PhilHealth to hike benefit packages next year

THE Philippine Health Insurance Corporation (PhilHealth) is set to adjust the rates of most of its benefit packages for its members, president and chief executive officer Emmanuel Ledesma said yesterday.

In a statement, Ledesma said the financial coverage for Filipinos’ healthcare expenses year “are likely to increase to a maximum of 30 percent across all cases.”

Ledesma said the move “is expected to lower out-of-pocket expenses of patients during hospitalization and in the availment of PhilHealth benefits for outpatient care.”

“It is about time that PhilHealth adjusts its rates… We want our members to be able to feel the value of their benefits,” he said.

Ledesma said PhilHealth will adopt a variable inflation adjustment across all types of health facilities, which means that “higher-level facilities shall get higher adjustments in rates up to a maximum of 30 percent.”

The official also said that PhilHealth shall prescribe a cost-sharing mechanism, wherein health facilities and the members will have fixed co-payment rates on top of what is being paid for by PhilHealth as the insurer.

“This will be our way of controlling healthcare costs, by making member’s expenses predictable, and by discouraging irrational use of healthcare services among facilities,” said Ledesma.

The planned fine-tuning of the case rates next year follows the expansion of dialysis coverage to 156 sessions, from the previous 90 sessions, beginning 2023.

It will also come after PhilHealth approved an increased coverage for ischemic stroke from P28,000 to P76,000; and hemorrhagic stroke from P38,000 to P80,000.

PhilHealth is also set to release a circular before year-end to widen its coverage for pneumonia high-risk from P32,000 to 90,100.

The PhilHealth chief said the planned benefit rate adjustment is aimed at helping members cope with the increasing costs of medical care in the country.

“The adjustment is prompted by the increasing costs of healthcare in the country brought about by inflation,” he said, noting that most of the case rates were established way back in 2013, when the state-run health insurer first implemented the case rate payment system.

Under the said system, PhilHealth