The Department of Health (DOH) announced on Thursday, Dec. 5, that it is seeking approval for the first-ever outpatient benefit package, which would cover the assessment of children for refractive errors, including the provision of prescription glasses if necessary.
In a statement, the DOH said that Health Secretary Dr. Teodoro J. Herbosa chaired the Philippine Health Insurance Corporation (PhilHealth) Benefits Committee (BenCom) on Dec. 4 to review the design of two new benefit packages and the improvement of four existing ones — including another round of case rate increases.
According to the DOH, this is in preparation for their presentation to the PhilHealth Board of Directors en banc.
The DOH also noted that Herbosa presided over the BenCom as it discussed the first-ever outpatient benefit package that would cover the assessment of children for refractive errors, including a pair of prescription glasses if necessary.
During the initial presentation, technical staff focused on children aged five to six years old, the DOH said.
Upon discovering that "the benefit of correcting vision problems in children, enabling them to learn better among other advantages, far outweighs the cost of consultation and glasses," DOH said Herbosa and the BenCom members instructed that more age groups be included.
The DOH highlighted that the BenCom has approved a proposal to rationalize case rates for cataract extractions, which would also cover selected intraocular lenses, particularly for pediatric patients.
The DOH-led BenCom also endorsed proposed implementing guidelines for an emergency care benefit under Konsulta Plus, the comprehensive outpatient benefit mandated by the Universal Health Care (UHC) Act.
This proposed benefit would cover emergency department services, including ambulance coverage, the DOH said.
Rate increases
The DOH noted that in addition to the two groundbreaking benefit proposals, the BenCom also scrutinized and approved the proposed implementing guidelines for a second round of increases in selected case rates, by as much as 50 percent.
“The first round of case rate increases was only for around 30 percent more to correct for aggregate health inflation from 2012 to 2022,” the DOH said.
The DOH added that the committee also endorsed proposals to markedly increase the package rates for coronary artery bypass graft (CABG) surgery, closure of ventricular septal defect (VSD) and VSD with aortic stenosis, and total correction of Tetralogy of Fallot.
Similar Z benefit packages for heart valve repair or replacement in valvular heart disease were also evaluated and cleared for presentation to the Board, the DOH said.
Presidential directive
The DOH said that the recent developments were in response to the directive of President Marcos to improve PhilHealth benefits.
“We take President Marcos Jr.'s instructions seriously, especially when he says that he wants better benefits for the masses,” Herbosa said.
“The job of PhilHealth is to pay the health benefits of its members. It has so much potential to bring down out-of-pocket health costs for families,” he added.
The DOH said that since Herbosa decided to chair PhilHealth's BenCom, it has already approved ten (10) new or improved benefit packages.
The PhilHealth Board en banc will hold its next regular meeting in mid-December, before the Christmas break, to consider these six additional items.
The DOH outlined eight major steps required to implement a new PhilHealth benefit or enhance an existing one: benefit development, policy development, policy approval, IT system development, publication, IT system enhancement, user training/orientation, and effectiveness assessment.
The DOH said that board action is required for only two of these eight steps: policy development and policy approval. It added that the remaining six steps are under the direct control of Management and the President and CEO.