Health officials urged to expand PhilHealth coverage

MANILA, Philippines — Agri party-list Rep. Wilbert Lee on Wednesday told health officials that he would “move to defer” the Department of Health’s (DOH) budget for 2025 if the Philippine Health Insurance Corporation (PhilHealth) would not expand its coverage.

During the House panel on appropriations hearing, Lee said cancer, eye problems, magnetic resonance imaging (MRI), positron emission tomography (PET), and CT scans should be included in PhilHealth’s coverage.

“[Kapag] hindi po ito nangyari, madam chair, I will be left with no choice but to move to defer the budget allocation of the DOH of the year 2025 at the proper time during the plenary deliberations. Napakasimple lang po nito,” he said.

(If this does not happen, madam chair, I will be left with no choice but to move to defer the budget allocation of the DOH of the year 2025 at the proper time during the plenary deliberations. This is very simple.)

Lee said the hospital bill of a patient, who underwent a radiofrequency ablation 3D mapping, amounted to over P470,000, but PhilHealth only shouldered P24,000.

During the hearing on DOH’s proposed budget for 2025, Agri party-list Rep. Wilbert Lee showed the hospital bill of a patient, who underwent a radiofrequency ablation 3D mapping, amounted to over P470,000, but PhilHealth only shouldered P24,000. (Screenshot from Youtube/House of Representatives)

READ: Recto favors better PhilHealth benefits over reduced contributions

“Ang mga deduction ay hindi maramdaman ng taumbayan. Short of saying, lugi pa sila sa binabawas na contribution sa kanila buwan-buwan,” he pointed out.

(Citizens can’t feel these deductions. Short of saying, they are not benefiting even if they are paying their premium contributions every month.)

Health Secretary Teodoro Herbosa said radio ablation is a new procedure.

“So I don’t think the previous PhilHealth and previous BenCom (benefits committee) have actually included it in the procedure, as mentioned earlier by the officer of PhilHealth,” he said.

“The procedures are based on the high burden illnesses and also the impact on the catastrophic, but definitely if there is a request to include this on the benefit package, we would be happy to get them from the physician or the hospital that do the high-frequency ablation,” he added.

Lee also pointed out that diagnostic scans are costly, so PhilHealth must also cover these.

“Marami po dito ang hindi nabanggit, including diagnostic scans which is very important dahil napakamahal po ng mga ‘to. Dahil [kapag] ito po ay nireseta, sa kasamaang palad, lahat po ng mga public hospital dito katulad ng PET scans, sa buong Metro Manila, NKTI (National Kidney and Transplant Institute) lang po ang meron nito,” he said.

(A lot was not mentioned, including diagnostic scans which is very important because this is very expensive. If it is prescribed, unfortunately, in public hospitals in Metro Manila, only NKTI has PET scans.)

“Napakahaba ng pila so ang choice po ay pumunta sa private hospital na napakamahal po. Wala pong coverage ito kapag hindi ka naka-confine so ano pong mangyayari, mag-iipon. [Kapag] nakaipon at nakakuha na, malala na po ang sakit,” he added.

(The waiting lines are long so they will be left with no choice but to go to private hospitals. If you are not confined in the hospital, this is not covered so what will happen is they will save money for it. When they have saved up for it, their illness is already severe.)

Lee then asked DOH and PhilHealth officials why couldn’t they expand the coverage of the state health insurance.

“Bakit hindi po natin ito gawin? Naiiyak po ako kapag naaalala ko po yung mga taong namamatay. Wala po ba tayong pakialam?” he asked.

(Why can’t we do this? I cry every time I remember the people who are dying. Do we not care for them?)

“We will review as requested by our dear congressman all these packages we have also been pushing as chair in the PhilHealth as I have been telling the board,” Herbosa replied.

PhilHealth President and Chief Executive Officer Emmanuel Ledesma Jr. said they will also be “looking thoroughly” into Lee’s request.

“There are close to 10,000 case rates in PhilHealth and we are really trying to cover all. We are realizing the importance for the health sector for all of these. This takes time,” he added.

In a previous hearing, Ledesma said PhilHealth members can expect another 30 percent increase in health benefits by the end of 2024.

READ: PhilHealth: Expect another 30% increase in benefits by year-end