Full PhilHealth coverage for major operations sought

A lawmaker is pushing for full PhilHealth coverage on major hospital operations apart from the approved 30 percent increase on the agency’s benefits such as cancer treatment and heart bypass surgery.

AGRI Party-list Representative Wilbert Lee said that the treatments for the said illnesses cost millions, while PhilHealth coverage only offers P150,000 to P600,000 for the entire course of treatment.

"In the case of cancer, we know that the treatment cannot be done in installments. We want to make it unlimited and what needs to be treated for cancer, PhilHealth needs to answer all that," Lee stressed.

"For heart bypass surgery, coronary artery bypass, the coverage limit is P550,000 but you will spend millions on that," he added.

To recall, the agency is set to implement the 30% increase on most of its benefit packages on 14 February 2024.

Lee had earlier sought to expand PhilHealth healthcare packages and coverage, following the complaints he received that some hospitals did not want to accept indigent patients because they were unable to pay their doctors and employees due to the state health insurer’s huge debts.

It can be recalled that upon Lee’s questioning during the deliberation of the proposed 2024 budget of the Department of Health on September 2023, it was revealed that PhilHealth had P466 billion worth of investible funds and P68.4 billion net income.

Through a letter to the PhilHealth leadership on October 2023, he recommended a 30 percent across-the-board increase in the agency’s benefit packages and coverage.

Lee also filed House Resolution 1407, urging the state health insurer to update and increase its coverage by 30 percent, saying that its case rate “is no longer responsive to the hospitalization cost of the beneficiaries.”

Meanwhile, the lawmaker also urged President Ferdinand Marcos Jr. to temporarily suspend the implementation of the PhilHealth premium rate hike from 4 percent last year to 5 percent this year.