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PhilHealth must reassess service delivery capabilities to ensure fulfillment of promises

Published Mar 12, 2023 11:39 pm
Emerging from a meeting with President Ferdinand R. Marcos, Jr. in Malacañang last week, the Philippine Health Insurance Corporation (PhilHealth) announced that upon the President’s directive, dialysis coverage will be increased from 90 to 156 sessions; the pay-whichever-is-lower corporate policy in payment claims will be repealed; and that the case rate of the top four packages covering 25 percent of filed claims will be increased. According to its acting president and chief operating officer Emmanuel Ledesma, Jr., these will be the focal plans of the agency’s short-term plan until June 2023. The widened dialysis coverage will cover three times a week dialysis sessions for outpatients, which is equivalent to full weekly coverage annually. The state insurer’s short-term plan will also introduce the PhilHealth mobile app and short message service (SMS) confirmations, as well as new benefit packages—outpatient mental health benefit package and outpatient package for severe acute malnutrition for children below five years old. It also aims to strengthen its Konsulta package. PhilHealth officials also spelled out its mid-term plan, which will be introduced in 2024. Highlighting the plan is a general amnesty for employers and government agencies with missed premium payments. This will particularly benefit businesses, employers, and individuals, especially small and medium enterprises that cannot shoulder the three percent interest on missed premium payments. Instead of revoking the accreditation of erring doctors and hospitals, the state insurer will simply impose penalties, amend the Universal Healthcare Law (UHC), and increase the case rates of top 10 packages with the highest claims filed. PhilHealth also plans to introduce an anti-fraud system and reorganize the agency to improve claims processing and frontline services. Its long-term plans include digitalization and the construction of PhilHealth-owned buildings and facilities. PhilHealth’s airing of its immediate and mid-term plans comes like a whiff of fresh air. Recall that during the previous administration, PhilHealth was the object of close scrutiny on account of revelations made by some of its top officials pertaining to alleged irregularities. This prompted the Senate to convene itself as a committee-of-the-whole to conduct a full-dress investigation --- aided by the Department of Justice – into reportedly anomalous and graft-tainted transactions. As both the government and the public were then preoccupied with fending off the harsh impact of the Covid-19 pandemic, these concerns somehow receded into the background until these were sporadically mentioned during the 2022 election campaign. Judging from the tenor of the PhilHealth acting president’s pronouncements, the public is given the impression that all’s now well with the agency – and that it is prepared to respond to the President’s directives that reflect the public clamor for more effective coverage of the most common diseases that afflict Filipinos. While installing an anti-fraud system and digitalization could not be realistically completed immediately, postponing the start of these programs until 2024 conveys a lack of sense of urgency that these are important prerequisites to the effective implementation of benefits. The PhilHealth management should reassess the agency’s priorities as well as service delivery capabilities – mindful that there is heightened public awareness and limited tolerance for the resurgence of malfeasance.

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PhilHealth Philhealth coverage covid-19 Editorial Manila Bulletin
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