PhilHealth to study doubling coverage for hemodialysis to P5,200

FILE: BUSINESS UNUSUAL. Philippine Health Insurance Corp. transactions go through the manual process, like in this branch in Mother Ignacia Avenue, Quezon City, on Tuesday (Sept. 26, 2023), four days after its system was attacked by the Medusa ransomware. The cyberhackers are reportedly demanding USD300,000 or about PHP17 million to decrypt the files, but the state health insurer said it won’t pay. (PNA photo by Joan Bondoc)

MANILA – The Philippine Health Insurance Corp. (PhilHealth) will study the proposal to double its coverage amount for hemodialysis from the current PHP2,600 per session to PHP5,200, an official said on Tuesday.

In a press conference at the Batasang Pambansa Complex, PhilHealth Executive Vice President Eli Santos said the goal of this proposed increase is to remove out-of-pocket costs of hemodialysis patients.

“Ang PhilHealth po ay pag-aaralan yung pag-increase po nito to PHP5,200… binigyan po kami ng one month po na pag-aralan po ito (The PhilHealth will study the increase [of the coverage] to PHP5,200… we are given one month to study this),” Santos said.

Santos said erythropoietin, which is used by people on dialysis, is usually purchased outside of dialysis facilities, which increases patient costs.

House Deputy Majority Leader and ACT-CIS party-list lawmaker Erwin Tulfo expressed optimism that increasing the coverage amount to PHP5,200 is “doable” following his meeting with PhilHealth officials.

“Base sa meeting namin kanina is doable naman. Base doon sa funding at pondo, every year naman nagbibigay ng pondo ang Congress sa PhilHealth, so maaring doon ho huhugutin (Based on our meeting earlier, I think it’s doable. Congress allocates funds for PhilHealth each year based on available budget, so that could be a source),” he said.

Tulfo said the current hemodialysis cost of PHP2,600 per session does not typically cover the vials to be injected to the patients.

“The good news is hopefully by next month, wala na talagang ica-cash out yung mga nagpapadialysis lalo na yung mga three time a week. Kasi ngayon kailangan nila bumili ng mga vials sa botika. Dadalhin nila doon sa dialysis center para i-injection sa kanila (The good news is hopefully by next month, patients undergoing dialysis, especially those who go three times a week, would no longer need to cash out. Currently, they have to buy vials at a pharmacy. They would bring it to the dialysis center so that it would be injected to them),” Tulfo said.

Santos, meanwhile, said PhilHealth’s assets amount to PHP589.5 billion, including PHP463.7 billion worth of reserve funds.

Tulfo also reported that mammograms and ultrasound have already been included in PhilHealth’s Konsulta Packages nationwide since May 15.

Santos said the capitation rate for the Konsulta program has been increased to PHP1,700 per patient for both government and private Konsulta package providers.

Basic dental services

The PhilHealth is also looking into the inclusion of basic dental services in its packages under the Universal Health Care (UHC) law, following Senator Raffy Tulfo’s observation that procedures are limited to tooth extraction and cleft palate surgeries.

“We are currently exploring it, studying it, looking closely to doing (a) study,” PhilHealth president and chief executive officer Emmanuel Ledesma said in at a media forum in Pasig City.

He added that the PhilHealth has enough funds for such services.

Meantime, PhilHealth Benefits Development and Research Development senior manager Melanie Santillan said the Philippine Dental Association (PDA) still needs to come up with the guidelines for dental practice.

“Sa kanila kase ngayon palang nila ini-i-standardize ‘yung dental services. Kunwari, ano ang gingawa during oral prophylaxis. Baka iba iba sila ng practice (They are standardizing the dental services just now. For example, what do they do during prophylaxis. They might have different practices),” she said. “We do not want patient safety to be compromised.”

Senators are considering amendments on the UHC law so it can cover basic dental services like checkups and cleaning since 73 million Filipinos suffer from tooth decay, based on a National Health Survey in 2018.

The PDA reported in February that 72 percent of the population have cavities.