PhilHealth set to expand hemodialysis coverage, to 'rationalize' COVID package

Vivienne Gulla, ABS-CBN News

Posted at Feb 15 2023 07:48 PM

MANILA - The Philippine Health Insurance Corporation (PhilHealth) is set to expand this year its coverage for outpatient hemodialysis to 156 sessions from the current 90, according to its President and Chief Executive Officer Emmanuel Ledesma Jr.

PhilHealth’s benefits committee has approved the expanded coverage, and the board is set to tackle the matter before the end of the month.

“This increase in the number of sessions covered is based on standards for adequate dialysis, which requires three 4-hour sessions every week for chronic kidney disease stage 5 patients,” Ledesma said Wednesday.

He added that PhilHealth is providing P270,000 in financial support to patients on peritoneal dialysis, and P600,000 for renal patients qualified under Z Benefits for kidney transplant.

PhilHealth also plans to introduce this year the outpatient benefit package for mental health, and the outpatient package for severe acute malnutrition for children below 5 years old.

Meanwhile, it will review the COVID-19 benefit packages, aiming to “rationalize” particularly the inpatient packages, RT-PCR and rapid antigen tests and isolation packages.

PhilHealth Senior Vice President Dr. Israel Francis Pargas explained that the packages may increase or decrease depending on the new COVID protocols and treatment guidelines.

“In aligning with the new protocols and treatment guidelines, we will also rationalize our benefits. So, ‘yung rationalization could mean, pwedeng madadagdagan, pwede ring mababawasan, depende ito ngayon sa mga magiging bagong protocols and guidelines,” he explained.

“Rest assured when we review everything, we will really have the best interest of the Filipino people at heart... Kung kailangan pagandahin pa, gagawin namin,” Ledesma said.

PhilHealth’s plan to introduce new and expanded benefits comes even as it had to defer the scheduled hike in membership contributions this year, in compliance with the order of President Ferdinand Marcos Jr.

The premium rate for PhilHealth was supposed to increase this year to 4.5 percent from 4 percent, based on Section 10 of the Universal Health Care Act. PhilHealth estimates that it would have earned an additional P17 billion had the hike pushed through.

Despite this, Ledesma assured the public that PhilHealth’s cash flow is “very healthy” and “robust."

“By not increasing the premium by 0.5%, we’re giving up roughly P17 billion. Ma-aabsorb naman ‘yan. Kasi close to P400 billion naman ang cash position, and then we have the monthly contributions coming in, and then very strong net income. So very healthy and robust ang cash flow ng PhilHealth,” he said.

“I think it’s safe to say that at least for this year, the 0.5% for this year, and the 0.5% for next year, if ever again masu-suspend, I think PhilHealth will be okay. Walang problema. So total of two 0.5% increases. As to after that, I guess we’ll have do more pencil pushing. We’ll have to see kung kakayanin pa,” Ledesma added.

“We will not only continue with the benefits, gaganda pa,” he noted.

PhilHealth had said it posted a record net income of P46 billion, as of September 2022. That brought the corporation’s total assets to P394 billion, 13 percent higher than the December 2021 figures.

Asked about its actuarial life, Executive Vice President and Chief Operating Officer Eli Santos said “PhilHealth will definitely last... There is no limit sa life span ng PhilHealth.”

The state health insurer is currently processing outstanding claims amounting to P11.9 billion, and its average turnaround time in payment of claims is 29 days, well within the prescribed 60 days. Ledesma said PhilHealth is in coordination with partner providers to improve payment of claims.

The PhilHealth president noted that he is constantly on the lookout for any wrongdoings in PhilHealth that need to be rectified. 


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