Philippine Health Insurance Corp. (PhilHealth) president and CEO Emmanuel R. Ledesma Jr. on Tuesday assured President Ferdinand R. Marcos, Jr. that PhilHealth members and their beneficiaries can expect better and more responsive health benefit packages.
“We have laid down many enhancements which can be felt by beneficiaries,” Ledesma said, adding that this will include lower hospital bills.
Ledesma announced that the 30-percent increase in most of its case rate packages already took effect for all admissions starting Feb. 14, 2024.
This was the first time that an across-the-board increase was implemented since the all case rate scheme was launched in 2013.
He noted that the 30% increase in case rates will restore substantial coverage affected by health inflation.
Ledesma noted that the PhilHealth’s benefit committee has recently approved the enhancement of the Z Benefits for breast cancer effective in March 2024.
He also highlighted that the agency enhanced several benefit packages after 13 years without changes, including: High Risk Pneumonia, from P32,000 to P90,100, or a 182-percent increase; Acute Stroke Ischemia from P28,000 to P76,000, a 171-percent increase; and Acute Stroke Hemorrhagic from P30,000 to P80,000, a 111-percent increase.
He said the Z Benefits package for colon and rectal cancers were also recently enhanced, allowing patients with metachronous colorectal tumor to re-avail of the package for colon and rectal cancer.
Ledesma said PhilHealth also revised the policy on select orthopedic implants, which allowed beneficiaries to avail of a maximum of two Z Benefits packages, regardless of laterality for procedures that were done on different dates, or on the same day, within the same confinement period by patients with single or multiple injuries that requires more than one implant.
In 2023, the PhilHealth Board approved the expansion of its coverage of hemodialysis from 90 to 156 sessions per year. This has increased the annual benefit coverage of patients with Chronic Kidney Disease Stage 5 to P405,600 from P234,000. In 2023, PhilHealth paid a total amount of P17.43 billion for hemodialysis claims alone.
In October last year, it launched the Outpatient Mental Health Package which provides outpatient coverage for general and specialty mental health services for P9,000 and P16,000 per patient annually, respectively. The Agency is partnering with the National Center for Mental Health for the initial implementation of the package and is currently contracting more providers at the grassroots level to make this even more accessible to more than three million Filipinos with mental health conditions.
PhilHealth was able to implement the benefits enhancements despite the suspension of the scheduled adjustment in contribution rate in 2023 from 4 percent to 4.5 percent.
“Our commitment to continuously provide Filipinos with responsive benefit packages remains, as guided by our thrust of “Pinalawak at mga Bagong Benepisyo para sa Mamamayang Filipino,” he added.
For 2024, members have more to expect from PhilHealth. “We will rationalize case rates for bronchial asthma and bacterial sepsis in newborns and COVID-19 inpatient benefits,” said Ledesma. He further said that guidelines for outpatient therapeutic care benefits package for severe acute malnutrition in children aged 5 years old and below and services for physical medicine and rehabilitation will also be expected this year.
Another benefit to look forward to is the enhancement of peritoneal dialysis under the Z Benefits Package.
“This is where the importance of adjusting our contribution rates comes into play. It will generate funds necessary for us to complete our benefit plans, and more importantly to sustain the reforms in the benefit packages,” he stressed.
For 2024, the Agency has allotted some P243 billion to pay for these benefits, P30 billion of which is earmarked for its PhilHealth Konsultasyong Sulit at Tama or Konsulta package. The Konsulta will be further expanded to include treatment for TB, animal bite, malaria and HIV/AIDS. This is in addition to expanding coverage for medicines from the current 21 to 53 through PhilHealth’s Guaranteed and Accessible Medications for Outpatient Treatment or GAMOT.
“We are set to expand access points for these medicines by engaging pharmaceutical service entities to make these essential medicines within reach by our Kababayans needing them,” Ledesma vowed.