THE Philippine Health Insurance Corp. (PhilHealth) will raise the rates of most of its benefit packages starting next year to increase the coverage for Filipinos’ hospitalization expenses, as it acknowledged the rising costs of health care brought about by inflation.
The case rates will likely increase by up to 30 percent across all cases to lower the out-of-pocket expenses of patients during hospitalization and receipt of outpatient care, the state insurer announced on its website last week.
Under the case rate system introduced by PhilHealth in 2013, it set a fixed amount for reimbursement for a specific medical condition or surgical case.
However, the rates for specific medical conditions typically cover only a fraction of the PhilHealth member’s medical bill, so that the member usually has to seek help from charitable institutions and local government units, or use private health insurance (if the company he works for provided him with one) to cover other portions of the bill, in order to reduce the portion of the bill that he must pay for himself.
To discourage the “irrational use of healthcare services among facilities” and control health care costs when the rates are adjusted, PhilHealth president and chief executive officer Emmanuel Ledesma Jr. said PhilHealth would prescribe a cost-sharing mechanism.
Under this mechanism, health facilities and the members would have “fixed co-payment rates on top of what is being paid for by PhilHealth as the insurer.”
This would help members to predict how much they should pay for amenities and other services beyond those provided in basic or ward accommodations, while also encouraging health facilities to be more efficient in using their resources to treat patients, PhilHealth said.
Philhealth said the upward adjustment in case rates would be “on top” of the rate rationalization already approved earlier by its board.
Recently, PhilHealth hiked its coverage for ischemic stroke from P28,000 to P76,000, and hemorrhagic stroke from P38,000 to P80,000.
Before yearend, it plans to release a circular to widen its coverage for pneumonia high-risk from P32,000 to P90,100, the insurer said.
Other benefits PhilHealth members can expect are a package for Severe Acute Malnutrition, and the expansion in 2024 of the Z Benefits for breast cancer “to include coverage of targeted therapy of up to P1 million per patient per year.”