PhilHealth asked to scale up case rate packages

WITH the surge in coronavirus cases starting to overwhelm Metro Manila’s healthcare infrastructure, a House leader on Sunday proposed that the Philippine Health Insurance Corp. (PhilHealth) scale up its case rate packages from the current P4,000 to P32,000 per beneficiary to a range of P150,000 to as much as P400,000 for each treated patient afflicted with coronavirus disease-19 (COVID-19).

Deputy Speaker and Camarines Sur Rep. LRay Villafuerte, lead author of the House version of Republic Act (RA) 11469 or the “Bayanihan to Heal as One Act,” has proposed a tenfold increase in the case rate packages “to incentivize private and public hospitals to put up more facilities, even temporary ones within their respective premises, and then accommodate a lot more patients who are either PUIs (persons under investigation) or PUMs (persons under monitoring).”

“Far higher PhilHealth case rate packages would also encourage LGUs (local government units) to invest in COVID-related facilities and equipment so they, too, could eventually accommodate PUIs and PUMs in their localities,” Villafuerte, a former CamSur governor, said.

Villafuerte suggested to PhilHealth to increase the amount of its rate package between P300,00 and P400,000 for COVID-19 patients suffering from severe illness or in critical condition that require intubation and use of ventilators.

He said the rate package should be raised to P150,000 to P200,000 for patients with mild cases, as such persons are required to be hospitalized for two weeks for their complete recovery from this disease.

Villafuerte made his proposal as five top hospitals in Metro Manila have stopped accepting new suspect cases because their facilities could no longer accommodate additional patients for treatment.

These five hospitals are St. Luke’s Medical Center (SLMC) and De los Santos Medical Center, both in Quezon City; SLMC Global City in Taguig City; The Medical City (TMC) in Pasig City; and Makati Medical Center (MMC) in Makati City.

Quezon City Mayor Joy Belmonte earlier reported that three infected persons were sent home by the hospitals because it was the alleged policy of that policy to send home for self-quarantine patients found to only have mild cases.

Local hospitals are having their hands full treating suspect cases because of the country’s low hospital bed-to-population ratio of one bed (in both private and government hospitals) for every 1,062 people.

According to 2018 data of the Health Facilities and Services Regulatory Bureau (HFSRB) of the Department of Health (DOH), there were 99,627 beds in 1,231 licensed hospitals that year for a population of 105,755,180.

“If PhilHealth makes an over ten-fold increase in its case rate packages, I believe we will be seeing hospitals investing in facilities to accommodate more people suspected of COVID-19 infection,” he said. “They would probably even be converting empty or unused spaces in their buildings or covered parking areas into temporary wards for COVID-19 patients.”

Following President Rodrigo  Duterte’s signing into law of RA No. 11469, PhilHealth president Ricardo Morales announced that this state-run insurance firm was releasing an initial P30 billion-worth of financial assistance to its accredited hospitals—through its Interim Reimbursement Mechanism (IRM)—to help these health facilities respond to the COVID-19 threat.

Morales announced that PhilHealth will cover all the COVID-related medical expenses of all its members, as well as health workers, including volunteers asked to augment the health workforce, and non-medical personnel necessary for the operation of hospitals.

He added that PhilHealth will shoulder the cost of the testing kits, provided these are administered by qualified laboratories and not self-administered tests. “Lahat ng hospitalized sasagutin yan. ‘Yun lang mga nako-confine, iyon lang ang masasagot ng PhilHealth,” Morales was quoted by the media as saying.

“Morales should match his rhetoric with action by asking PhilHealth’s Board to approve the increase in its case rate packages for COVID-19 patients,” he said. “Only a resolution approved by the PhiHealth Board is needed to make this happen, in support of the ‘Bayanihan to Heal as One Act’ signed by President Duterte.”

At present, persons placed under observation for suspected COVID-19 are entitled to an “isolation” health package of P14,000 per patient, while those tested in lower level facilities but referred to hospitals capable of performing quarantine procedures are each entitled to the “referral” health package of P4,000.

Patients exhibiting moderate pneumonia resulting from COVID-19 are entitled to  P15,000 and those that end up with severe pneumonia or adult respiratory distress syndrome (ARDS) are entitled to the maximum package of P32,000.

Villafuerte said the case rate bump for COVID-19 patients would be the most fitting cap to the series of measures taken by PhilHealth on Morales’ watch, in support of RA No. 11469 and the Duterte administration’s efforts to combat the dreaded virus.

On top of releasing an initial P30 billion to accredited hospitals for COVID-19 treatment, Villafuerte recalled that PhilHealth was also reported by the media as waiving its policy on the single period of confinement and the 45-days coverage, extending the filing period for claims from the usual 60 days to at least 120 days, and extending the deadline of payment of first-quarter contributions by its self-paying direct contributors to April 30 from the original deadline of March 31—and without interest.

Villafuerte pointed out that the Congress wrote the “Bayanihan to Heal as One Act” to empower President Duterte to, among others, reallocate and realign savings from the 2020 General Appropriations Act (GAA) and the extended 2019 GAA as well as oft-budget funds of government-owned and -controlled corporations (GOCCs) to provide emergency relief to 18 million households dependent on the “no-work, no-pay” system and enable our frontline health workers to better protect themselves and treat suspect cases and those who had been exposed to these patients.

He said the government has identified P275 billion of such funds that the President can use with his special but limited powers for three months—P200 billion for the emergency subsidy for the 18 million households and P75 billion for the health-related programs.