PhilHealth evaluating fixed rate payments

Philippine Health Insurance Corporation (PhilHealth) officials will evaluate the newly implemented fixed case rate payment policy in February amid criticisms that the new policy limits the subsidy of PhilHealth as the burden of payment is transferred to the patient.

Dr. Rey B. Aquino, Philhealth CEO and president, said that since its implementation in September, the Philhealth board has agreed to monitor and discuss the effect of the new payment procedure.

“We are monitoring on a monthly basis since we implemented it last September 1. In February, we are going to sit together and look at the prices if we need to adjust them,” Aquino said in a phone interview.

“We are willing to increase if there is a need,” Aquino said.

The case-rate payment came under fire as private hospitals warned that members may need to pay the fee in excess of the amount covered by PhilHealth.

Since September 1, PhilHealth applied the case rate payment in 11 medical and 12 surgical cases in all accredited healthcare institutions nationwide.

The new policy provides a fixed limit to the following medical conditions: Dengue 1 – P8,000; Dengue 2 – P16,000; Pneumonia 1 P15,000; Pneumonia 2 – P32,000; Essential hypertension – P9,000; Cerebral Infarction – P28,000; Cerebro-vascular accident with hemorrhage – P38,000; Acute gastroenteritis – P6,000; Asthma – P9,000; Typhoid fever – P14,000; Newborn care package in hospitals and lying-in clinics P1,750.

For surgical procedures, the case payment rates are: Radiotherapy - P3,000; Hemodialysis - P4,000 per session; Maternity care package – P8,000; Normal spontaneous delivery package in level 1 hospitals – P8,000; normal spontaneous delivery package in levels 2 to 4 hospitals – P6,500; Caesarian section –P19,000; Appendectomy – P24,000; Cholecystectomy – P31,000.

According to Aquino, they based the computation of their case-payment rates on the amount of subsidy for the above-mentioned diseases recorded over a number of years.

The PhilHealth official said they are adjusting their rates based on updated prices of medical services.

For instance, he said, Philhealth used to subsidize only P4,500 for normal delivery.

By JENNY F. MANONGDO
Manila Bulletin

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