PhilHealth to reimburse 22 medical, surgical cases

CEBU, Philippines – The Philippine Health Insurance Corporation (PhilHealth) members in accredited hospitals nationwide will soon avail reimbursement for 22 common medical and surgical cases.

This as Philhealth is set to launch in the first half of the year a standardized set of reimbursement for the said cases, as they are still currently fine tuning its preparation before these are formally offered to its members.

In a press statement, the state health insurance said among the 11 medical cases that will soon be paid on a case rate basis are dengue 1 and 2, pneumonia 1 and 2, essential hypertension, cerebral infraction and hemorrhage, acute gastroenteritis, asthma, typhoid fever, and newborn care package.

For surgical cases, these would include radiotherapy, dialysis, normal deliveries and deliveries by caesarian section, appendectomy, cholecystectomy, hysterectomy, dilatation and curettage, thyroidectomy, herniorrhapy and mastectomy.

Philhealth said that as soon as these are introduced, these will be reimbursed on a case-rate basis, a payment method that reimburses hospitals a pre-determined fixed rate for each treated case.

According to Philhealth, the new system is a departure from the usual “fee-for-service” method where providers are paid for each unit of service, over which there is a tendency for abuse because expenditures tend to increase if more services than what is needed are provided or more expensive services are substituted for less expensive ones.

Philhealth is moving towards this kind of system to help ensure better health outcomes, fair health financing, and equitable access to health care especially to the disadvantaged sectors.

With the case-rate payment, PhilHealth expressed optimism that it will significantly reduce high out-of-pocket payments by its members, and gives the member a clear idea of the benefits that they will be able to avail of.

On the other hand, the 1,600 accredited healthcare providers taking part in this new development are saved from the normally tedious administrative work for their reimbursements.

It can be recalled that PhilHealth already adopted the case rate system in its maternity care package for normal spontaneous delivery, newborn care benefit package, outpatient HIV/AIDS package, and outpatient malaria package. (FREEMAN)