PhilHealth New Case Rate Payments - The Evolution of Health Care in the Philippines

PhilHealth has a lot of cash these days. One hundred seven billion pesos to be exact. That’s a lot of money and it shows that there’s a pathway to a better health insurance system for Filipinos.

Who’s to argue against the fact that our system of health insurance is inadequate? Although a lot of us get some benefits from PhilHealth, the subsidy that it provides is so small to cover our medical needs. For people who can afford to pay for their own hospitalization, this may not matter at all. But for ordinary working families, this system of insurance coverage is problematic.

Unpleasant Experience

I’ve had my share of considerable hospital expenses to wish something better. My son went through several surgeries because of his inborn illness and the expenses set us back a couple of hundred thousand pesos in the process. Although I didn’t mind starting from scratch again, I've thought about some possibilities other than what I went through.

How about if people who encounter these medical needs do not have enough savings for these operations? What if the amount needed were just too high? Should the people have to suffer for lack of medical resources? Can’t our government or we as a society do something to make our situation better?

Universal Health Care

I guess what I’m really driving at is for the Philippines to have a universal health care coverage for Filipinos. My dream is for a time when medical expenses will not mean bankruptcy or when anyone will not have to die because it will cost too much to get well.

I know this is possible because this is how it works for other countries with good social services. It’s not a dream that we should easily give up on.

But I also know that it’s not yet within our reach as of the moment. I don’t know when this will be realized but I sure hope it’s soon enough. For the meantime, we’re stuck with what we have. It’s not as bad as having nothing so we might as well improve our knowledge with it.

New Case Rates

I’ve found out that there are several updates on PhilHealth that I didn’t know about. I heard an interview over a radio program which discussed these matters. And I thought if I didn’t know about this stuff, some people probably have no idea about it as well.

One of the main changes is regarding “case rates”. For all the times that I had to pay for medical bills, I was left guessing how much PhilHealth would cover. They had a complicated system which makes it difficult to know how much the subsidy will be. Apparently, this has also resulted to delayed reimbursements of PhilHealth to hospitals.

The new case rates specify a number of cases with fixed and predetermined amount for subsidy. This will make certain to those affected how much help they’d get from PhilHealth. It will mean a more efficient system of transactions for PhilHealth and the hospitals. Both of them will cut costs and lessen processing times.

Medical Cases
Dengue I - P 8,000.00
Dengue II - P 16,000.00
Pneumonia I - P 15,000.00
Pneumonia II - P 32,000.00
Essential Hypertension - P 9,000.00
Cerebral Infarction - P 28,000.00
Cerebro-vascular accident with hemorrhage - P 38,000.00
Acute Gastroenteritis - P 6,000.00
Typhoid Fever - P 14,000.00
Asthma - P 9,000.00
Newborn Care Package - P 1,750.00

Surgical Procedures
Radiotherapy - P 3,000.00
Hemodialysis - P 4,000.00
Maternity Care Package - P 8,000.00
NSD, Level 1 - P 8,000.00
NSD, Levels 2-4 - P 6,500.00
Caesarean Section - P19,000.00
Appendectomy - P 24,000.00
Cholecystectomy - P 31,000.00
Dilatation and curettage - P 11,000.00
Thyroidectomy - P 31,000.00
Herniorrhaphy - P 21,000.00
Mastectomy - P 22,000.00
Hysterectomy - P 30,000.00
Cataract surgery - P 16,000.00

It’s hard to say whether these new case rates would mean more or less subsidy for patients. I would guess that it would depend on how much the hospital will charge a patient. Obviously, a fixed rate’s worth will always be relative to the total hospital bill one has to pay.

Private Health Insurance

Employed Filipinos usually have medical benefits which include private health insurance policies on top of their PhilHealth. For some cases, these might be good enough. But for a majority of life-threatening illnesses, I think these are often inadequate.

This makes private health insurance a very good option. I’d like to discuss more about private health insurance options in my succeeding articles. Hope you stay tuned.