PhilHealth reminds public on new case rate system

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Sunday, June 22, 2014


TO ASSURE win-win situation between hospitals and patients, Philippine Health Insurance Corp. (PhilHealth)-Cordillera Administrative Region reminds the public on the new case rate payment system.

The case rate payment system is the amount of benefits for hospitalization paid on a fixed amount for each treated medical or surgical case.

The new scheme applies in all public and private PhilHealth accredited hospitals.

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President and Chief Executive of PhilHealth Alexander Padilla announced recently the new payment method is more efficient and fair.

"Alam ng hospital kung magkano ang makukuha nila, at alam rin ng pasyente kung magkano ang dapat ibabawas sa kanilang mga bill," he said.

He noted the case rate payment system is already "all in" where hospital charges and professional fees are already covered.

Medical cases covered by the case rate includes dengue I with a corresponding fixed amount of benefits at P8,000; dengue II at P16,000; pneumonia I at P15,000; pneumonia II at P32,000; essential hypertension at P9,000; cerebral infarction at P28,000; cerebro-vascular accident at P38,000; acute gastroenterities at P6,000; asthma at P9,000; typhoid fever at P14,000; newborn care package in hospital and lying-in clinics at P1,750.

The scheme also covers surgical cases such as radiotherapy with fixed amount of benefits at P3,000; hemodialysis at P4,000; maternity care package at P8,000; normal spontaneous delivery in Level 1 hospitals at P8,000; normal spontaneous delivery in Level 3 and 4 hospitals at P6,500; caesarean section at P19,000; appendectomy at P24,000; cholecystectomy at P31,000; dilation and curettage at P11,000; thyroidectomy at P31,000; herniorraphy at P21,000; mastectomy at P22,000; hysterectomy at P30,000; and cataract surgery at P16,000.

The amount of benefits should be deducted from the total hospital bill before discharge. The only amount the PhilHealth member or patient will shoulder is the balance.

However, for sponsored members, the No-Balance Billing Policy will apply.

If a patient’s reason for confinement is not covered by the case rate system, the patient can still avail the benefits under the Fee-For-Service method where a patient must be confined in a PhilHealth accredited hospital for not less than 24 hours.

The benefits under the FFS method includes room and board, drugs and medicines, x-ray and other laboratory examinations, operating fees and doctors’ professional fees.

Although both can be applied to avail of the PhilHealth benefits, the difference between case rate system and FFS is that in FFS, the amount of benefits varies depending on the hospital level, doctor’s qualification, and severity of illness and complexity of operation.

Published in the Sun.Star Baguio newspaper on June 23, 2014.

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