New PhilHealth scheme threatens members’ benefits

A NUMBER of lawmakers have warned that the benefits provided by the Philippine Health Insurance Corp. (PhilHealth) would dry up in light of the P39.4 billion allocated for the Conditional Cash Transfer (CCT) Program and the fixed rates of the new PhilHealth payment scheme.

Representatives Rodolfo Albano of Isabela province and Angelo Palmones of Agham party-list noted that the new scheme, identified as case rates payment, might not be enough for the agency’s beneficiaries.

The scheme identified 22 medical and surgical cases with fixed rates or fixed amounts to be paid directly to both state and private hospitals and clinics.

The case rates payment covers: dengue 1 (P8,000); dengue 2 (P16,000); pneumonia 1 (P15,000), pneumonia 2 (P32,000); essential hypertension (P9,000), cerebral infarction cerebro-vascular accident hemorrhage 1 (P28,000); cerebro-vascular accident hemorrhage 2 (P38,000); acute gastroenteritis (P6,000); asthma (P9,000); typhoid fever (P14,000); and newborn care package in hospitals and lying-in clinics (P1,750).

On the other hand, the surgical procedures include radiotherapy (P3,000 per session); hemodialysis (P4,000 per session); maternity care package (P8,000) coupled with the normal spontaneous delivery (NSD) Package in Level 1 (P8,000) and Levels 2 to 4 hospitals (P6,500); caesarian section (P19,000); appendectomy (P24,000); cholecystectomy (P31,000); dilatation and curettage (P11,000); thyroidectomy (P31,000); herniorrhaphy (P21,000); mastectomy (P22,000); hysterectomy (P30,000); and cataract surgery (P16,000).

The original scheme of PhilHealth was to pay for services where rates were based on the category of hospital, length of stay at the hospital, kind of illness and complications, among others.

“PhilHealth members and beneficiaries can avail of these for free if the government would provide more budgetary support for PhilHealth. Giving funds to PhilHealth than the CCT would be a better option since members and beneficiaries of PhilHealth are properly identified and registered with the agency,” Albano said.

He added that the government only allotted a measly P12 billion for PhilHealth in 2012—an amount that paled in comparison to CCT’s P39.4 billion.

Palmones, for his part, argued that the new PhilHealth scheme could only last for so long.

“PhilHealth members should be given the opportunity to be informed and heard on the new policy, especially the less privileged. While we understand that the new scheme is for the best interest of the public, it would be better to get their side or opinion because they will be most affected by this new policy,” he said. –LLANESCA T. PANTI, Manila Times