Payments for COVID-19-related claims reach P16.7 billion – PhilHealth

MANILA, Philippines — Total reimbursements for COVID-19-related claims last year reached over P16 billion, according to the state health insurer.

The claims amounting to P16.7 billion include payments for inpatient care, COVID-19 testing, services and supplies for testing provided by the laboratory, isolation measures, community isolation package and home isolation package, the Philippine Health Insurance Corp. (PhilHealth) said.

Inpatient care comprised the bulk of total payments, at 88 percent or P14.6 billion for 72,511 claims.

This included critical pneumonia, adult and pediatric (P5 billion); severe pneumonia, adult and pediatric (P4.5 billion); moderate pneumonia (P4 billion); mild pneumonia, elderly or with comorbidities (P685 million).

Also under inpatient care are the full financial risk protection for health workers (P336 million), intermediate package, severe and critical pneumonia (P2.8 million) and intermediate package, moderate pneumonia (P2.3 million).

For COVID-19 testing, PhilHealth reimbursed P1.97 billion representing 852,779 claims, which is 12 percent of the total amount.

Testing services and supplies provided by the laboratory reached P1.4 billion; test kits donated to the laboratoryn P405 million; test kits donated to the laboratory, cost of running the laboratory as well as RT-PCR machine for testing subsidized by the government, P61 million; services and supplies procured and provided by the testing laboratory, P98 million; PCR cartridges donated to the testing laboratory, P11.9 million; PCR cartridges donated to the testing laboratory, cost of running cartridge-based PCR test subsidized by the government, P7.3 million and facility-based COVID-19 rapid antigen test, P1.6 million.

PhilHealth reimbursed P86.6 million (4,208 claims) for isolation measures.

Under the community isolation package, PhilHealth reimbursed P81.68 million for 3,643 claims. Admissions referred to ICU from higher-level facilities for step-down care amounted to P2.17 million, with 97 claims.

For the COVID-19 home isolation package, PhilHealth reimbursed P2.76 million for 468 claims.

More than two weeks ago, PhilHealth announced plans this year to rationalize case rates for various conditions, including COVID-19 inpatient benefits.