By: Merlyn H. Ybañez
This was bared by Datu Masuding Alonto, Vice President for PhilHealth, Northern Mindanao, who said the shift from fee-for-service to case rates for these medical and surgical cases was prompted by developments taking place in the health care industry.
“Most notable of these developments is the need to provide optimal financial risk protection, especially, to the most vulnerable groups, including the poorest of the poor," he said.
Alonto also said that it is the opinion of the PhilHealth President and Chief Executive Officer, Dr. Rey B. Aquino, that better member appreciation and faster reimbursement of fees to health care providers were also among the major considerations for introducing this new type of provider payment scheme.
Meanwhile the PhilHealth CEO said the use of case rates is an internationally accepted payment mechanism that serves to package payment for health interventions.
Through this mechanism, members will be able to predict how much PhilHealth will be paying for each of the services provided and empowered with just the right amount of information he needs for a particular disease or illness.
Among the medical cases and the corresponding package rates are Dengue I Php8,000, Dengue II, Php16,000, Pneumonia I, Php15,000, Pneumonia II, Php32,000, and Essential Hypertension, Php9,000.
Cerebral Infarction (CVA I), Php28,000, Cerebro-vascular Accident with Hemorrhage (CVA II, Php38,000, Acute Gastroenteritis , Php6,000, Asthma, Php9,000, Typhoid Fever, Php14,000, and Newborn Care Package in Hospitals and Lying-in clinics, Php1,750.
Surgical procedures including Radiotherapy, Php3,000 per session, Hemodialysis , Php4,000 per session, Maternity Care Package (MCP), Php8,000, coupled with the Normal Spontaneous Delivery (NSD) Package in Level 1, Php8,000 and Levels 2-4 hospitals, Php6,500.
Caesarian Section, Php19,000, Appendectomy, Php24,000.00, Cholecystectomy, Php31,000, Dilatation and Curettage, Php11,000, Thyroidectomy, Php31,000, Herniorrhaphy, Php21,000, Mastectomy, Php22,000, Hysterectomy, Php30,000 and Cataract Surgery, Php16,000.
However, the "No Balance Billing" (NBB) policy, meaning no other fees nor expenses shall be charged to or paid for by the patient-member above and beyond the package rate, applies to the Sponsored Program members who are admitted in government hospitals.
The NBB policy shall also apply to any other member type, such as, the employed, individually paying and overseas workers, who will avail themselves of the MCP and NCP in all accredited MCP non-hospital providers, such as, maternity clinics, and birthing homes.
This policy was approved after a series of consultations with concerned medical societies and other institutional partners.
These conditions and procedures were also among the top 49 percent of total claims PhilHealth paid for over the previous years.
With all of these packages in place, the government agency needs about Php3 billion in the next six (6) to 12 months once members start availing themselves of the packages early this month.
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