The Senate panel on health and demography, chaired by Senator Christoper Go, holds a hearing on Tuesday, August 20, 2024. (Screenshot from Youtube/Senate of the Philippines)
MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) will assess the possible removal of a policy prohibiting readmissions under one case benefit among its members.
PhilHealth President and Chief Executive Officer Emmanuel Ledesma Jr. referred to the single period of confinement policy as he spoke on Tuesday before the Senate panel on health and demography chaired by Senator Christopher Go.
“It’s been so long, we are going to study, thoroughly study the revision and possible removal of policy of the single period of confinement so rest assured po, we shall do it immediately,” said Ledesma.
According to the Philhealth circular, case rates are subjected to the rule of single period of confinement.
It states that “admissions and readmissions due to the same illness or procedure within a 90-calendar day period shall only be compensated with one (1) case rate benefit.”
Go questioned the policy and how it has not been changed for the past years. According to Ledesma, the policy was imolemented in 2013.
“‘Pag nag-bleeding ka ngayon, after two weeks, bawal na ang same confinement?” (If you’re bleeding now and this reoccurs in two weeks, you can’t have the same confinement?) Go asked.
“Hindi niyo tinignan ito? Hindi niyo binago?” (You didn’t look into this? You didn’t change it?) he added.
The following are the only case rates exempted from the single period of confinement rule:
- Blood transfusion, outpatient
- Brachytherapy
- Cataract surgery (subject to provisions)
- Chemotherapy
- Dialysis other than Hemodialysis
- Hemodialysis
- Radiotherapy
- Simple Debridement
- Asthma in Acute Exacerbation
“There seems to be a flaw at the circular so like I said, rest assured we will look into it immediately, study thoroughly,” Ledesma noted.
Go called on the removal of the single confinement policy, arguing that people will never know when they will get sick.
“‘Yong mga kababayan nating mahihirap, kahit saan lang po yan kumakain and they are very prone na magkasakit so tanggalin niyo ‘yong single confinement policy. Di natin alam kung kailan tayo magkakasakit,” he said.
(The poor eat anywhere and they are very prone to sickness, so this single confinement policy must be removed. We will never know when we will get sick.)
“As soon as we review this and there’s a change in the period of confinement, I will personally inform you po para at least alam niyo na ginawa na namin ‘yong promise namin. Rest assured ‘yan po,” Ledesma told Go.
(As soon as we review this and there’s a change in the period of confinement, I will personally inform you so you will at least know that we fulfill our promise. Rest assured.)
The Department of Finance previously ordered the transfer of P89.9 billion unused subsidy of PhilHealth to the national treasury to fund unprogrammed appropriations.
This sparked controversy among health groups and advocates, raising concerns that it violated the Republic Act No. 11223, or the Universal Health Care Act of 2019.
Section 11 of the law states that “no portion of the reserve fund or income thereof shall accrue to the general fund of the National Government or to any of its agencies or instrumentalities, including government-owned or -controlled corporations.”
PhilHealth has already returned the P20 billion to the general fund in May while the rest of the tranches will be given on Wednesday, August 21, October 16, and May 26, 2025.