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PhilHealth's Z Benefits For Catastrophic Illnesses Launched July 3, 2012

TODAY, President Benigno Aquino III and Health Secretary Enrique Ona unveiled the Philippine Health Insurance Corporation's (PhilHealth's) newest package of benefits that will primarily address catastrophic cases.

The package is called 'Z benefit,' for if we were to rank and classify all illnesses from A to Z, those illnesses that push patients into prolonged hospitalization and very expensive treatments would be the last letter or the Z illnesses. These illnesses are what the package will be addressing. The package was developed after almost four months of hospital hopping, consultations, brainstorming, hard work and perseverance.

"We need to aggressively reduce household out-of-pocket health care costs, especially in times of catastrophic illnesses that may or even further push Filipinos into poverty," PhilHeath's President and CEO Dr. Eduardo P. Banzon said.

With this in mind, PhilHealth came up with a benefit that will not just cover hospital expenses, but also ensure totality of care and attainment of better health outcomes.

Initially, the cases identified under the 'Z' benefit are childhood acute lymphocytic leukemia (ALL), breast and prostate cancer. The package costs for the complete treatment of these cases are P210,000 for ALL, and P100,000 each for breast and prostate cancer.

Included in the package are payment for hospital services such as hospital room and board fees, drugs and laboratory exams, operating room and professional fees for the entire course of treatment, including mandatory and other services required per illness.

All eligible PhilHealth members under the Employed Sector, Individually Paying, Lifetime Member Program, Sponsored Program and Overseas Workers Program members including their qualified dependents are entitled to avail of the said benefit.

The No Balance Billing (NBB) or the "walang dagdag bayad" policy is applicable for Sponsored members who will avail of the Z package while fixed co-pay will be applied to non-Sponsored members. The fixed co-pay is an identified amount charged and shouldered by the member on top of the Z package but will not exceed the benefit payment being paid for by PhilHealth.

"We also want to protect our non-Sponsored members against possibly high fees for treatment of type Z diseases that is why we forged ties with our partner providers to ensure proper and strict implementation of the fixed co-pay," Banzon said.

PhilHealth has initially partnered with selected reference and contracted government hospitals nationwide to provide the Z benefits. Reference hospitals provide technical services such as the development of a registry hub called the Z Benefit Information Tracking System or the ZBITS that contains patient information and monitors the registered Type Z cases, costing and acquiring of agreed mandatory services as well as in the setting of standards of care. On the other hand, contracted hospitals are any level 3 and 4 hospitals that have signed the performance commitment and contract to provide total quality care for the Type Z conditions.

Among the reference hospitals that have committed to provide the Z benefits are the Philippine Children's Medical Center in Quezon City for the treatment of ALL; Jose R. Reyes Memorial Medical Center in Manila for Breast Cancer; and National Kidney and Transplant Institute in Quezon City for Prostate Cancer. About 19 government hospitals have already been contracted by PhilHealth nationwide.

The Z benefit shall be paid directly to the references hospital thus PhilHealth members will have their benefit automatically deducted from their total hospital bill.

ln addition to these cancers, other diseases where Z benefit packages had been developed or are being developed include end-stage renal disease and congenital cardiac diseases.

"Better benefits come with quality service. We want to lessen the burden of our members afflicted with catastrophic diseases by improving not just the benefits but also ensure hassle-free availment," Banzon said.

"Every Filipino has the right to have a better and complete medical treatment so they can fight and continue living. It is not proper to deprive them of what is due them. Z is not a benefit per se nor is it the end, but the beginning of a new standard in providing quality health care," he added. (END)

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