Despite facing potential budget cuts in 2024, the Philippine Health Insurance Corporation (PhilHealth) has outlined plans to expand its health benefit packages, with a focus on cancer care.

PhilHealth senior vice president for Health Finance Policy Sector, Dr. Israel Francis Pargas, said Monday the agency is set to enhance benefits for lung, liver, ovarian, cervical and prostate cancer.

Coverage for rare diseases like Maple Syrup Urine Disease and Methylmalonic Acidemia will also be expanded, along with support for rehabilitation services, peritoneal dialysis, kidney transplants and post-transplant care.

The announcement came as the Senate Finance Committee recommended cutting over P5.7 million from PhilHealth’s proposed P53.3-billion budget. Despite the potential reduction, PhilHealth president and CEO Emmanuel Ledesma Jr. said the agency will manage within its allocated budget.

“We will always find ways to make it work, no matter the decision,” Ledesma said.

Ledesma also addressed concerns about the P89.9 billion in unutilized PhilHealth funds, clarifying that this was not sourced from member contributions and the agency had enough reserves to proceed with its planned benefits expansion.

“Personally, I don’t see any problem. We have ample funds and reserves,” Ledesma said. He added that if a shortfall arises, PhilHealth would receive support from other government institutions.

PhilHealth officials explained that implementing multiple benefit enhancements at once is not feasible. Ledesma noted that financial studies and actuarial analyses are necessary for each package.

Pargas said benefit prioritization is guided by the health data, including the leading causes of death and illness. “We base our priorities on the burden of disease, claims utilization and the amount of financial support provided for these cases,” he explained.

Developing benefits, according to Pargas, involves careful costing and consultation with stakeholders. “We gather data on treatment methods, guidelines, and associated costs. These costing data are provided by our stakeholders.”

10 rare diseases

PhilHealth has expanded benefits for 10 rare diseases, chronic kidney diseases, and primary care.

Ledesma said the state insurer’s board approved a more than 1,000-percent increase in benefits for rare diseases under the Z Benefits Package on 29 November.

The higher benefits are applicable to 10 rare diseases: Maple Syrup Urine Disease, Methylmalonic Acidemia/Propionic Acidemia, Galactosemia, Phenylketonuria, Gaucher Disease, Pompe Disease, Fabry Disease, Hunter and Morquio Syndromes, and Osteogenesis Imperfecta.

“We are pleased to unveil a total of six enhanced packages for inpatient care, Z Benefits and Konsulta. These expanded benefits reflect our dedication to providing accessible and affordable healthcare through better health insurance coverage,” Ledesma said.

For chronic kidney diseases, PhilHealth raised benefits for transplants from P600,000 to over P2 million, a 258-percent increase.

In the first year of post-transplant, the insurer covers drugs totaling P506,000 and laboratory tests worth P85,000. For the second year, PhilHealth will provide P496,000 for drug support and P45,000 for laboratory tests.

For peritoneal dialysis, PhilHealth will cover costs for catheter insertion, infection management, and continuous peritoneal dialysis, amounting from P29,000 to P585,500 for adult patients. Meanwhile, benefits coverage for pediatric patients was set from P16,800 to P1.5 million.

In terms of primary care under the Konsulta Package, Ledesma said PhilHealth has approved financial aid for oral screening, prophylaxis, fissure sealants, emergency tooth extraction and fluoride varnish application.

PhilHealth Senior Vice President for Fund Management Renato Limsiaco Jr. said the health insurer maintains more than adequate funds of P485 billion for benefit payments this year and the next few years.

As of 22 November, he said PhilHealth collected P172 billion in premium payments while benefit payments reached P148 billion, much higher than the P118 billion recorded last year.

“We have yet to see the full November and December figures, so we still expect an excess of around P116 billion,” Limsiaco said.

Limsiaco said PhilHealth will continue to expand benefits for other diseases partly through revenue shares from sin taxes and the Philippine Charity Sweepstakes Office, with a combined contribution of over P61 million to PhilHealth this year.

For next year, he said this amount will increase to over P78 million.