PhilHealth Moves Forward with UHC

PhilHealth is rapidly expanding its program in support of universal health care by providing heath insurance coverage for all national government-paid 5.2 million poor families  and  an additional over 5 million families paid for by local government units. As of May 2012, PhilHealth has   paid out over 16 billion pesos of benefits and expects to further expand benefit payments to over a billion pesos weekly starting July 2012. 

It has improved its hospitalization benefits for members with case payments and the deployment of 530 nurses (PhilHealth CARES) in hospitals all over the country. It has implemented several new benefits to address the heath needs of its members including primary care benefits and the Z benefits for catastrophic illnesses. Enhanced benefits are now being enjoyed by its members.

With over a hundred billion pesos of reserves, PhilHealth is committed to ensure true financial risk protection for its members particularly the poor.

With regards to its alleged delayed claims payments, PhilHealth has been addressing this issue since late last year.

In 2011, the average number of claims was around 340,000 a month. During this period, the average claims turn around time (TAT) was more than 60 days. Thirty eight percent (38%) of submitted claims were paid beyond 60 days.

By the end of June 2012, despite an increase in the number of claims to 450,000 a month, the TAT even decreased to 48 days. The TAT for claims paid by case rates is even lower at 46 days. As to the percentage of claims paid beyond 60 days, this has been reduced to 26% for all claims, and 23% for claims paid by case rates.  

As to allegations of old unpaid claims, PhilHealth has been working with hospitals to reconcile these claims with PhilHealth and we have harmoniously conducted the reconciliations since last year.

Still, the Corporation recognizes that we need to do more.  A shift to all case rates and electronic claims processing are key to attain claims efficiency that everyone will be happy with.

Thus by September 1, we will start to pay hospitals electronically provided that they have LandBank account. By October 1 , we will start to recieve electronic submission of claims.  By the end of the year, we expect to pay all claims by case rates.