In 2023 has been a fruitful year for Philhealth. Even without an increase in premium contribution PHILHEALTH were able to implement enhancement in benefits aligned with the commitment of the government of Pinalawak at mga Bagong Benepisyo para sa Mamayang Pilipino.
BENEFIT ENHANCEMENTS
- Philhealth Institutionalized the coverage of hemodialysis to 156 sessions per year from 90 sessions. Many Filipinos, especially those Filipinos suffering from Chronic Kidney Diseases Stage 5, lauded this move.
- Philheallth rationalized the most common cases being availed of by patients in the country, significantly increased coverage for stroke, both ischemic and hemorrhagic, and
- High-risk pneumonia.
On average, these three (3 ) benefits package have increased by about 150%.
They also plan to rationalize six (6) other case rate for the top cases or the most burdensome diseases and commonly availed cases among Filipinos. This is in accordance to benefit plan in the next two years starting 2024.
On top of that, Philhealth is looking in reviewing all case rate in 2024. This is prompted by the increasing costs of healthcare in the country brought about by inflation. This move is expected to greatly lower out-of pocket expenses of patient during hospitalization and outpatient care.
ON PHILHEALTH KONSULTA
More than the inpatient care, the government believes in strengthening primary care in the country to support a person’s health needs through prevention and condition management.
Ang Philhealth ay patuloy na tatayta sa kalusugan ng bawat Pilipino, kung kaya pinapalakas at pinagbubuti pa ang Philhealth Konsulta Package. Ngayon Taon, ang budget allocation para sa Konsultan Package ay 30 Bilyon Piso, Layunin ng Philhalth na ang bawat Pilipino at matingnan ng mga healthcare professional at mabigyan ng serbisyo at gamot na kinakailangan.
Talking about the medicines, Philhealth already published the guidelines for the implementation of PhilHealth GAMOT or the outpatient Drug Benefits which will improve our coverage of outpatient medicines. The package increases the initial 21 medications covered by the Konsulta program to include an additional 32 other commonly prescribed outpatient medicines. This will bring Philhealth’s coverage to a toal of 53 outpatient medicatons, raging from regiments covering infections up to maintenance medications for non-communicable diseases.
ON CLAIMS PAYMENT
As of December 31, 2023, Philhealth paid a total 45.1 billion pesos to partners health facilities, both private and government, between the months of August and December of 2023despite the cybersecurity issue in September. The situation has impacted the stakeholders’ receivables in the month of September and October, but Philhealth was able to release payment of more than 12 billion pesos in August and more that 10 billion pesos in November. They bounced back in capacity to process payables and even exceeded the commitment to settle their obligation with partners facilities in 90 days.
They appeal to partner health facilities to submit good claims and comply the policies to avoid return or denied claims for they are bound by auditing rules and regulation of the government. Philhealth assures partners that their doors are always open for communication and reconciliation of claims records.
To move forward, Philhealth plan to implement the following initiatives to address the bottlenecks in claims processing. The immediate solution is to implement the claims system override support or SOS this month. Within the year, they are geared to launch various modules such as the cloud base application systems deployment, online filing for claims on motion for recommendation, adjustment module, to name a few. By 2025, as part of the long-term solution, they intent to deploy automated e-claims submission and processing via cloud base application system.
IMPLEMENTATION OF 5% PREMIUM RATE, JANUARY 1, 2024
Philhealth need to continue strengthening it funds and to be able to sustain these benefits enhancement. As provided for in section 10 of Republic Act 11223 or the Universal Health Care Act, Philhealth shall implement the last adjustment of premium contribution or the 5% contribution rate and income ceiling of P100,000.00 this year.
As a key implementer of the UHC Law and one that administer the implementation of the National Health Insurance Program under the National Health Insurance Act of 2013. Philhealth is bound to implement with what was mandated; otherwise, Philhealth will be remiss in its duty to the Filipino people that the lawn intends to serve and benefit from.
The law also prescribed that every increase in the rate of contribution, Philhealth shall provide for a corresponding increase in benefits.
Nitong nakalipas na mga lingo, bagamat nasa batas ang pagpapatupad ng premium adjustment, minabuti ng Philheslth na makipag-ugnayan sa ibat-ibang partners at stakeholders upang magkatuwang na ipatupad ang kahuli-hulihang rate adjustment sa contribution ayon sa UHC Law, at para siguraduhin magtutulo-tuloy ang mga pinagbuting benepisyo sa mga miyenbro.
At present, Philhealth financial position remains strong and robust and commit to fund the proposed rationalization and expansion of benefits to ease the burden of the Filipino people in times of medical need and lessen the out-of-pocket expenses of members.
Phlhealth remains committed to continuously enhance and expand the benefit packages, consistent with the mandate of UHC Law to provide every Filipino with equitable access to quality and affordable health care and good services, ensure quality health out comes and protected against financial risk.
