PhilHealth studies labor, patient figures for higher benefits

The Philippine Health Insurance Corporation (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.

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."

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.

She said the entire country needs to employ more doctors to serve at 2,000 more hospitals and clinics PhilHealth aims to provide accreditation for the Konsulta package alone.

"Council members committed to developing a practical framework that will guide this expansion while ensuring service delivery capability," PhilHealth said.

As a major exporter of health workers, the Department of Health highlighted the lack of 92,000 doctors in the country during the pandemic.

According to The Lancet, a respected medical journal founded in the United Kingdom, Filipino health workers have been migrating overseas to earn higher incomes for their families and acquire quality higher education from government-backed programs and institutions.

"Many local government units are unable to provide adequate benefits and professional support, either due to resource limitations or political biases," a report from The Lancet said.

The Lancet said around 75 percent of cities and municipalities have been underserved since the migration of Filipino health workers started accelerating in the 1990s.

"Alternate funding options, including potential partnerships with the private sector, must be explored, and PhilHealth must be concurrently and deliberately strengthened," the medical journal added.