The Philippine Health Insurance Corp. (PhilHealth) has issued a circular giving end-stage renal disease (ESRD) patients, undergoing renal replacement therapy under its case rate payment mechanism, 90 more sessions of peritoneal dialysis every year.
Under the PhilHealth Circular No. 022-2015, the coverage of peritoneal dialysis sessions for member patients has been expanded from a maximum of 270 days to 360 days a year. ESRD patients can also avail of 45 additional days of hemodialysis sessions a year from the usual 45 days.
“Medical conditions that make renal replacement therapy indispensable to one’s daily survival are extremely debilitating, can impoverish even the most affluent, and can become unbearable to those who are already wallowing in it,” stated the circular signed by PhilHealth president Alex Padilla on Aug. 17.
“In the end, it is the society as a whole that will have the duty to bear the financial, social and physical burden brought about by these catastrophic illnesses,” it further stated.
The circular also announced that the package rates for peritoneal and hemodialysis have been changed to P2,600 per session—enough to cover the professional and health care institution’s fees, at P350 and P2,250, respectively.
Previously, PhilHealth paid a case rate amount of P4,000 for the two procedures per session.
The insurance firm explained that based on consultations with various stakeholders, the prevailing case rate amount for hemodialysis was “more than enough” to cover each session in the majority of cases.
“It has also been noted on record that altruistic health care institutions unilaterally extend their services to PhilHealth members on hemodialysis beyond the 45-day limit because of the adequacy of the package,” it stated.
PhilHealth also noted in its circular that the additional sessions should be used exclusively for outpatient hemodialysis and peritoneal dialysis. Inpatient confinements with or without dialysis would not be covered by the additional sessions after the regular benefit limit of 45 days have been used up, it said.
The regular benefit limit of 45 days for the principal member and another 45 days shared by all qualified dependents per calendar year will still be observed, according to Philhealth.
One session of hemodialysis will be equivalent to one day deduction while four days of peritoneal dialysis will be equivalent to one day deduction, according to the circular.
While both procedures are used to treat kidney failure, hemodialysis uses a man-made membrane or a dialyzer to filter wastes and get rid of extra fluid from the blood.
On the other hand, peritoneal dialysis uses the patient’s own body tissues inside the abdominal cavity as a filter to remove excess water and waste products from the body.
In other countries, the latter is being promoted as the first line of treatment and management for end- stage renal disease.
According to PhilHealth, the incidence of this disease in the country is at 120 per million population and its most common causes among Filipinos are diabetes, hypertension and chronic glomerulonephritis. (Jocelyn R. Uy, Philippine Daily Inquirer)