PhilHealth to review confinement policy

During the Senate Committee on Health Public Hearing on 20 August, Chairperson Senator Christopher "Bong" Go urged Philippine Health Insurance Corporation (PhilHealth) CEO and President Emmanuel R. Ledesma, Jr., to eliminate the agency's single period of confinement policy.

Under PhilHealth Circular No. 0035, series of 2013, a single period of confinement means that admissions and re-admissions for the same illness or procedure within a 90-calendar day period are only covered by one case rate benefit.

Ledesma committed to thoroughly reviewing the policy and considering its removal, acknowledging that it had flaws.

In his opening statement, Senator Go questioned the policy: “Bakit ganyan ang polisiya? Kunyari nagka-kumplikasyon ka sa panganganak pag nagka-bleeding, makaka-claim ka base sa case rate. Pero sa susunod na linggo, pag mag-bleed ka ulit, hindi ka na makakaclaim.”

Go added, “Kung ma-confine ang isang tao dahil sa diarrhea at nagamit na nya ang PhilHealth nya, hindi na sya pwedeng magka-diarrhea within 90 days dahil hindi na nya maa-avail ang PhilHealth benefits for the same illness. Mapipigilan mo ba ang diarrhea? Mapipigilan mo ba ang bleeding o pneumonia? Pwede ba nating sabihin, sorry po pero hindi ka na pwedeng magka-diarrhea within the next 90 days.”

Go pointed out that the policy's lack of coverage for repeated illnesses forces some doctors to provide different diagnoses to help patients access their PhilHealth benefits.

Improve Benefits, Utilize Funds

During the same hearing, Senator Go urged PhilHealth to increase their benefits due to recent spikes in illnesses, including leptospirosis, dengue, and, most recently, monkeypox.

“Katumbas ng kalusugan ang buhay po ng bawat Pilipino,” Go noted.

Senator Go also highlighted the out-of-pocket health expenses of Filipinos, citing a 2024 Philippine Institute for Development Studies (PIDS) report. The research revealed that 48% of health expenses are paid out of pocket, 25% come from government sources such as PhilHealth, and the remainder is covered through voluntary and compulsory health care payment schemes.

Go also reiterated his strong opposition to the transfer of billions in PhilHealth funds to the national treasury. Executive officials have stated that these funds will be redirected to other government programs and projects.

“Hindi ito katanggap-tanggap para sa akin lalo na dahil maraming pasyente pa po hanggang ngayon ang naghihingalo at hindi makalabas sa hospital dahil wala pong pambayad. Lalung-lalo na po yung mahihirap nating kababayan,” Go said.

“Seryosong usapin po ito dahil buhay po ang nakataya dito… Natutulog po yung pondo dyan, kaya nga po nawawalis ng ating mga finance officials ng gobyerno dahil bilyon-bilyong piso ang nakatengga na dapat sana magamit para sa mga pasyente. Imagine P500 billion reserve fund, ilang pasyente pa ang mabubuhay imbes mamatay kung magagamit po itong pondo na ito? Bakit, bangko na ba ang PhilHealth na kailangan nitong mag-accumulate ng liquid assets?” he added.