PhilHealth coming up with emergency care package by December 2024

MANILA, Philippines — The Philippine Health Insurance Corporation will come up with a package to cover emergency patients admitted for less than 24 hours by December this year, PhilHealth Executive Vice President Eli Santos said on Wednesday.

Santos bared the plan  during a Senate committee on health and demography hearing where committee chair Senator Christopher “Bong” Go called out PhilHealth over its “anti-poor” 24-hours confinement policy.

The policy is based on PhilHealth Circular 2020-0007, where the 24-hour confinement refers to “the compensability of a claim based on the required minimum number of hours of hospitalization or confinement for inpatient care in an accredited healthcare institution.” 

According to Santos, the reason PhilHealth does not cover confinements of less than 24 hours—excluding emergency cases—is due to “cost-containment and fraud prevention measures.”

“If we indiscriminately allow coverage, financial coverage for all visits to the emergency room, this might promote immoral hazard—abuse in short,” Santos said.

Santos, however, citing PhilHealth President and Chief Executive Officer Emmanuel Ledesma Jr., committed that PhilHealth is already developing an emergency care package by December 2024.

“We committed already, and our President and COO has already presented a timeline for this year, and we committed to craft or develop an emergency care package by December of 2024,” said Santos.

Go asked if the new package would mean PhilHealth won’t have to wait for patients to be admitted for 24 hours before it covers their bill, to which Santos responded in the affirmative.

“As contribution of PhilHealth to the whole government and whole of society approach in the health care delivery system, yes. We commit to that,” Santos said.