In response to the escalating costs of healthcare due to inflation, the Philippine Health Insurance Corporation (PhilHealth) is set to implement rate adjustments for its benefit packages starting in 2024.
According to a statement released by PhilHealth on Nov. 20, the move is intended to improve hospitalization costs coverage for Filipinos and guarantee that members receive the full benefit of their membership.
PhilHealth said that the current case rate payment system, introduced in 2013, will see adjustments, with rates potentially increasing by a maximum of “30 percent across all cases.”
The adjustment is anticipated to alleviate out-of-pocket expenses for patients during hospitalization and the utilization of PhilHealth benefits for outpatient care, it added.
Emmanuel R. Ledesma, Jr., PhilHealth President and Chief Executive Officer, emphasized the need for these adjustments, saying, “It is about time that PhilHealth adjusts its rates in order for our members to cope with the increasing cost of medical care. We want our members to feel the value of their benefits, which translates to meaningful financial risk protection."
To mitigate inflationary effects, PhilHealth plans to implement a cost-sharing mechanism.
Health facilities and members will have fixed co-payment rates in addition to PhilHealth's reimbursement.
The health insurer emphasized that this approach aimed to promote efficient resource use by health facilities, while allowing members to predict their expenses for amenities and extra services beyond basic accommodations.
In an effort to control healthcare costs and discourage irrational use of services, PhilHealth will adopt a variable inflation adjustment across types of health facilities, with higher-level facilities receiving higher adjustments, up to a maximum of 30 percent.
"This will be our way of controlling healthcare costs, making members' expenses predictable, and discouraging irrational use of healthcare services among facilities,” Ledesma said.
Moreover, the rate adjustments come alongside ongoing benefit expansion and rationalization approved by the PhilHealth Board.
It highlighted an increase in dialysis coverage, rationalized rates for commonly available conditions, and expanded coverage for conditions such as ischemic and hemorrhagic strokes.
PhilHealth remains committed to responding to the healthcare needs of Filipinos, aligning with President Marcos Jr.'s 10-point agenda for affordable and universal healthcare for all citizens.
The state health insurer said it will continue to enhance its benefit packages, with plans to expand Z Benefits for breast cancer in 2024, including coverage for targeted therapy of up to P1 million per patient per year.
PhilHealth has already introduced initiatives like the Outpatient Mental Health Package and plans to launch a package for severe acute malnutrition, demonstrating its dedication to improving and expanding healthcare services for the Filipino population.