PhilHealth hikes benefit packages for heart patients

QUEUE FOR BENEFITS Members of PhilHealth visit the state insurer’s office in Quezon City, shown in this 2023 photo, to inquire about their benefits. —Grig C. Montegrande

MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) has substantially increased the benefit packages for members confined for heart ailments to up to P500,000 in some cases.

Circular No. 2024-0032, signed by PhilHealth president Emmanuel Ledesma Jr. on Dec. 18, raised the health packages for ischemic heart disease-acute myocardial infarction (IHD-AMI), which were previously at P18,900.

For patients admitted for IHD-AMI and needing percutaneous coronary intervention (PCI), the reimbursement rate is now P523,853. The PCI is a nonsurgical, minimally invasive procedure to relieve the narrowing of the coronary artery, usually by ballooning the narrow segment or deploying a stent to keep the artery open. It is a combination of coronary angioplasty with stenting.

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On the other hand, the case rate for those who need fibrinolysis—treatment to break up the blood clots in the coronary artery to restore blood flow—has been raised to P133,500, while those who need emergency medical services with coordinated referral and interfacility transfer can avail themselves of a package worth P21,900.

Those needing cardiac rehabilitation are entitled to a package totaling P66,140. The medically supervised program is designed to improve the cardiovascular health of those recovering from a heart attack, heart failure, or other heart problem that requires surgery or medical care. This includes exercise counseling and training, education for heart-healthy living, and counseling to reduce stress.

The new IHD-AMI packages took effect on Dec. 21.

Priority conditions

“PhilHealth identified IHD-AMI as one of the priority conditions for improving financial coverage and protection against catastrophic healthcare expenditure during illness,” the state health insurer said.

The average cost of treatment for a heart attack is around P1 million—around P100,000 for the initial diagnosis; P500,000 for treatment and procedures upon hospital admission; and P400,000 for postsurgery rehabilitation. The IHDs refer to heart damage caused by narrowed or blocked arteries, usually due to a buildup of fat, cholesterol, and other substances.

When arteries narrow, less blood and oxygen reach the heart muscle, which can lead to acute myocardial infarction or a heart attack. Prompt treatment is needed to prevent death.