On lowering out-of-pocket expense in healthcare

In keeping with PhilHealth’s commitment to the Universal Health Care (UHC) program, the agency, through the leadership of our president and CEO Emmanuel R. Ledesma Jr., has been working tirelessly to expand the health insurance coverage of all members, especially those in the marginalized sectors.

With the support of the PhilHealth Board, we have made significant strides in providing Filipinos with adequate financial protection against health risks by enhancing the existing benefit packages, with special focus on the most burdensome diseases in the country. As of this writing, six out of the 10 identified conditions have been enhanced by leaps and bounds. These are the case rates for high-risk pneumonia, acute stroke, chronic kidney disease, bronchial asthma, neonatal sepsis, and ischemic heart disease.

To keep up with medical inflation, PhilHealth also increased the rest of more than 9,000 case rates packages by 30 percent. Another 30 to 50 percent increase is expected to be implemented before the end of November this year. This on top of the 1,400 percent increase in our breast cancer package from P100,000 to up to P1.4 million, and the introduction of outpatient packages for mental health and therapeutic care for severe acute malnutrition for children below five years, two of the most pressing health issues affecting Filipinos today.

Work on the rest of the packages and other priorities in the Board-approved benefit plan, and even those that have been raised during recent hearings in Congress are well within the timetable as committed by PCEO Ledesma. We are collaborating with patient groups, health experts and healthcare providers to ensure affordable and accessible healthcare benefits for all Filipinos.

These enhancements in the benefits are being carried out aggressively at an unprecedented speed and will very soon translate to lower out-of-pocket expense if not totally without co-payment as envisioned in the Universal Health Care Act. The heightening of public awareness on these efforts will surely encourage more and more patients to seek treatment, knowing that PhilHealth has their back.

On claims payments

From January to end September this year, PhilHealth paid a total of P117.6 billion in claims to both government and private facilities, which is P25.4 billion or 27 percent higher compared to the same period last year, with a turnaround time of 24 days on average. As of this writing, we are releasing weekly payments at an average of P4.2 billion for the month of October.

The consistent flow of payments for good claims at a quicker TAT (36 days faster than the 60 days prescribed under the law) are among the welcome developments that numerous healthcare providers from different regions have duly acknowledged and commended.

To help lower, if not avoid, the incidence of returned and denied claims, we are constantly reaching out to our partner health facilities to educate them on common pitfalls that affect health insurance reimbursements. Through the PhilHealth Financial Management Reporting and Enhancement Program (PFinMaREP), we conduct claims reconciliation efforts between the health facilities and PhilHealth accounting offices to reconcile our claims records so we are both looking at a single source of truth. As of now, claims reconciliation process has already reached 75 percent of the target health facilities nationwide. As stewards of the people’s fund, we take great pains in conducting these initiatives as part of our due diligence and prudence in the management of members’ contributions.

REY T. BALEÑA

Acting vice president, Corporate Affairs Group, Philippine Health Insurance Corp.