Utilization of PhilHealth benefits by poor members on uptrend

By , on January 3, 2016


(Photo from PhilHealth's Facebook page)
(Photo from PhilHealth’s Facebook page)

MANILA – The Philippine Health Insurance Corporation (PhilHealth) has noted a big increase in the utilization of benefits among PhilHealth members included in the National Household Targetting System for Poverty Reduction (NHTS-PR) – a data bank and information management system that identifies who and where the poor are in the country.

“I think utilization among NHTS members has increased tremendously…So, malaki na ang nalalaman nila sa mga benepisyo tungkol sa PhilHealth at nagagamit mismo ng mahihirap,” PhilHealth President and CEO Atty. Alexander Padilla told the Philippines News Agency.

“In terms of claims processing, we are now averaging around 1.2 million claims from the NHTS and sponsored members, representing almost 32 percent or one-third of our claims processing,” Padilla said.

Members of these sectors are also the ones being assisted by the government under the Pantawid Pamilyang Pilipino Program (4Ps) being implemented by the Department of Social Welfare and Development (DSWD).

Payment for their premium contributions is being shouldered by the government because their income is not sufficient.

This is part of the effort of the Aquino administration to ensure that the poor will not be left behind and have access to quality health care and other services as part of promoting the inclusive growth or in reaping the fruits of good governance.

Based on the data of PhilHealth from Jan. 1 to June 30, 2015, a total of PhP44 billion benefit payment was made by PhilHealth in the first half of the year.

In comparison, Padilla said that such amount was equivalent to the benefit payment that the agency made for the entire 2012.

“So, in a matter of four years’ time, our PhP44-billion payment in 2012 is only six months of payment benefits for 2015,” the PhilHealth president said.

He noted that with the continuous uptrend, they have projected that they will be paying roughly PhP88 billion by the end of 2015.

Last year (2014), PhilHealth paid a total of PhP78.2 billion in benefit claims, up from PhP55 billion in 2013 and PhP44 billion in 2012.

For the first half of 2015, more than PhP13 billion of benefit payments were used for NHTS/sponsored members who had utilized their PhilHealth claims for their health needs or even sickness of their dependents numbering 1,210,668 claims.

“So iyon, lumalaki and benefits na binabayaran naming… We have also expanded the Z-benefits to include colon and rectum cancers for this year,” Padilla said.

Z-benefit package refers to catastrophic illnesses that ordinary citizens may not be able to afford the cost of treatment.

Examples of catastrophic illnesses are acute lymphocytic/lymphoblastic leukemia, breast cancer, prostate cancer, end state renal disease requiring kidney transplantation, coronary artery bypass, etc.

Padilla said the complete list of such catastrophic illnesses can be viewed at PhilHealth website or www.philhealth.gov.ph

At present, there are 15,288,583 indigents covered by PhilHealth.

Dependents of these indigent members total to 30,118,509 individuals which when added together total to 45,407,092.

About 40 percent of PhilHealth members are indigents; one percent comprise sponsored members; 13 percent, senior citizens; 35 percent from the formal economy; and nine percent from the informal economy.

For this year, about 3.5 million senior citizens were added as members under Republic Act No. 10645 which mandated that PhilHealth must cover the senior citizens who were not members before or not included in any category.

The government pays the premium of these senior citizens through the Sin tax revenues.

At present, the PhilHealth is proud to say that nine out 10 Filipinos or 89.4 million of the 100 million population are covered by PhilHealth.