Metro Manila, Philippines – The board of directors of the Philippine Health Insurance Corp. (PhilHealth) lifted the 45-day benefit limit policy for its members.
In a statement on Thursday, March 20, PhilHealth president and CEO Edwin Mercado said that the 45-day benefit limit is an “outdated cost-containment strategy.”
“Naiintindihan natin kung bakit ito inilagay noon, ngunit, sa pagbabago ng ating payment mechanism, napapanahon na rin talagang repormahin ito,” Mercado said.
[Translation: We understand why the policy was implemented before, but now, with the changes in our payment mechanism, it’s time to make a reform.]
“We cannot always predict or schedule our medical needs,” Mercado said. “Marami ring mga serbisyo ang kinakailangan ng higit sa 45 days na coverage [Many services need over 45 days of coverage].”
Implemented in 2006, PhilHealth gives an annual maximum of 45 days to each member for room and board allowance and another 45 days to be shared by all of the dependents.
Recognizing the need to cover more than 45 days for certain conditions before, the state health insurer previously extended the number of sessions covered by hemodialysis packages from 90 to 156 sessions.
Mercado said the PhilHealth wants Filipinos with severe diseases, chronic conditions, or who need longer hospitalization to continuously receive health services.
The PhilHealth reminded that availing of benefits must be based on “proper medical indication, necessity, and alignment with the patient’s treatment plan,” and must adhere to standards.
“To ensure the responsible and effective implementation of this policy, PhilHealth will closely monitor patient admissions, readmissions, and benefit utilization exceeding 45 days,” PhilHealth said in its statement. “Health facility compliance with clinical standards and reimbursement rules will be rigorously assessed through the Health Care Providers Performance Assessment System (HCPPAS).”
