PhilHealth rate hike to fund more treatments

THE Philippine Health Insurance Corp. (PhilHealth) said it plans to cover new treatments after the planned hike in its member contribution rates.

The state-run health insurer said in a statement that it will come out with guidelines soon for outpatient therapeutic care benefits packages for severe acute malnutrition in children aged five years and below, as well as services for physical medicine and rehabilitation.

PhilHealth will also enhance its coverage for peritoneal dialysis under the Z Benefits Package.

“We will rationalize case rates for bronchial asthma and bacterial sepsis in newborns and COVID-19 inpatient benefits,” PhilHealth President and Chief Executive Officer Emmanuel R. Ledesma said on Tuesday.

“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,” Mr. Ledesma said.

PhilHealth said it allotted about P243 billion to pay for these benefits, P30 billion of which will be for the PhilHealth Konsultasyong Sulit at Tama or Konsulta package.

The package will be expanded to include treatment of tuberculosis, animal bites, malaria, and human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS).

PhilHealth will also be expanding its list of covered medicine to 53 from 21 through the Guaranteed and Accessible Medications for Outpatient Treatment.

“We are set to expand access points for these medicines by engaging pharmaceutical service entities to make these essential medicines within reach,” Mr. Ledesma said.

PhilHealth said it is seeking to comply with a presidential directive to increase the value of coverage to match the recent increase in contribution.

Under Republic Act No. 1123 or the Universal Health Care law, PhilHealth premium contributions should have increased by half a percentage point yearly starting 2021 until they reach 5% by 2024. The hikes were suspended due to the pandemic.

“We’ve started on the improvement of our benefits last year, and we will continue it this 2024. We have a lot of planned enhancements that will be felt by members due to the lower cost of hospitalization, if not no cost,” Mr. Ledesma said. —