PhilHealth moves to ensure equal access to medical benefits

The Philippine Health Insurance Corp. (PhilHealth) is now conducting a review of its case rate system to ensure patients’ equal access to its benefit packages.

According to PhilHealth acting president and chief executive officer Roy Ferrer, the review is primarily aimed at determining the appropriate levels of support that it should provide to members.

PhilHealth is gearing toward adopting the Diagnostic Related Groups (DRGs) as a primary mode of paying its health care providers, he said.

With DRG, the agency is expecting to further rationalize provider payments based on the economic severity of an illness or condition being claimed for.

Based on case rate system, PhilHealth sets fixed rate for procedures or surgical interventions being reimbursed by the corporation. This is intended to prevent accredited health care facilities and health professionals from over-charging.

Ferrer assured that PhilHealth is initiating reforms that “level the playing field so that both the financially capable and those that are not get equal access in terms of health insurance coverage, and more importantly in terms of equal treatment.”

PhilHealth has a “particular bias for the poor and the underprivileged, but it does not leave out the financially capable and the moneyed just so they have the capacity to avail themselves of health care,” he added.

The official noted that “even the rich can be reduced to impoverishment if a dreaded disease or a mishap come their way.”

“Hence, not one Filipino, regardless of their station in life, should be left behind. The state health insurer is making it a point that financial protection against costly treatments is a basic need of and therefore should be afforded to all,” he added.

In an earlier statement, the Coalition for People’s Right to Health (CPRH) said that rich patients benefit the most from PhilHealth. Of the 10 claims paid by PhilHealth, only six are for most indigent patients.

CPRH claimed that 60 percent of Philippine accredited facilities are privately owned, “hence it is not difficult to piece together the fact that private health institutions and facilities get more out of PhilHealth payments than public facilities.”