PhilHealth, DOST-PCHRD roll out expanded healthcare benefits

Millions of Filipinos now have improved access to physical medicine, rehabilitation services, and assistive mobility devices through new benefit packages developed under a partnership between the Department of Science and Technology–Philippine Council for Health Research and Development (DOST-PCHRD) and the Philippine Health Insurance Corporation (PhilHealth).

The expanded coverage aims to improve the quality of life for persons with disabilities while providing financial risk protection.

The benefit packages were crafted through the PhilHealth STUDIES program — Thrust for Universal Health Care through Data, Information, and Knowledge Exchange Systems — funded by PhilHealth and led by researchers including Dr. Josephine Bundoc of Physicians for Peace Philippines. The initiative promotes evidence-based health policy reforms aligned with Universal Health Care.

Previously, PhilHealth’s Z Benefits Package primarily supported rehabilitation for stroke and heart attack patients, and outpatient care for children with disabilities. The new and expanded package now includes initial, follow-up, and discharge assessments; rehabilitation therapies; mobility aids; laboratory and diagnostic tests; and essential medications.

Services now covered include physical therapy, occupational therapy, speech and language pathology, psychological support, and assistive devices such as wheelchairs, walkers, crutches, and canes—key to helping patients regain independence. According to the Philippine Statistics Authority, around 12 percent of Filipinos aged 15 and above experience severe disability.

To operationalize the expanded package, PhilHealth issued Circular 2025-0003, which sets standards of care, provider requirements, referral protocols, and service rates, based on findings from the PhilHealth STUDIES research.

“Research is essential in crafting health policies and programs that address the real-world needs of persons with disabilities,” said DOST-PCHRD Executive Director Dr. Jaime Montoya. “The PhilHealth STUDIES program bridges health policymakers with research that enhances healthcare accessibility for Filipinos,” he added.

Beyond rehabilitation and assistive device coverage, the PhilHealth STUDIES has contributed to the development of new benefit packages prioritizing other health conditions, including mental health conditions and heart disease. One key initiative is the Outpatient Benefit Package for Mental Health, with the team of Dr. Lester Sam Geroy of the Alliance for Improving Health Outcomes (AIHO) providing technical assistance to the policy development.

The package was introduced in 2023 through PhilHealth Circular 2023-0018, featuring two sub-packages: general mental health services and specialty mental health services, ensuring a broader spectrum of support for individuals in need.

Under the package, patients can avail of up to P9000 worth of general mental health services per year, which covers screening, diagnostics, 12 follow-up visits, psychoeducation, and access to DOH-provided essential medicines. For specialty mental health services, coverage is up to P16000 per year, which includes diagnostics, psychotherapy, and follow-up visits with psychiatrists, neurologists, or psychologists.

To provide financial protection against high cost of treatment for heart attack, particularly those with ST-Elevation Myocardial Infarction (STEMI), Dr. Geroy’s team provided technical assistance in the development of the Benefit Package for Ischemic Heart Disease - Acute Myocardial Infarction which covers four essential sub-packages: percutaneous coronary intervention (PCI), fibrinolysis, emergency medical services (EMS) with coordinated interfacility transfers, and cardiac rehabilitation. The package was launched through PhilHealth Circular No. 2024-0032, significantly expanding coverage for heart attack services with package rates of PHP 523,853 for PCI, PHP 133,500 for fibrinolysis, PHP 21,900 for EMS with coordinated interfacility transfer, and PHP 66,140 for cardiac rehabilitation.

These initiatives — focused on rehabilitation, mental health, and cardiac care — were spotlighted during the DOST-PCHRD’s “Talakayang HeaRT Beat” Press Conference on 11 June 2025. Representatives from DOST-PCHRD and PhilHealth presented updates on implementation and usage of the packages developed under PhilHealth STUDIES.

“Through evidence-based health policy reforms, PhilHealth and DOST-PCHRD remain committed to making healthcare more accessible,” said Dr. Montoya. “By expanding support for persons with disabilities and patients with critical health conditions, we reinforce the fundamental belief that quality healthcare should be a right, not a privilege.”

This partnership between DOST and PhilHealth is aimed at providing science-based, innovative, and inclusive solutions across four strategic pillars: human well-being, wealth creation, wealth protection, and sustainability.