PhilHealth gears up for new payment scheme

CEBU, Philippines - The Philippine Health Insurance Corporation (PhilHealth) is set to orient officials of government health care facilities as part of their preparation in adopting changes and implementing a new payment scheme.

During the Association of Government Information Officers (AGIO)-7 forum, Lawyer Karisma Agraviador, Pulic Relations Officer of Philhealth, explained that this new program benefits all members, providers and the corporation as it is much simpler to administer is potentially more transparent in terms of prices for interventions.

She said better member appreciation and faster reimbursement of fees to health care providers were also among the major considerations for introducing this new type of provider payment scheme prompting them to adopt the shift from fee-for-service to case rate.

Agraviador said the new system will keep members within the PhilHealth system as well as encourage prospective members to join the social health insurance fund.

Through the new mechanism, members will be able to predict how much PhilHealth would be paying for each of the services provided.

Under the new case rates, reimbursement rates for all cases are specified as:

• medical, dengue 1 (dengue fever and DHF Grades I & II) P8,000

• dengue II (DHF Grades III & IV) P16,000

• pneumonia I (moderate risk) P15,000

• pneumonia II (high risk) P32,000

• essential hypertension P9,000

• cerebral infarction (CVA I) P28,000

• cerebro-vascular accident (hemorrhage) (CVA II) P38,000

• acute gastroenteritis (AGE) P6,000

• Asthma P9,000

• typhoid fever P14,000

• care package in Hospitals and lying-in clinics P1,750.

For surgical cases:

• radiotherapy P3,000

•hemodilaysis P4,000

•maternity care package (MCP) P8,000

•NSD package in level 1 hospitals P8,000

•NSD package in levels 2 and 4 hospitals P6,500

•caesarian section P19,000

•appendectomy P24,000

•cholecystectomy P31,000

•dilatation and curettage P11,000

•thyroidectomy P31,000

•herniorrhaphy P21,000

•mastectomy P22,000

•hysterectomy P30,000

•cataract surgery P16,000.

In addition to case rate payments and with government’s thrust to attain Universal Health Coverage in 3 years by providing optimal financial risk protection for all its members, they adopted a “No Balance Billing” policy (NBB) for the most common medical and surgical conditions.

This new policy applies to all PhilHealth Sponsored Program members and their dependents for the specified cases and as long as the patient is admitted to government facilities or hospitals.

Agraviador said, this new policy means that no other fees or expenses shall be charged or paid for by the patient-member based on the mentioned package rates. (FREEMAN)