DOST at PhilHealth layong gawing mas abot-kaya ang mga health benefit packages at serbisyo sa mga Pilipino
Upang mas mapalawak pa ang saklaw ng de-kalidad na serbisyong pangkalusugan sa mas maraming Pilipino, ibinida ng Department of Science and Technology – Philippine Council for Health Research and Development (DOST-PCHRD), kasama ang Philippine Health Insurance Corporation (PhilHealth), ang tatlong research initiatives sa Talakayang HeaRT Beat noong 29 Mayo 2024 sa Quezon City.
“In advancing health science initiatives, we invest in building stronger and healthier Filipino communities. We at the DOST remain dedicated in supporting the research needs of PhilHealth to sustain the implementation of healthcare policies that are inclusive and attuned to the needs of our people” [sa wikang Filipino: Sa pagsusulongng mga programa sa agham pangkalusugan, namumuhunan kami sa pagbuo ng mas malakas at malusog na komunidad. Kami sa DOST ay nananatiling nakatuon sa pagsuporta sa mga pangangailangan sa pananaliksik ng PhilHealth upang mapanatili ang pagpapatupad ng mga patakaran sa pangangalagang pangkalusugan na saklaw at naaayon sa mga pangangailangan ng ating mga kababayan] ani Dr. Renato U. Solidum, Jr., Kalihim ng DOST.
Sa pangunguna ni Dr. Corazon Ngelangel ng Unibersidad ng Pilipinas Manila (UP Manila), iminungkahi ng pag-aaral na may pamagat na “Protecting Against Financial Catastrophe: Evaluation of the Z Benefits in Providing Financial Risk Protection and Improving Clinical Outcomes,” ang pagpapalawak ng Z Benefit Package paramapabilang ang mas maraming uri ng sakit at mapalawak ang saklaw na kritikal na sakit, maisama ang tinatawag na “quality of life measures” sa mga pagsusuri ng mga pasyente, at paigtingin ang pagpapalaganap ng impormasyon ukol dito sa mga pasyente at healthcare provider.
Upang gawing mas simple ang reimbursement para sa inpatient care, inilunsad ng PhilHealth ang All Case Rates (ACR), isang patakaran na sinimulan noong 2013. Ito ay bunga ng proyektong “All Case Rates Review and Assessment,” na pinangunahan ni Dr. Fernando Garcia ng UP Manila. Base sa kanilang pag-aaral, bumaba ang bilang ng mga benepisyaryo ng PhilHealth na indigent members at patuloy na tumataas ang claims mula sa informal economy at sponsored beneficiaries, kaya’t ipinatupad ang ACR.
Ayon sa project team, ang pagbaba ng pagpaparehistro ng miyembro, lalo na sa indigent population, ay isang malaking hadlang sa pagtatamo ng adhikaing universal coverage. Bukod dito, ang mga isyu sa pagberipika ng status ng pagiging miyembro aynagdudulot duda sa integridad ng sistema.
Ipinarating naman ng proyektong “Development of a Diagnosis Related Group-System Based Global Budget Payment Mechanism,” na pinangunahan ni Dr. Karlo Paredes ngAlliance for Improving Health Outcomes, Inc. (AIHO) ang pangangailangang palitan ang sistemang provider payment for inpatient care ng Diagnosis Related Group (DRG)-system based Global Budget Payment (GBP), kung saan case-based angsistema base sa clinical variable. Ito ay iminungkahi ng project team dahil sa mga nakitang kakulangan sa kasalukuyang ACR reimbursement system.
Ang tatlong proyektong ito ay bunga ng patuloy na pagtutulungan ng DOST-PCHRD at PhilHealth mula pa noong 2015 sa pamamagitan ng programang tinatawag na PhilHealth STUDIES (Supporting the Thrust for UHC through Data, Information, andKnowledge-Exchange Systems) Program, na nagbibigay ng pondo para sa mga proyektong pananaliksik at iba pang kaugnay na gawain na naaayon sa PhilHealth Research Agenda.
Nagpahayag ng pagpapahalaga si Dr. Edwin M. Oriña ng PhilHealth Corporation sa magkatuwang na proyekto ng DOST-PCHRD at Philhealth. Kanyang tinuran “Nais ko pong pasalamatan ang DOST-PCHRD, sa kanilang pakikipagtulungan para maibigay ang benepisyong pangkalusugang sapat at de-kalidad para sa lahat,” sa kanyang mensahe.
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PhilHealth Enhanced Benefits for Neonatal Sepsis, Bronchial Asthma and Konsulta Package
Good afternoon! I would like to thank you all for attending today’s PhilHealth Kapihan with Media. In our previous press conferences, we usually mention PhilHealth’s plans to enhance the benefit packages. True to this commitment, we are pleased to inform you that we have just enhanced two more health benefits in order to alleviate the burden of members on these burdensome conditions.
Effective May 1 of this year, the benefit package for neonatal sepsis is now P25,793 from P11,700 or an increase of 120%. We have also increased our coverage for bronchial asthma in acute exacerbation from P9,000 to P22,488, a jump of 150%.
Another good news, these new packages are effective immediately. Based on the implementing guidelines of the two benefit packages which we issued through PhilHealth Circular Nos. 2024-0008 and 2024-0009, all admissions due to neonatal sepsis and bronchial asthma in acute exacerbation starting May 1, 2024, are already entitled to these new rates.
You might be wondering why we have enhanced our coverage for neonatal sepsis and bronchial asthma.
According to the World Health Organization, neonatal sepsis is responsible for 3 out of 10 neonatal deaths in the world. It is also among the leading causes of neonatal deaths in the country. In 2023, more than 57,000 cases were paid by PhilHealth in the amount of P733.86 million.
Neonatal sepsis is defined as a serious medical condition that affects babies younger than 28 days old.
On the other hand, asthma remains to be a high-burden disease in the Philippines despite the medical advancements in the treatment of this condition. The majority of Filipinos with asthma do not have adequate control over their condition, which results in confinement. Based on PhilHealth data for 2023, asthma ranks eighth in the top medical confinements we have paid for with more than P717 million for more than 90,000 confinement cases.
In addition, PhilHealth identified these two cases – neonatal sepsis and bronchial asthma – as priority conditions in rationalizing select All Case Rates packages to improve financial coverage as we transition our payment mechanism to Diagnostic Related Groups or DRG, as mandated in the Universal Health Care Law.
The good news does not stop here. I am also happy to announce that the enhanced Konsulta Package was already effective last May 16, 2024. Previously we were covering 13 laboratory and diagnostic tests, now we are expanding it to 15 which now includes mammogram and ultrasound of upper abdomen, pelvic and breast. With these enhancements, the annual capitation, or the amount we pay our Konsulta Package Providers per patient is now P1,700 for both public and private from the previous P550 per patient. This is also our response to the call of our partner Konsulta Package Providers to increase the capitation.
I thank Speaker Ferdinand Martin Romualdez, Cong. Erwin Tulfo for staunchly supporting these developments as well as to the Board of Directors, headed by Secretary of Health Ted Herbosa for approving all these benefit enhancements.
Later, resource persons from the Benefits Development and Research Department and Project Management Team for Primary Care will give in depth discussions on these enhanced packages.
Dear media partners, PhilHealth has started implementing important enhancements in benefits in 2023, such as the expansion as well as the institutionalization of 156 hemodialysis sessions for patients with Chronic Kidney Disease Stage 5, increase in coverage for ischemic and hemorrhagic stroke and high-risk pneumonia, and the launch of the groundbreaking Outpatient Mental Health Package.
This year, the 30-percent increase in the All Case Rates took effect, and just last March, PhilHealth Z Benefits for breast cancer had a 1,400% leap from P100,000 to P1.4 million.
With all these benefit developments implemented in the last 11 months, PhilHealth is surely a bearer of hope to Filipinos who seek treatment for their various medical conditions. Ngayon, masasabi natin na mas nararamdaman na ng mga Kababayan natin ang kanilang benepisyong PhilHealth dahil malaking bahagi ng kanilang gastusing medikal ay sagot na ng PhilHealth.
Your PhilHealth continues to bring positive changes in how the government cares for the people through various social services. We are committed to further unburdening our Kababayans by providing responsive financial coverage under our thrust “Pinalawak at mga Bagong Benepisyo para sa Mamamayang Filipino”.
Let me end with a very motivating story that Mr. Antonio Owen S. Maramag, Senior Vice President and Chief Marketing Officer of the Development Bank of the Philippines, recently shared during our Annual Investment Forum. This was about his mother who was able to avail of her PhilHealth benefits. Mr. Maramag said, “PhilHealth provides peace of mind to the patients and their families who are already worried about their loved one’s ailment and the added burden of bills”. He added that “the thought that PhilHealth is there to pay or subsidize for the important procedures and charges is reassuring – yung may maaasahan ka na tulong sa mga bayarin na hindi ka na hihingi pa.”
In addition, I also would like share with you another message, this time from Mr. Carlos “Cholo” Baviera, former Vice President of Aliw Broadcasting Company and now a PhilHealth Lifetime Member, on how PhilHealth was able to assist him not only on his hemodialysis expenses.
According to Sir Cholo, PhilHealth shoulders 80-90% of hemodialysis patients expenses which is a big factor especially to him, being a senior citizen and a retiree. What I appreciate most is his call to fellow Filipinos to support PhilHealth. He said “We have to support PhilHealth, all the way. ‘Yan ang nagustuhan ko sa PhilHealth. Totoo po na hindi sila pang pa-pogi lang”.
I sincerely thank Mr. Maramag and Mr. Baviera for sharing their experience with us. These kinds of messages serve as an inspiration to all of us to strive even more and do even better for our countrymen.
Again, thank you dear partners in media for joining us today. Muli, ang aking panawagan sa inyong lahat na tulungan ninyo kaming ihatid ang magandang balitang ito sa ating mga Kababayan. Maraming salamat po.
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PhilHealth increases benefits for neonatal sepsis and bronchial asthma
Effective May 1, 2024, the Philippine Health Insurance Corporation (PhilHealth) is implementing another round of enhancements in two of its existing benefit packages, this time for neonatal sepsis and bronchial asthma which have been increased heftily by more than 100%.
PhilHealth Circulars 2024-0008 and 0009, the implementing guidelines of these two case rate packages, prescribe that all patients admitted on May 1, 2024 onwards may avail themselves of the increased benefits in accredited health facilities.
According to PhilHealth President and CEO Emmanuel R. Ledesma Jr. “the PhilHealth Board has approved the increase in package rate for neonatal sepsis to P25,793 from P11,700 and bronchial asthma in acute exacerbation to P22,488 from P9,000. The increase translates to 120% and 150%, respectively”.
Neonatal sepsis and other infectious conditions are among as the leading causes of neonatal deaths in the Philippines. In 2023, PhilHealth paid P733.86 million for more than 57,000 cases for the said condition.
On the other hand, asthma remains to be a high-burden ailment in the Philippines despite medical advancements. The majority of Filipinos with asthma do not have adequate control over their conditions, resulting to confinements. Based on PhilHealth data for 2023, asthma ranks eight among the top medical confinements paid by the state insurer, where P717 M have been paid for, for more than 90,000 cases of asthma.
PhilHealth identified neonatal sepsis and bronchial asthma as priority conditions in rationalizing its All Case Rates packages to further improve financial coverage and lower, if not eradicate the patients out-of
pocket expenses.
Ledesma explained that “PhilHealth is continuously improving its benefit packages in line with our thrust Pinalawak at mga Bagong Benepisyo para sa Mamamayang Filipino. We are hoping that these enhancements bring positive impact in the behavior of the Filipinos in seeking medical attention. Sa mga nangangailangang magpagamot, huwag na pong magdalawang isip dahil nakaalalay ang PhilHealth sa kanilang gastusing medikal”.
PhilHealth also reminded the members that the adjusted case rates may be availed of in Levels 1 to 3 accredited public and private health facilities nationwide. Meanwhile, the previous rates of P11,700 for neonatal sepsis and P9,000 for bronchial asthma will be applied to patients admitted in accredited primary care facilities.
laboratory tests, hospital admission due to worsening of asthma will be avoided”, Ledesma added.
The PhilHealth Chief also urged all members to register to their preferred to Konsulta Package Provider to avail themselves of free consultations, health screening and assessment, as well as any of the 21 essential drugs and medicines and 13 laboratory tests as will be required by their primary care physician.
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