PhilHealth seeks to lower out-of-pocket expenses
THE Philippine Health Insurance Corp. (PhilHealth) aims to reduce out-of-pocket expenses of its members as part of its mission for the next 30 months, the agency's chief, Edwin Mercado, said Thursday. To achieve this, PhilHealth aims to expand the support value it covers, including outpatient drugs. "Hopefully, there will always be a stock of medicines and laboratory reagents because that is also an out-of-pocket component. The public hospital will say that you will not pay, but if there is no medicine, the patient will also come out to buy the medicine out of their own pocket. So hopefully, if we pay the benefit claims of our public hospitals quickly, they will also have additional resources to continue that," Mercado said. This is a part of PhilHealth's plan to retain and support its members by expanding their benefits despite budget constraints. To save on funds, Mercado said PhilHealth has scaled down its events, such as its anniversary celebration, which this year will be limited to Mass and simultaneous flag ceremonies, said Israel Vargas, senior vice president of the health finance policy sector. One of their new projects is Emergency Care, which will reimburse members for an x-ray, ultrasound, MRI or a CT scan every time they go to the emergency room, Mercado said. Benefit coverage has also been expanded to maternal care and open-heart surgeries, among others. PhilHealth also plans to digitalize its operations to strengthen its institutional capacity, Mercado said. Toward this goal, the agency has already formed a technical advisory group. Mercado, who was appointed in February, said he has been able to issue new z-benefits packages (illnesses deemed medically and economically catastrophic) for heart surgery and heart valve repair. He has also been able to expand ER coverage and recruit new officers for key roles, with the aim to build an organization that is quick, fair and trustworthy. PhilHealth, he said, encourages people to look into the other benefit packages to aid their needs and fully lower their out-of-pocket costs, particularly on high-cost or high-burden diseases. PhilHealth, he said, is also addressing the P8.8 billion worth of denied claims due to late hospital filing. "With the approval of the board, the claims that we denied, that our corporation denied because of the 60-day late filing period, will be paid. This will cover all our accredited facilities, public and private, that have claims," Vargas said. Based on this new policy, PhilHealth is giving all concerned health facilities a six-month period to submit their previously denied claims within the period of Jan. 1, 2018 to Dec. 31, 2024. "We will process them again to ensure that hospitals that have provided essential services to our citizens are properly compensated," Mercado said.
Tomas Kauer - Moderator 
THE Philippine Health Insurance Corp. (PhilHealth) aims to reduce out-of-pocket expenses of its members as part of its mission for the next 30 months, the agency's chief, Edwin Mercado, said Thursday.
To achieve this, PhilHealth aims to expand the support value it covers, including outpatient drugs.
"Hopefully, there will always be a stock of medicines and laboratory reagents because that is also an out-of-pocket component. The public hospital will say that you will not pay, but if there is no medicine, the patient will also come out to buy the medicine out of their own pocket. So hopefully, if we pay the benefit claims of our public hospitals quickly, they will also have additional resources to continue that," Mercado said.
This is a part of PhilHealth's plan to retain and support its members by expanding their benefits despite budget constraints.
To save on funds, Mercado said PhilHealth has scaled down its events, such as its anniversary celebration, which this year will be limited to Mass and simultaneous flag ceremonies, said Israel Vargas, senior vice president of the health finance policy sector.
One of their new projects is Emergency Care, which will reimburse members for an x-ray, ultrasound, MRI or a CT scan every time they go to the emergency room, Mercado said.
Benefit coverage has also been expanded to maternal care and open-heart surgeries, among others.
PhilHealth also plans to digitalize its operations to strengthen its institutional capacity, Mercado said. Toward this goal, the agency has already formed a technical advisory group.
Mercado, who was appointed in February, said he has been able to issue new z-benefits packages (illnesses deemed medically and economically catastrophic) for heart surgery and heart valve repair. He has also been able to expand ER coverage and recruit new officers for key roles, with the aim to build an organization that is quick, fair and trustworthy.
PhilHealth, he said, encourages people to look into the other benefit packages to aid their needs and fully lower their out-of-pocket costs, particularly on high-cost or high-burden diseases.
PhilHealth, he said, is also addressing the P8.8 billion worth of denied claims due to late hospital filing.
"With the approval of the board, the claims that we denied, that our corporation denied because of the 60-day late filing period, will be paid. This will cover all our accredited facilities, public and private, that have claims," Vargas said.
Based on this new policy, PhilHealth is giving all concerned health facilities a six-month period to submit their previously denied claims within the period of Jan. 1, 2018 to Dec. 31, 2024.
"We will process them again to ensure that hospitals that have provided essential services to our citizens are properly compensated," Mercado said.
