PhilHealth scraps ‘single period of confinement’ rule

MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) board has decided to abolish the “single period of confinement” (SPC) rule, a policy that states that admissions and re-admissions due to the same illness within a 90-calendar day period shall be entitled to the benefit only once.

PhilHealth spokesman Israel Pargas said the meeting conducted by the board last Friday resulted in the scrapping of the SPC.

“(The board en banc) approved the lifting of the SPC to align with the provisions of the Universal Health Care law,” Pargas said in a Viber message.

The PhilHealth official emphasized that even with the decision, it is important that quality health care to patients is ensured.

“Control measures should be in place to ensure that quality care is given to all members and to prevent possible abuse,” he said.

He added that the lifting of the SPC would provide members immediate eligibility to program benefits.

“Members will get benefits if re-admitted or reconfined for the same illness within 90 days,” Pargas said. “These patients admitted for similar illness will be paid now, unlike before.”

PhilHealth said the date of effectivity would be confirmed upon the issuance of a circular.

A week ago, the PhilHealth board’s benefits committee, chaired by Health Secretary Ted Herbosa, decided in a special meeting to recommend to the board the removal of the SPC rule on its case rates.

The agency’s SPC rule has denied 26,750 claims in 2023 alone, according to the Department of Health. These cases usually include acute gastroenteritis, urinary tract infection, chronic kidney disease and community-acquired pneumonia.

During a hearing of the Senate committee on health on Sept. 10, PhilHealth president and chief executive officer Emmanuel Ledesma Jr. said they would scrap the rule before the “end of the month (September).”

Ledesma also said PhilHealth plans to subject most of its benefit packages to another round of 30-percent increase in November.