MANILA, Philippines – The Philippine Health Insurance Corporation (PhilHealth) has promised to increase benefit package rates by 50% before the year ends.
“We started with a 30% increase almost across the board last February 14 and then I committed now, we’ll do another round of 30% before Christmas. Now again, I’m going to commit, maybe we can do an additional 50% before Christmas,” PhilHealth President Emmanuel Ledesma Jr. said on Wednesday, September 4, during the budget briefing of the Department of Health (DOH) and its allied agencies.
Should PhilHealth fulfill its promise to lawmakers, the state insurer’s benefit packages will have an 80% increase in its coverage in total in 2024.
Early in the briefing, AGRI Representative Wilbert Lee threatened to defer the department’s budget if PhilHealth does not expand its benefit packages for diagnostic scans, among others, before plenary deliberation on the agency’s budget.
PhilHealth’s benefits program is outdated. Before Ledesma took the helm of the state insurer, benefit packages were left untouched for over a decade.
“As soon as I joined, and it’s been less than two years, we have been very aggressive in increasing almost all the benefit packages,” Ledesma said.
Among the first packages expanded was the “Z benefit” package for breast cancer patients. For more than a decade, PhilHealth coverage for breast cancer only stood at P100,000. This was only increased in March 2024 to cover P1.4 million of a patient’s expenses — from diagnostics to chemotherapy, among other treatment needed.
The state insurer also improved its coverage for neonatal sepsis, bronchial asthma, expanded its Konsulta package, and its hemodialysis benefit package.
Ledesma’s promise of an additional 50% for case rates and benefit packages was made after AnaKalusugan Partylist Representative Ray Reyes pressed the state insurer about its plans to make up for the years that it failed to improve its outdated case rates.
He also noted that under the Universal Healthcare Act, patients’ out-of-pocket expenses should only stand at around 35% of their total hospital bills.
“Ang lumalabas lang sa atin dito is baka ang naco-cover lang ng PhilHealth is 10% to 15% of the total bill. Dapat 65% ‘yan e, so we do need to ramp up (PhilHealth might be covering just 10% to 15% of the total bill. That should be 65% so we do need to ramp up),” Reyes said.
Ledesma noted that “all these things take a while,” but assured lawmakers that they are addressing concerns with urgency.
Among the benefit packages in the pipeline for increased coverage are services for COVID-19 patients, hemodialysis, chemotherapy for cancers in the lung, liver, ovary, and prostate, and open-heart surgeries.
“We will do it before the year ends, [Congressman]. Makikita niyo (You’ll see),” Ledesma said. – Rappler.com