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.
