EDITORIAL — Higher fees, higher expectations

With no order from President Marcos stopping the move, the Philippine Health Insurance Corp. increased starting this month its members’ premium contributions, from four percent to five percent. The increase is stipulated in Republic Act 11223 or the Universal Health Care Act, affecting members earning between P10,000 and P100,000 a month, according to PhilHealth officials.

Higher premiums mean more funds, which must be used judiciously. The state health insurer has been rocked by a string of scandals in the past years, involving corruption, inefficiency and mismanagement even at the height of the COVID pandemic.

Limited funding prevented the full rollout of the Universal Health Care Act when it was signed in February 2019. The implementation of the UHC was instead scheduled over several years. The full rollout was further slowed down by the funding requirements for responding to the COVID-19 pandemic.

With increased PhilHealth premiums, the full rollout of the UHC can be speeded up. PhilHealth president and CEO Emmanuel Ledesma Jr. said with the increased premiums estimated to amount to P17 billion, the agency intends to increase the benefit package across the board for its 115 million members. The government is also providing limited services for mental health care as well as treatment of HIV / AIDS.

Private hospital operators also hope for the timely release of their reimbursement claims. At the height of the pandemic, the hospitals complained that PhilHealth owed them billions, with smaller hospitals the most burdened during the public health crisis. Technology allows the speedier verification of claims, which should speed up PhilHealth processes and allow hospitals to provide better service.

PhilHealth has stressed that the higher premiums would allow increased financial coverage for members’ hospitalization expenses. Coverage rates may go up by up to 30 percent across all specific medical conditions or surgical operations covered by state insurance.

Last year, PhilHealth had expanded its coverage of dialysis sessions and more than doubled its coverage rates for ischemic and hemorrhagic strokes. An outpatient mental health package was launched in October. In the works are packages for severe acute malnutrition and coverage of targeted therapy for breast cancer.

With the higher premium contributions, PhilHealth must be ready to meet increased public expectations of expanded and improved services.