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PhilHealth Guarantees Not One Filipino Should Be Left Behind July 11, 2018

The package consists of health screening and assessment, consultation, diagnostics and laboratory procedures such as complete blood count, urinalysis, fecalysis, lipid profile, fasting blood sugar, chest X-ray, sputum microscopy, Oral Glucose Tolerance Test, Papsmear/VIA and ECG; and a complete dose of medicines for disease conditions that include Acute Gastroenteritis, Urinary Tract Infection, Upper Respiratory Tract Infection, low risk pneumonia, asthma, hypertension, and diabetes. These medicines include amoxicillin, co-amoxiclav, co-trimoxazole, erythromycin, ofloxacin, amlodipine, enalapril, metoprolol, among others, and will be made available to beneficiaries in government or private PCB providers, both for the initial and follow-up stages, with a very minimal share of the cost.

Once implemented, at least 70 percent of the Philippine population will benefit from the said outpatient primary care benefit without having to pay additional premium contributions to the program. With such a move, the Philippines will no longer hear of a fellow Filipino who died without seeing a doctor in their lifetime.

Leveling up provider payment mechanisms:

There also is an ongoing review of its case rate system, particularly on the appropriate levels of support that it should provide the members with. As this happens, PhilHealth is gearing towards adopting the Diagnostic Related Groups or DRGs as a primary mode of paying its health care providers. The DRG is expected to further rationalize provider payments based on the economic severity of an illness or condition being claimed for.

But aside from the supply side, PhilHealth also needs to strike a balance in the payment equation by ensuring that patients do not suffer from the unintended inflationary effect of improved level of payments. Hence, the idea of a fixed co-payment is also being vigorously pursued so that patients are properly shielded from unwarranted fees and charges by their hospitals and attending doctors.

The fixed co-payment scheme eliminates the anxiety that every patient has each time they check their hospital bills. It immediately informs them of the amount that they ought to put up in advance, if there is any, thereby eliminating unnecessary stress and animosity at the point of discharge.

And if a qualified patient is in a public facility, the NBB will make it even more a pleasant surprise. (END) (Rey T. Baleña)

Reference: Corporate Affairs Group | Trunkline: 441-7444 loc. 7652 & 7653

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PhilHealth Guarantees Not One Filipino Should Be Left Behind