After much criticism from concerned and responsive government officials, notably Sen. Bong Go, and the private sector call for better benefits from the national health insurance agency, the Philippine Health Insurance Corporation (PhilHealth) is moving up a bit from its poor performance.

Some 114 million members rely on PhilHealth to handle their hospital expenses when the need arises so they will not be financially challenged.

Hospitalization, not just sickness, is one of the major concerns of Filipinos. It is worse than “Yolanda” and other calamities that hit us. It drains financially and mentally each and every family, everyone for that matter, who are confronted with exorbitant hospital bills. Curiously, there is no government agency keeping in check how medical facilities charge their patients. They charge at will. Very pathetic.

Anyway, pressured to do better amid the call for Mr. Emmanuel Ledesma and the Board to either resign or be fired by President Bongbong Marcos Jr., PhilHealth is now implementing a new benefits package covering outpatient emergency care services, which took effect on 1 January under PhilHealth Circular No. 2024-0033.

Under the new policy, the Outpatient Emergency Care Benefit (OECB) package covers a wide range of services for patients treated in emergency departments (ED) of accredited facilities, including pre-hospital transport. It abolished the 24-hour confinement policy. No more need to be confined before being able to avail of PhilHealth coverage. Senator Go welcomed this but he believed it wasn’t enough, reiterating the need for further reforms to ensure Filipinos can access full healthcare services.

PhilHealth committed to Go to increase the benefit packages for the top 10 mortality diseases; to increase case rates by up to 50 percent across-the-board; to expand benefit packages for dental, outpatient, mental health, optometry and other services; and to scrap the 24-hour confinement rule which prevented emergency outpatient coverage, among others.

Patients under the OECB package can now claim coverage for emergency services without the previously required hospital admission. Cases, such as dizziness, diarrhea, persistent vomiting, elevated blood pressure, seizures and even sexual assault are covered. Additionally, diagnostic services such as X-rays, CT scans, nebulization and blood tests are now covered by PhilHealth.

Notwithstanding the commitments PhilHealth made to Go, the clamor of 114 million members remains at a high pitch. The positive adjustments in benefits coverage remain below par because they do not address the major concern of patients and their families confronted with hospitalization.

The issue of patients and their families having to pay the larger share of hospital bills remains since PhilHealth only covers about, or merely, 30 percent of the confinement cost. It is grossly wrong that the state insurance agency handles only about a third of the entire bill. That’s not the law’s intent. Worse, there’s enough money in PhilHealth vaults where P90 billion was taken by the not so good finance secretary instead of having the funds cover patients’ bills.

Grrr. It’s perhaps safe to say that it’s a crime.

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