The Philippine Health Insurance Corp. (PhilHealth) is looking into healthcare providers’ staffing capabilities and patient volumes in enhancing its benefit packages.

In a recent statement, state-owned PhilHealth said its Technical Advisory Council will be crafting a “market-based” expansion of benefits for certain diseases that reflects hospitals’ operation costs and patients’ overall expense in obtaining healthcare.

“By improving our actuarial assumptions, we can better predict healthcare costs and utilization patterns,” PhilHealth president and chief executive officer Dr. Edwin Mercado said.

PhilHealth said these were the priority tasks the council members discussed in their second meeting last 10 March under the leadership of Mercado.

Doctor-hospital ratio checked

He said PhilHealth is gathering data on the sufficiency of doctors at hospitals nationwide to help ensure patients receive all the benefits under the insurer’s multiple health packages.

“This means we can expand benefits in a sustainable way while ensuring members can actually access the care we’re promising,” Mercado said. “We want to ensure our members can find qualified providers to deliver that care without excessive out-of-pocket expenses or long travel times,” he added.

PhilHealth National Capital Region Office vice president Dr. Bernadette Lico told the media last month existing doctors for the Konsulta package or primary healthcare in Metro Manila and the province of Rizal can serve only 20,000 patients per Konsulta facility out of the total 17 million residents in those areas.