable groups, including the poorest of the poor," PhilHealth explained.

Better member appreciation and faster reimbursement of fees to health care providers were also among the major considerations for introducing this new type of provider payment scheme. “The use of case rates is an internationally-accepted payment mechanism that serves to package payment for health interventions. Through this mechanism, members will be able to predict how much PhilHealth will be paying for each of the services provided." (CGC)

Published in the Sun.Star Bacolod newspaper on August 22, 2011.


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