ARMED with a 5 percent premium contribution rate, the Philippine Health Insurance Corporation (PhilHealth) is setting aside P243 billion to pay member claims for this year.
“We have already started enhancing the member benefits last year, and we will continue it this year. For 2024, the agency has allotted some P243 billion to pay for these benefits,” PhilHealth president Emmanuel Ledesma said in a statement.
“This is where the importance of adjusting our contribution rates come into play. It will generate funds necessary for us to complete our benefit plans, and, more importantly, to sustain the reforms in the benefit packages,” he added.
Last January, PhilHealth started implementing the 5 percent premium rate for its members. The increased premium rate is expected to provide PhilHealth with around P35 billion in additional income. Last month, PhilHealth said its 30 percent increase in most of its case rate packages have begun to take effect.
Ledesma said PhilHealth is set to rationalize case rates for bronchial asthma and bacterial sepsis in newborns as well as COVID-19 in-patient benefits.
He also said that guidelines for out-patient therapeutic care benefits package for severe acute malnutrition in children aged 5 years and younger, and services for physical medicine and rehabilitation, will also be enhanced.
Another benefit to look forward to this year is the enhancement of peritoneal dialysis under the Z Benefits Package.
Ledesma also said the PhilHealth Konsultasyong Sulit at Tama (KONSULTA) package will be further expanded to include treatment for TB, animal bite, malaria, and HIV/AIDS.
Ledesma said this is in addition to expanding the coverage for medicines to 53 from 21 under its Guaranteed and Accessible Medications for Outpatient Treatment (GAMOT) package.
Last year, pneumonia (moderate and high risk) had the most number of PhilHealth claims with 479,632 or about P7.1 billion.
Medical cases with similar high claims count are acute gastroenteritis with 225,809 (P1.2 billion), dengue with 163,209 (P1.5 billion), urinary tract infection with 160,548 (P1.07 billion), and peptic ulcer disease with 150,215 (P940.7 million).
Completing the top 10 medical cases with claims payment in 2023 are hypertensive emergency/urgency with 141,436 (P1.2 billion), stroke infarction with 128,054 (P3.6 billion), asthma with 90,080 (P717 million), upper respiratory tract infection with 75,935 (P283 million), and COVID-19 pneumonia with 72,511 (P14.6 billion).