PhilHealth benefits up

Members of Philippine Health Insurance Corporation are set to receive higher benefit packages next year.

Emmanuel Ledesma Jr., PhilHealth president and CEO, said the adjustments will result in increased financial coverage for members' hospitalization expenses.

He said PhilHealth's move was prompted by the increasing cost of healthcare in the country brought about by inflation.

"It was about time that PhilHealth adjusted its rates in order for our members to cope with the increasing cost of medical care," said Ledesma in a statement on Monday.

"We want our members to feel the value of their benefits which translates to meaningful financial risk protection," he added.

In 2013, PhilHealth first implemented the case rate payment system wherein it reimbursed members a fixed amount for specific medical and surgical conditions.

The rates are likely to increase to a maximum of 30 percent across all cases, lowering the amount patients would have to shell out for hospitalization and outpatient care.

PhilHealth said it will prescribe a cost-sharing mechanism wherein health facilities and members will have fixed co-payment rates on top of what will be paid by PhilHealth to minimize untoward inflationary effects.

"This way, health facilities will be more efficient in the use of resources to achieve the desired health outcomes, while members can predict how much they should pay for amenities and other extra services availed of beyond those provided in basic or ward accommodations," it said.

"Other strategies to control the untoward effects of this adjustment include measures to prevent insurance fraud and doctor's moral hazard," it added.

Ledesma said this "will be our way of controlling healthcare costs, in making member's expenses predictable, and in discouraging the irrational use of healthcare services by facilities."

PhilHealth shall adopt a variable inflation adjustment system across all types of health facilities, which means that higher-level facilities shall get higher adjustments in rates up to a maximum of 30 percent.

This year, PhilHealth expanded dialysis coverage to 156 sessions from the previous 90 sessions. It also rationalized the rates for conditions mostly availed of by Filipinos.

In mid-October, the state-run health insurer launched its Outpatient Mental Health Package, and it will soon launch a package for Severe Acute Malnutrition. It also started to enhance its various Z Benefits packages.

Next year, PhilHealth said the Z Benefits for breast cancer will likewise be expanded, which will include coverage of targeted therapy of up to P1 million per patient per year.