President PNoy leads launch of PhilHealth's prosthesis benefit package and new provider payment mechanism November 12, 2013

President Benigno Aquino III and Health Secretary Enrique Ona recently led the launching of PhilHealth's new benefit package for lower limb prosthesis and various enhancements in services including a complete shift in the way it pays claims of its engaged health care providers.

The President launched the Z-MORPH or the Mobility, Orthosis, Rehabilitation, Prosthesis Help which aims to benefit persons with disabilities with lost or deficient limbs. It is the latest addition to its Z Package for certain catastrophic cases. The move is in support of government initiatives to protect the interest and well being of Persons with Disability (PWD).

"We recognize the equal right of every person with disability to live a productive and normal life by providing them benefits coverage for quality prosthetic services," PhilHealth President and CEO Alexander A. Padilla announced during the ceremony.

The Z-MORPH covers initial fitting of external lower limb prosthesis at a package rate of P15,000 per limb or P30,000 for both limbs for the entire pre and post-prosthetic management of either the foot, symes and ankle or below knee levels of amputation.

Eligible members and their qualified dependents can initially avail of the benefit at the University of the East Ramon Magsaysay Medical Center, Philippine Orthopedic Center and Philippine General Hospital, being among the institutions that possess expertise and capability in setting and providing standard care in the management of limb prosthesis.

The Z Package was introduced in 2012 to realize better health outcomes and provide true financial risk protection for PhilHealth members faced with medically and financially catastrophic conditions. Among those already covered are kidney transplant for P600,000; Coronary Artery Bypass for P550,000; and Surgery for Tetralogy of fallot for P320,000.

The PhilHealth Chief also announced PhilHealth’s complete shift from the traditional Fee-for-Service (FFS) to case-based payment system for all compensable medical and surgical cases.

"The successful implementation of case-based payment for the initial 23 common medical and surgical cases in 2011 led to this shift, which aims to contain costs without sacrificing the quality of care that members deserve to receive from their health care providers", Padilla said.

With the new payment scheme which is accepted internationally, PhilHealth will now pay a pre-determined amount for all compensable treatments and procedures. Since its inception and even during the Medicare era, PhilHealth reimbursed its members using the FFS wherein providers are paid for each unit service they provide the patients.

The FFS is prone to abuse as it can lead to prolonged hospital stays and over utilization and unnecessary use of services, among others.

The complete shift will also enable members to immediately and easily know how much benefits PhilHealth will pay for a specific disease whether in government or private hospitals.

"With this our engaged hospitals can also expect faster and efficient reimbursement as this will greatly reduce turn-around-time of claims processing," Padilla said.

Padilla also reminded all indigent members that the “No Balance Billing” Policy is still applicable in the availment of all medical and surgical conditions that they are to avail of. “We reiterate that indigent members of PhilHealth need not pay a single centavo when admitted in government hospitals” Padilla stressed. (END)