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Monday, May 20, 2024

PhilHealth rate hike to go thru sans new law

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Premium contributions for the Philippine Health Insurance Corp. (PhilHealth) are set to increase next year after two previous hikeswere postponed by President Marcos and his predecessor, Rodrigo Duterte.

Rey Balena, acting VP of PhiHealth corporate affairs group, said the next increase in premium contributions is set in 2024 in accordance with the Universal Healthcare Law.

“If that law won’t be amended, we will fulfill it because we promised to implement it (UHC Law),” Balena said in a TeleRadyo Serbisyo interview.

Based on the schedule, the contribution rate from the public will increase to 5 percent with the ceiling set at P100,000. The current contribution rate is at 4 percent.

The official said that even before the PhilHealth increase, the stateinsurer already implemented enhancements in its coverage plan, including the expansion of hemodialysis sessions from 90 sessions to 156 sessions and a 100-percent increase in coverage for acute stroke patients.

Last week, PhilHealth also said it will adjust the rates of most of its benefit packages in 2024, which will result in increased financial coverage for Filipinos’ hospitalization expenses.

It said the adjustment is in response to the increasing costs of healthcare in the country brought about by inflation.

The state insurer first implemented the case rate payment system in 2013 when it reimbursed a fixed amount for a specific medical condition or surgical case.

“It is about time that PhilHealth adjusts its rates in order for our members to cope with the increasing cost of medical care. We want our members to feel the value of their benefits which translates to meaningful financial risk protection,” said PhilHealth president and chief executive Emmanuel Ledesma Jr.

The case rates are likely to increase to a maximum of 30 percent across all cases, it said. This is expected to reduce out-of-pocket expenses of patients during hospitalization and in availing PhilHealth benefits for outpatient care.

To minimize untoward inflationary effects after rate adjustments, PhilHealth said it would prescribe a cost-sharing mechanism where health facilities and the members would have fixed co-payment rates on top of what is being paid for by PhilHealth as the insurer.

This way, health facilities would be more efficient in the use of resources to achieve desired health outcomes, while members could predict how much they should pay for amenities and other extra services availed of beyond those provided in basic or ward accommodations, it added.

Other strategies to control the untoward effects of this adjustment include measures to prevent insurance fraud and doctor moral hazard.

“This will be our way of controlling healthcare costs, in making member’s expenses predictable, and in discouraging irrational use of healthcare services among facilities,” said Ledesma. PhilHealth said it would adopt a variable inflation adjustment across types of health facilities, which means that higher-level facilities would get higher adjustments in rates up to a maximum of 30 percent.

The upward adjustment in case rates is on top of the ongoing benefit expansion and rationalization that was already approved by the PhilHealth board. With Macon Ramos-Araneta


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