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Monday, December 4, 2023

PhilHealth adjusting rates of benefit packages in 2024 to expand coverage

The Philippine Health Insurance Corp. (PhilHealth) said Monday 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. Dapat ramdam ng mga kababayan natin ang benepisyo nila sa PhilHealth,” 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. This is expected to reduce out-of-pocket expenses of patients during hospitalization and in the availment of PhilHealth benefits for outpatient care.

PhilHealth said to minimize untoward inflationary effects after rate adjustments, 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.

It said that in 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. 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.

PhilHealth said that in 2023, it implemented the expansion of dialysis coverage to 156 sessions from the 90 sessions. It also rationalized the rates for conditions mostly availed of among Filipinos. Recently, it released Circular 2023-0021 to increase the coverage for ischemic stroke from P28,000 to P76,000, and hemorrhagic stroke from P38,000 to P80,000. It is set to release a circular before year-end to widen its coverage for pneumonia high-risk from P32,000 to 90,100.

The state health insurer also launched its outpatient mental health package in mid-October and will soon launch a package for severe acute malnutrition. It also started to enhance its various Z benefits packages.

Z Benefits for breast cancer will also be expanded in 2024 to include coverage of targeted therapy of up to P1 million per patient per year.

“PhilHealth will continue to respond to Filipinos’ needs in line with President Ferdinand Marcos Jr.’s 10-point agenda, especially in the area of affordable and universal health care for all Filipinos,” Ledesma said.

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