PhilHealth underscores case rate packages which may be availed of by members

By Philippine Information Agency (PIA 8)
January 6, 2012

TACLOBAN CITY  –  Case rate packages for selected medical conditions and surgical procedures are now available in institutional health care facilities accredited by the Philippine Insurance Corporation.

This was underscored by Dr. Noel Arteche of PhilHealth Tacloban during the Suruswerte Ha PIA radio program on Friday.

Dr. Arteche said there has been a shift from fee-for-service to case rates for these medical and surgical cases.  This was prompted by developments taking place in the health care industry, most notable of which is the need to provide optimal financial risk protection especially to the most vulnerable groups, including the poorest of the poor.

He added that better member appreciation and faster reimbursement of fees to health care providers were also among the major considerations for introducing this new type.

Through this mechanism, members will be able to predict how much PhilHealth will be paying for each of the services provided.

"Gone are the days when we could not even give a definite amount of benefits for each of these common medical conditions and surgical procedures," Arteche said, "now, the member is empowered with the right amount of information he needs for a particular disease or illness."

Among the medical cases and the corresponding package rates are Dengue I (P8,000.00), Dengue II (P16,000.00), Pneumonia I (P15,000.00), Pneumonia II (P32,000.00), Essential Hypertension (P9,000.00), Cerebral Infarction (CVA I, P28,000.00), Cerebro-vascular Accident with Hemorrhage (CVA II, P38,000.00), Acute Gastroenteritis (P6,000.00), Asthma (P9,000.00), Typhoid Fever (P14,000.00), and Newborn Care Package in Hospitals and Lying-in clinics (P1,750.00).

On the other hand, the surgical procedures include Radiotherapy (P3,000.00 per session), Hemodialysis (P4,000.00 per session), Maternity Care Package (MCP, P8,000.00) coupled with the Normal Spontaneous Delivery (NSD) Package in Level 1 (P8,000.00) and Levels 2-4 hospitals (P6,500.00), Caesarian Section (P19,000.00), Appendectomy (P24,000.00), Cholecystectomy (P31,000.00), Dilatation and Curettage (P11,000.00), Thyroidectomy (P31,000.00), Herniorrhaphy (P21,000.00), Mastectomy (P22,000.00), Hysterectomy (P30,000.00) and Cataract Surgery (P16,000.00).