PhilHealth eyes new hospital fee system

PhilHealth branch facade—CONTRIBUTED PHOTO

The Philippine Health Insurance Corp. (PhilHealth) is eyeing the nationwide implementation by 2026 of the capitation payment scheme in its accredited hospitals and health facilities, according to its spokesperson Israel Pargas.

Under this model which is being pilot tested in selected areas, the state health insurer will advance to a public health facility a P500 capitation fee for every accredited patient. For private clinics, it will be P750 each.

“In this kind of payment scheme, we will distribute [the payments] first to make sure that the facilities have funds and they have no reason to tell members that they don’t have medicines or money, and that they can’t provide services,” Pargas told the Inquirer.

The new “frontloading” scheme was launched in July in public health facilities in Bataan, Guimaras, Quezon and South Cotabato provinces, as well as in Baguio City. It is part of PhilHealth’s efforts to veer away from current reimbursement mechanisms in which services are rendered first to members before health-care providers may apply for claims from the agency.

PhilHealth, however, has been criticized for its slow processing of claims and obligations filed by accredited health-care providers. As of now, the unpaid claims have ballooned to about P27 billion.

This issue was also raised at the House of Representatives last week during a hearing on the proposed 2024 budget of the Department of Health, of which PhilHealth is an attached agency.

To expedite the payment of arrears to hospitals, Pargas said that PhilHealth may adopt a debit-credit payment method which was successfully used to settle claims during the COVID-19 pandemic.

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