PhilHealth benefit payments reach P37B for S1-2014

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Thursday, July 31, 2014


THE Philippine Health Insurance Corporation (PhilHealth) expects its total benefit payments to reach P36.85 billion for the first semester of 2014, representing a 41 percent increase compared to the P26.19 billion it paid for the same period last year.

“We are releasing about P1.35 billion per week for benefit payments this year,” which is 33 percent higher than the P1.2 billion we released every week last year,” said PhilHealth President and CEO Alexander A. Padilla.

“For the period January-April of this year alone, we have already reimbursed a total of P23 billion which is 30 percent higher from the P17.5 billion disbursed during the same period in 2013,” he added.

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Payments for the benefits of Formal Economy members were highest at P9.0 billion, a 22 percent increase from the previous year’s benefit payments.

Coming in second were payments to members from the Informal Economy at P6.3 billion representing 58 percent of total benefit payments followed by payments to indigent/Sponsored members at P5.92 billion, and to Lifetime members at P1.73 billion.

The upward trend in benefit payment amounts for all sectors is attributed to the continuing enhancement of PhilHealth’s benefits portfolio which now covers a substantial portion of the hospital expenses of members and their qualified dependents.

For instance, under its Z Benefit Package, coverage for end stage renal disease is worth P600,000, while coverage for childhood leukemia is at P210,000.

At the same time, Z benefits for early stage breast cancer and low to intermediate risk prostate cancer is at P100,000 each, covering the entire course of treatment.

The state health insurer continues to introduce new benefit packages to ensure totality of care and the attainment of better health outcomes.

“The introduction of more catastrophic packages such as for Coronary Artery Bypass for P550,000, Surgery for Tetralogy of Fallot for P320,000, Surgery for Ventricular Septal defect for P250,000, Cervical Cancer chemo-radiation with cobalt and brachytherapy (low dose) for P120,000 and P175,000 respectively also played a major part in the increase of benefit payments this year,” Padilla said.

The continued expansion of service facilities also contributed to increasing benefit payments.

Nine out of 10 hospitals licensed by the Department of Health are now PhilHealth-accredited, translating to 1,761 health care providers and 32,323 health care professionals nationwide.

“More accredited and engaged facilities and professionals means better access for our members anywhere in the country,” the PhilHealth Chief said.

Padilla added that the continuously expanding membership coverage also pushed benefit payments upward, with more and more beneficiaries now gaining greater access to health care though social health insurance.
PhilHealth also underscored the various innovations initiated by its regional teams as significantly contributing to the rise in benefit payments.

For instance, PhilHealth Regional Office VIII introduced the PhilHealth LINK, a call center initiative which assists members availing of PhilHealth coverage.

The initiative has bagged the Galing-Likha Kalusugan Award, for being one of the top three outstanding health innovations in the country.

Improvements in turn-around-time of processing good claims from 60 days to 13 days in some of the regional offices, also helped benefit payments this year.

“Benefit enhancement and quality assurance remain at the forefront of what we do to be more relevant to the millions of members not only here but also abroad,” Padilla added.

Published in the Sun.Star Cagayan de Oro newspaper on July 31, 2014.

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