With new regulations, PhilHealth should now be called PhilSick

New requirements put members at risk as parameters on treatment are set.

By Health Alliance for Democracy (HEAD)
February 7, 2016

QUEZON CITY – The group Health Alliance for Democracy (HEAD) strongly condemned two recently released circulars by the Philippine Health Insurance Corporation (PhilHealth) as arbitrary and anti-patient/anti-member.

PhilHealth Circulars 2016-001 and 002 or the Policy Statement on the Diagnosis and Management of Acute Gastroenteritis and Urinary Tract Infection, respectively, require a minimum hospital stay of 3 days for AGE and 4 days for uncomplicated UTI. Otherwise, claims will be denied.

“Since when did it become PhilHealth’s role to determine and set limits to the diagnosis and management of patients?” decried Dr. Joseph Carabeo, HEAD secretary-general.

“In the first place, AGE and UTI do not often warrant hospital admission” Carabeo added. “When they do, the management is based on the status of the patient. Therefore, pre-determining the length of hospitalization is preposterous!”

“Additional but unnecessary burden is placed on healthcare providers. Longer hospital stay means use of more hospital resources. At the same time, patients are put on an even higher risk of hospital-acquired infection.”

“A health financing agency, a state-run one at that, should not in any influence patient care. PhilHealth is now acting like a private HMO (health maintenance organization) that dictates the quality of care for its members.” In the United States, HMOs are notorious for interfering with patient care.