PhilHealth benefit for heart disease up by over fifteen-fold

by Info @Brand Zone | Jan. 3, 2025

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As Filipinos celebrate the holiday season, the Department of Health (DOH) recently called on people to prioritize their well-being by practicing moderation in their food intake and maintaining an active lifestyle. This is particularly important given that cardio-vascular diseases, specifically ischemic heart disease (IHD), remain the leading cause of death in the Philippines. 

To provide expanded financial coverage associated with heart disease treatment, the Philippine Health Insurance Corporation (PhilHealth) significantly increased its benefits coverage for Ischemic Heart Disease-Acute Myocardial Infarction (IHD-AMI) or “heart attack” for all inpatient admissions effective December 21, 2024. 

PhilHealth Circular No. 2024-0032 published on the same date provides coverage for (1) Percutaneous Coronary Intervention (PCI) at P524,000 from P30,300, an increase of 1,629 percent; (2) Fibrinolysis at P133,500 from P30,290 or a 900% increase; (3) Emergency Medical Services with Coordinated Referral and Interfacility Transfer at P21,900; and (4) Cardiac Rehabilitation after PCI at P66,140.

The expanded PhilHealth benefits packages for heart attack ensure that patients receive timely medical treatment by including emergency medical transport services to a capable health facility and all the medical interventions needed to ensure survival and good patient outcomes. 

"We understand the significant financial burden that heart disease can place on families," said PhilHealth President and Chief Executive Officer Emmanuel R. Ledesma, Jr. "We have listened to the patients and their families, and with the cooperation of our partner health facilities, we have been able to determine the prevailing costs that led us to adjust and substantially increase our financial support in these life-saving treatments,” he added. 

The enhanced heart packages support a comprehensive range of services that include emergency medical services, medicines, laboratory and diagnostic tests, medical supplies, use of equipment, and pertinent administrative fees. In the case of percutaneous coronary intervention, the procedure can be availed of at any of the 70 accredited Cath Labs nationwide. 

The PhilHealth Chief reminded the members that there should be no co-payment for inpatient admissions in basic or ward accommodations in both public and private health facilities nationwide. 

“But we should not forget, heart ailments can be prevented. To support our members in their journey towards better health especially in the coming new year, we encourage everyone to avail of our primary care benefits under Konsulta,” urged Ledesma, specifying consultations with primary care physician, laboratory tests for early detection as well as medicines to support those that already have heart conditions, all for free. 

"Through the Konsulta, we can identify potential health risks early on, including family history of heart disease, allowing for timely interventions such as medication for cholesterol management and lifestyle advice, to prevent or mitigate the development of heart disease,". He asked Filipinos to register to their Konsulta provider of choice at any of the local health insurance offices nationwide or through their own account in the PhilHealth Member Portal. 

By embracing a healthy lifestyle and by utilizing the Konsulta, Filipinos can better protect themselves from heart diseases for a healthier and productive future, he added.

Pondo ng PhilHealth sa 2025, sapat na — DOF

ni Angela Fernando @News | Dec. 30, 2024

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Photo: Ralph Recto / PhilHealth - FB

Iginiit ni Finance Secretary Ralph Recto nitong Lunes na sapat ang operating budget ng state insurer na PhilHealth para sa fiscal year 2025 kahit na walang nakalaang subsidiya mula sa pamahalaan.

Sa isang press briefing sa Palasyo matapos lagdaan ang P6.326-trillion national budget, sinabi ni Recto na mahigpit na babantayan ng Department of Finance (DOF) ang paggastos ng PhilHealth upang masiguro na magagamit ito nang wasto.

"Well, my understanding is that Congress did that because the budget for… the corporate operating budget of PhilHealth is sufficient. So, they have reserved funds of roughly 280 billion [pesos]. They have a surplus of roughly a hundred fifty billion, the last time I looked at it," saad ni Recto.

"They have investments of more than P400 plus billion. They will earn 200 billion in 2025. They will spend 150 billion. So 'yung surplus nila, madadagdagan na naman ng 50 billion 'yan. So, they have adequate resources," dagdag pa nito.

Binigyang-diin naman ng Finance Secretary na gagabayan ng DOF ang paggastos ng nasabing ahensya upang masigurong mas maayos ang paghawak nila rito.

Business as usual: Zero-subsidy not affecting PhilHealth benefits of All Filipinos

by Info @Brand Zone | Dec. 27, 2024

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The Philippine Health Insurance Corporation (PhilHealth) has reaffirmed its commitment to provide Filipinos with continuing access to their healthcare benefits despite the Bicameral Conference Committee's decision not to grant subsidy for CY 2025. 

“We assure the public of uninterrupted access to their benefits. Wala pong mawawala, walang mababawas na benepisyo. Despite the zero-subsidy for next year, your PhilHealth has adequate funds to cover your medical expenses," PhilHealth President and CEO Emmanuel R. Ledesma, Jr. assured.  

Ledesma emphasized that the decision reflects the wisdom of the Bicameral Conference Committee, a manifestation of its confidence on PhilHealth's strong and healthy financial position. 

As of October this year, the state health insurer has P281 billion in reserves set aside to meet benefit payments for two years and P150 billion in surplus. It also has an investment portfolio of P489 billion as of November 2024. 

The robust financial standing can manage this zero-subsidy scenario and adequately fund the rollout of more benefit packages that are due for enhancement in 2025 and beyond. 

"We adhere to what the UHC law is saying, that the current benefit packages for members will not be reduced. The way to go is up and you can be assured that we will continue to implement our Board-approved plans to improve more packages to lower out-of-pocket expense of patients," he asserted.      

The PhilHealth Chief reminded members not to delay treatment when sick, urging them to fully utilize their benefits whenever necessary: "Huwag na po kayong matakot sa pagpapagamot, sagot po kayo ng PhilHealth.”

Ledesma also allayed fears, especially among Indirect Contributors, that the lack of government subsidy will hinder their access to healthcare. "I say again, the benefits of our indigents, senior citizens, persons with disabilities and those from the marginalized sectors are guaranteed, with or without the subsidy.”

In fact, another set of benefit enhancements will be rolled out after the Board of Directors’ approval on December 16. These enhancements include emergency care, optometric services, heart surgeries, cataract surgery and lens implantation. PhilHealth will also implement another 50% increase in the rest of case rate packages not included in the rationalization track, bringing the total increase equivalent to 95% of the case rates just this year. 

Meanwhile, the guidelines for recently announced packages will be out soon. These packages refer to acute myocardial infarction or heart attacks, peritoneal dialysis, and kidney transplants, ten rare diseases under Z Miracles, oral health services under Konsulta package, and assistive mobility devices for priority conditions affecting those in need of physical rehabilitation. 

PhilHealth also completed the rationalization of seven packages among the top ten high-burden and mostly claimed health conditions, with increases ranging from more than a hundred to even more than 200 percent.

With all these developments, PhilHealth has enhanced a total of 30 benefit packages over a two-year period, an unprecedented feat accomplished under the leadership of Ledesma, who assumed office on November 2022.