ILOILO CITY — The Philippine Health Insurance Corporation (PhilHealth) in Western Visayas has released some PHP4.57 billion for benefit payments of 451,619 cases as of third quarter of this year.
Based on data for the said period, non-communicable diseases or lifestyle illnesses are fast-catching up in terms of top paid claims in the region.
As of end of third quarter this year, hemodialysis procedure has the highest claim count at 66,126 amounting to PHP309 million. The average value per claim is PHP4,675.93.
Moderate risk pneumonia came in second in claims count at 51,568 amounting to PHP763.885 million. The average value per claim is pegged at PHP14,813.17.
Dr. Bernadette Reyes, PhilHealth-6 health care management delivery division chief said the usual availment is only 45 days but the hemodialysis is extended to 90 days.
“We created this policy due to the alarming cases,” she said during Wednesday afternoon’s thanksgiving event. She added that there has been a sprout of dialysis centers because of the increase in demand.
Hence, PhilHealth is encouraging members to avail of its preventive program for early detection of their disease prior it would result to full-blown diseases.
Dr. Jerry Bagaforo, PhilHealth 6 accreditation section head, said that primary care benefit package is available in rural health units (RHUs) and municipal health units (MHUs) for indigent members. It is being offered free for sponsored, indigent, overseas Filipino workers and the latest to be included.
He said that each family is allotted PHP500 annually for their profiling. During the profiling, they can avail of free services such as consultation and blood pressure check for those with hypertension and needed diagnostics for those suspected with diabetes.
In cases the facilities are not available in RHUs and MHUs then they are allowed to outsource their services through a memorandum of agreement (MOA), he added.
Reynes added that since the thrust of the government is universal health care, then the plan is already to expand the program to the formal or employed sector.
“There is a plan next year to expand our primary care benefit for the formal sector. This is one of the reasons why we have some adjustment in our premium contribution because we will be expanding our program,” she said.
Also, it will already be made available in a private facility.
Meantime, also belonging to the top paid claims for medical cases were hypertensive emergency with PHP136.43 million released; pneumonia high risk with PHP285.42 million; sepsis, PHP166.23 million; newborn sepsis, PHP101.38 million; stroke infarction, PHP149.25 million and acute gastroenteritis, PHP88.185 million. (Perla Lena/PNA)
