PhilHealth paying P1.35B a week for beneficiary benefits

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Thursday, July 24, 2014

AT LEAST P1.35 billion is being shelled out by the Philippine Health Insurance Corporation (PhilHealth) a week in order to shoulder the health benefits of its members, a top official said Thursday.

PhilHealth President and CEO Alexander Padilla noted the sharp increase in benefit payments being spent by the agency in just the first half of this year compared to 2013.

"This is 33 percent higher than the P1.2 billion we released every week last year," said Padilla.


For the whole first semester of 2014, the PhilHealth head said a total of P36.85 billion has already been spent by PhilHealth for millions of its members.

"This amount represents a 41 percent increase compared to the P26.19 billion it paid for the same period last year," said Padilla.

Records show that the payments for the benefits of the Formal Economy members were highest at P9.0 billion; followed by payments to members from the Informal Economy members at P6.3 billion; payments to indigent/sponsored members at P5.92 billion; and payments to Lifetime members at P1.73 billion.

According to PhilHealth, the increase in payments could be attributed to the continued expansion of service facilities as nine out of 10 hospitals licensed by the Department of Health (DOH) are now PhilHealth accredited.

This translates to 1,761 health care providers and 32,323 health care professionals nationwide are covered by PhilHealth.

"More accredited and engaged facilities and professionals means better access for our members anywhere in the country," Padilla said.

He added that the continuously expanding membership coverage of PhilHealth also pushed benefit payments upward.

"More and more beneficiaries are now gaining greater access to health care though social health insurance," said Padilla.

As of June 2013, the total number of PhilHealth members and dependents has reached 80.6 million.

Also, Padilla noted that the continuing enhancement of PhilHealth's benefits portfolio when it began covering a substantial portion of the hospital expenses of members and their qualified dependents was a factor.

Padilla cited as an example the "Z Benefit Package", wherein coverage for end-stage renal disease is worth P600,000; coverage for childhood leukemia at P210,000; and early stage breast cancer and low to intermediate risk prostate cancer at P100,000 each, covering the entire course of treatment.

He also cited as a factor the introduction of new benefit packages that aims to ensure totality of care and the attainment of better health outcomes.

This includes the introduction of more catastrophic packages such as for Coronary Artery Bypass for P550,000; Surgery for Tetralogy of Fallot for P320,000; Surgery for Ventricular Septal defect for P250,000; Cervical Cancer chemoradiation with cobalt and brachytherapy (low dose) for P120,000 and P175,000, respectively, noted Padilla. (HDT/Sunnex)

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