PhilHealth mulls higher benefit package for kidney transplant

MANILA, Philippines — A higher Philippine Health Insurance benefit package may soon be provided to kidney transplant patients as the PhilHealth benefits committee, led by Health Secretary Ted Herbosa, met Wednesday to discuss ways of improving this service.

Herbosa reported that the committee carefully considered how to increase the PhilHealth benefit packages for kidney transplantation and the services needed after a patient undergoes the life-saving treatment.

“The gold standard of treatment for patients with end-stage renal disease is still a kidney transplant or KT. Post-KT patients have a better quality of life and are more productive than those kept on hemodialysis,” Herbosa said.

He noted that the costs of KT and post-KT care are less expensive when compared to life-long hemodialysis.

“We are improving these benefits together with prevention of diabetes and hypertension at primary care so that we won’t get kidney patients to begin with,” Herbosa said.

Since its launching in 2012, the PhilHealth benefit package for KT has remained at P600,000.

Under the Universal Health Care Act, PhilHealth is mandated to shift to paying healthcare providers in advance, using diagnosis-related groupings to account for additional patient characteristics, apart from medical diagnoses and procedures performed during the episode of care.

The current PhilHealth All Case Rates system pays only for the top two most resource-intensive diagnoses or procedures, even if a patient has more than two conditions or needs more than two treatments at the same time.

Herbosa said the payment mechanism is now under review by the committee.

“Having been a practicing trauma surgeon myself, I know how frustrating it is for both hospital patients and their doctors that today’s PhilHealth pays only for the top two conditions or procedures and nothing more. PhilHealth should pay more, so that families will pay less out of pocket,” Herbosa said.