PhilHealth sets treatment rates

The government’s health insurance program has released the specific amounts or case rate packages available to members for certain surgical procedures and ailments such as dengue, hypertension and pneumonia.

Now members of PhilHealth will be able to immediately know how much they would get to pay for a particular disease or illness, Dr. Rey Aquino, president of Philippine Health Insurance Corp. (PhilHealth) said in a statement on Sunday.

“Gone are the days when we could not even give a definite amount in benefits for each of these common conditions and surgical procedures,” added Aquino.

Package rate benefits for dengue I and dengue II have been pegged at P8,000 and P16,000, respectively; pneumonia I and pneumonia II, P15,000 and P32,000, respectively; essential hypertension, P9,000; cerebral infarction, P28,000; and cerebro-vascular accident with hemorrhage, P38,000.

PhilHealth also placed the package rates for acute gastroenteritis at P6,000; asthma, P9,000; typhoid fever, P14,000.

Package rates for surgical procedures include radiotherapy at P3,000 per session; hemodialysis, P4,000 per session; appendectomy, P24,000; cholecystectomy, P31,000; dilatation and curettage, P11,000; thyroidectomy, P31,000; mastectomy, P22,000, among others.

The maternity care package was pegged at P8,000 coupled with normal spontaneous delivery package in Level I hospitals of another P8,000; Levels 2 to 4 hospitals, P6,500; and Caesarian section package, P19,000.

A newborn care package has been pegged at P1,750.

The new case rate packages will be available for all members admitted in any of the accredited health care providers nationwide beginning Sept. 1, said Aquino.

The shift from fee-for-service to case rates for specific medical and surgical cases was prompted by developments in the health care industry which puts a premium on providing optimal financial risk protection to vulnerable groups, including the “poorest of the poor,” he explained.