Philhealth benefit payments seen up by P10 billion

THE Philippine Health Insurance Corp. (Philhealth) said it expects to post a P10-billion increase in total benefit payments to members and dependents this year.

“We’re on track to delivering between P44 billion to P47 billion worth of benefits this year, or 30 percent greater than the P34 billion we paid in 2011,” said Philhealth president and chief executive officer Dr. Eduardo Banzon.

Banzon said Philhealth has already distributed approximately P32 billion in cumulative benefits from January to September this year, up by P8 billion, or 33 percent, versus the P24 billion dispensed over the same nine-month period in 2011.

“Since August this year, we’ve already averaged nearly P1 billion in benefit payments every week,” he said.

Banzon attributed the huge increase in benefit payments to new and improved subsidies to multiple medical cases, plus expanded coverage as a result of more members and dependents enlisted.

The Philhealth board chaired by Health Secretary Enrique Ona has approved the launch of large benefit packs for catastrophic ailments affecting a growing number of members and dependents, including P600,000 for low-risk, end-stage renal disease requiring a kidney transplant; P210,000 for standard-risk childhood leukemia; P100,000 for early stage breast cancer; and P100,000 for low- to intermediate-risk prostate cancer.

Philhealth also introduced an P11,000-case rate payment for leptospirosis, the most common disease transmitted to people from animals, mainly rats; and a P3,000-Animal Bite Pack for rabies post-exposure prophylaxis.

These are on top of existing case rate payments for several medical conditions, including P38,000 for cerebro-vascular accident with hemorrhage; P32,000 for high-risk pneumonia; P28,000 for cerebral infraction; P16,000 for dengue hemorrhagic fever (DHF) with presence of shock; P15,000 for moderate-risk pneumonia; P14,000 for typhoid fever; P9,000 for essential hypertension; P9,000 for asthma; P8,000 for dengue fever or simple DHF; and P6,000 for acute gastroenteritis.

The payments cover the full cost of treatment, hospitalization and professional fees.

Philhealth has also enlisted as members some 5.2 million of the country’s poorest families listed under the Department of Social Welfare Department’s National Household Targeting System for Poverty Reduction (NHTS-PR). The number includes all families receiving conditional cash transfers.

They have been enrolled under Philhealth’s Sponsored Program, with their premiums paid for by the national government.

Philhealth has also enlisted another five million disadvantaged families not covered by the NHTS-PR. Their premiums have been subsidized by their local governments.

Those under the sponsored program, considered the most financially vulnerable, are entitled to Philhealth’s No Balance Billing Policy. Should they avail of any of the medical or surgical case rate packs, they check out of the hospital or outpatient service provider without paying a single centavo out of their own pockets.

Last summer, Philhealth began hiring and deploying 530 nurses to provide “personalized customer care” to members and dependents at point-of-service — in hospitals where they seek treatment.

They form part of Philhealth’s Customer Assistance, Relations and Empowerment Staff (CARES), and receive around P15,000 monthly plus health insurance.

Philhealth helps pay for the room and board, medicines, laboratory exams, as well as operating room and professional fees for each hospital confinement of not less than 24 hours of every member, his/her spouse and other dependents.

It also pays for outpatient services, including P30,000 annually for the anti-retroviral therapy of human immunodeficiency virus (HIV)-positive members and dependents; the six-month Directly Observed Treatment Short Course for tuberculosis; dialysis; radiotherapy; and day surgeries.

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