CABANATUAN CITY – The state-run health insurance corporation will change its benefits payment scheme from the traditional “fee-for-service” to “case payments” in a bid to guard its funds from reported abuses and “over utilization” by some quarters, including hospitals, the agency officials disclosed here Wednesday.
Philhealth President Rey Aquino said that case payments will “contain the cost of health care services, particularly in-patient care. The scheme, he said, is expected to roll out by next quarter.
Aquino said under the case payments, hospitals are paid a fixed amount per patient for particular diagnosis or procedure instead of the current system where hospitals would conduct the procedure before computing fees and charges based on receipts.
He said under the new scheme, members will readily know how much they are entitled to.
“Hindi na ho sila mahihirapan pang i-compute kung magkano ang dapat nilang maging benepisyo kung halimbawa sila ay naospital dahil sa dengue o sa pneumonia, o ma-operahan man,” Aquino said in a press briefing here.
This way, which is practiced in Taiwan, some unnecessary expenses could be avoided.
“We have earlier used this mode of benefit payment for normal spontaneous delivery, cataract extraction and several other benefit packages,” he stressed. The same mode, he said will be extended to eleven medical and eleven surgical procedures. He did not specify.
In selling the scheme, Aquino said the approach will result to faster reimbursement of claims for accredited providers since there is already a fix amount for diagnosis or procedure.
“While claims will still be scrutinized, the pace by which the processing will proceed will definitely be faster.”
PhilHealth has a total of 153,750 enrolled members in Central Luzon with Malolos Branch topping the list at 55,600 followed by Cabanatuan City, 47,493. Gapan City Branch is third with 20,519, Sta. Maria has 24,899; and Aurora, 5,239.
Philhealth President Rey Aquino said that case payments will “contain the cost of health care services, particularly in-patient care. The scheme, he said, is expected to roll out by next quarter.
Aquino said under the case payments, hospitals are paid a fixed amount per patient for particular diagnosis or procedure instead of the current system where hospitals would conduct the procedure before computing fees and charges based on receipts.
He said under the new scheme, members will readily know how much they are entitled to.
“Hindi na ho sila mahihirapan pang i-compute kung magkano ang dapat nilang maging benepisyo kung halimbawa sila ay naospital dahil sa dengue o sa pneumonia, o ma-operahan man,” Aquino said in a press briefing here.
This way, which is practiced in Taiwan, some unnecessary expenses could be avoided.
“We have earlier used this mode of benefit payment for normal spontaneous delivery, cataract extraction and several other benefit packages,” he stressed. The same mode, he said will be extended to eleven medical and eleven surgical procedures. He did not specify.
In selling the scheme, Aquino said the approach will result to faster reimbursement of claims for accredited providers since there is already a fix amount for diagnosis or procedure.
“While claims will still be scrutinized, the pace by which the processing will proceed will definitely be faster.”
PhilHealth has a total of 153,750 enrolled members in Central Luzon with Malolos Branch topping the list at 55,600 followed by Cabanatuan City, 47,493. Gapan City Branch is third with 20,519, Sta. Maria has 24,899; and Aurora, 5,239.
