PhilHealth rethinks plan to impose 30-50% increase across the board
MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) is reconsidering its plan to implement another 30% to 50% increase in benefit packages.
Instead of across-the-board rate increases, PhilHealth President Emmanuel Ledesma said on Tuesday, October 7, that they may focus on raising case rates for the top 10 most common diseases in the country.
Ledesma proposed this during the Senate Committee on Finance’s budget hearing on the proposed 2025 budget for the Department of Health (DOH) and its attached agencies, including PhilHealth.
“So instead of implementing an additional targeted 30-50% increase almost across the board this November, we are more inclined to looking at a corresponding increase on the top 10 most common diseases by morbidity and mortality,” he told senators.
Ledesma said the proposal was originally suggested to him by Rep. Stella Quimbo (Marikina, 2nd District) who chairs the House appropriations committee.
PhilHealth had committed to increasing benefit packages on September 4 after facing scrutiny from House lawmakers for accumulating P14.8 billion in unpaid claims to the DOH and for the slow enhancement of benefit packages, despite having a reserve fund of nearly P500 billion.
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What is a case rate? PhilHealth defines a case rate as the percentage of hospitalization fees for a specific disease that the insurer covers. In this context, a “case” refers to the disease itself.
Ledesma said PhilHealth reimburses a fixed amount for around 9,000 cases. To increase each case rate by 30 to 50% uniformly, he adds, “does not do the trick” as it may only be inflationary.
By proceeding with the proposal to increase reimbursement amounts for the top 10 diseases causing deaths among Filipinos, PhilHealth believes it “would not be as inflationary” compared to the original commitment of increasing case rates across the board.
PhilHealth added that the top 10 most common diseases by morbidity and mortality account for 80% of the 9,000 cases. Ledesma also emphasized that the increase for each case rate will not be uniform.
"Each increase depends on what is more common or needed. The increase may be larger, it depends on that,” Ledesma said in a mix of English and Filipino.
Sen. Pia Cayetano, chair of the finance committee, raised this concern after the Commission on Audit reported that the 30% increase implemented for most case rates in February was “without a concrete basis or methodology.”
Cayetano reiterated COA’s finding that this may indicate a “haphazard program and policy implementation.”
Senators' suggestion. While supporting Ledesma’s proposal, Cayetano and Sen. Bong Go expressed hope that PhilHealth could expand it to include the top 20 most common diseases rather than just the top 10.
Top causes of mortality
According to the Philippine Statistics Authority (PSA), ischaemic heart disease is the leading cause of death in the Philippines, affecting nearly 120,000 Filipinos from January to November 2023.
Second to this is neoplasm, characterized by abnormal cell growth similar to a tumor, which claimed the lives of over 60,000 Filipinos during the same period.
Cerebrovascular diseases, including strokes and aneurysms that disrupt blood flow in the brain, ranked third among the causes of death, resulting in nearly the same number of fatalities as neoplasms.
PhilHealth increased the benefit package for ischemic acute stroke by 171% in 2023, from P28,000 to P76,000.
For high-risk pneumonia, the national health insurer nearly tripled its coverage from P32,000 to P90,100.
The other leading causes of death according to the PSA by order include:
- Diabetes mellitus
- Pneumonia
- Hypertensive diseases
- Chronic lower respiratory diseases
- Respiratory tuberculosis
- Other heart diseases
- Some diseases affecting the reproductive and urinary systems
It was also found that nine of the top 10 leading causes of mortality in the country resulted in more fatalities in 2023 than in 2022. The only exception is pneumonia, which claimed slightly fewer lives in 2023.
PhilHealth is requesting a total budget of P74.432 billion for 2025, a 21% increase from this year's allocation of P61.515 billion.
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