Just five days after it endorsed five better benefits, Secretary of Health Ted Herbosa chaired another meeting of the Philippine Health Insurance Corporation (PhilHealth) Benefits Committee (BenCom) to review a new provider payment mechanism and to improve kidney transplant benefits, for consideration of the PhilHealth Board of Directors (Board).
Herbosa presided over the BenCom as it deliberated the forthcoming implementation of the Philippine Diagnosis Related Groups (PHL-DRG).
The Universal Health Care (UHC) Act mandates PhilHealth to shift to paying healthcare providers in advance, using diagnosis related groupings (DRGs). DRGs account for additional patient characteristics, apart from other medical diagnoses and procedures performed during the episode of care.
The current PhilHealth All Case Rates (ACR) system pays only for the top two most resource-intensive diagnoses or procedures, even if a patient has more than two conditions or needs more than two treatments at the same time.
“Having been a practicing trauma surgeon myself, I know how frustrating it is.”
“Having been a practicing trauma surgeon myself, I know how frustrating it is for both hospital patients and their doctors that today’s PhilHealth pays only for the top two conditions or procedures and nothing more. PhilHealth should pay more, so that families will pay less out of pocket,” the health chief explained.
In the same meeting, the BenCom also carefully considered how to increase PhilHealth benefit packages for kidney transplantation (KT) and the services needed after a patient undergoes life-saving treatment.
Launched back in 2012 among the first set of catastrophic care packages, the Z benefit for KT has stayed at its initial package rate of P600,000 only.
“The gold standard of treatment for patients with end stage renal disease is still a kidney transplant or KT. Post-KT patients have a better quality of life, and are more productive than those kept on hemodialysis. The costs of KT and post-KT care also end up being less than life-long hemodialysis,” the health head said.
“We are improving these benefits together with prevention of diabetes and hypertension at primary care so that we won’t get kidney patients to begin with.”
“We are improving these benefits together with prevention of diabetes and hypertension at primary care so that we won’t get kidney patients to begin with,” he added.
The PhilHealth Board en banc will have its next regular meeting before the end of the month.
There are eight major steps needed to implement a new PhilHealth benefit or to enhance an existing one: 1) benefit development; 2) policy development; 3) policy approval; 4) IT system development; 5) publication; 6) IT system enhancement; 7) user training/orientation; and 8) effectiveness assessment.
Board action is found in only two of these eight: policy development and policy approval.
The six other steps are within Management and the President and CEO’s direct control.
“President Marcos is a strong health advocate. He knows and understands that a properly functioning PhilHealth will bring us closer to UHC faster,” Herbosa concluded.
