MANILA, Philippines, March 20 ------ In a bid to extend “unhampered service” to its members, the Philippine Health Insurance Corporation (PhilHealth) has lifted its 45-day benefit limit rule. In a statement, PhilHealth Acting President and Chief Executive Officer (CEO) Edwin Mercado said the 45-day benefit limit is an “outdated cost-containment strategy.”
The 45-day benefit limit previously allowed PhilHealth members a maximum of 45 days of hospital confinement per calendar year. Their qualified dependents shared a separate 45-day confinement limit annually, the state insurer added. “Naiintindihan natin kung bakit ito inilagay noon, ngunit, sa pagbabago ng ating payment mechanism, napapanahon na rin talagang repormahin ito,” Mercado said. “We cannot always predict or schedule our medical needs. Marami ring mga serbisyo ang kinakailangan ng higit sa 45 days na coverage,” the PhilHealth chief further explained.
PhilHealth has previously expanded its hemodialysis package, increasing coverage from 90 to 156 sessions per year. With the removal of the 45-day benefit limit, a more inclusive approach will now extend to other medical services, the state insurer emphasized. “Nais natin na ang mga Pilipinong may malulubhang sakit, chronic conditions, o di kaya’y nangangailangan ng mahaba-habang pagpapaospital ay patuloy na makatanggap ng serbisyong pangkalusugan nang hindi pa nag-aalala kung sila ba ay mababaon sa utang,” Mercado expressed.
To ensure the responsible implementation of this policy, PhilHealth said it will closely monitor patient admissions, readmissions, and benefit utilization exceeding 45 days. The agency also underscored that availment of benefits should be based on “proper medical indication, necessity, and alignment with the patient’s treatment plan.” “Layon natin na ang bawat serbisyong sinusuportahan ng PhilHealth ay tunay na nagdudulot ng katiwasayan sa myembro. Ginagawa naman na ito ng ating mga ospital,” Mercado said. “Ako rin, bilang hospital administrator noon, ay pinagtuunan namin ng pansin ang pag-momonitor ng outcomes. Ngunit, ang gusto natin ngayon ay unti-unti mag-transition ang PhilHealth to value-based financing,” he concluded.
Source: inquirer.net
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