Department of Health (DOH) Secretary Teodoro Herbosa chaired a meeting of the Philippine Health Insurance Corporation (PhilHealth) Benefits Committee (BenCom) on Wednesday, to review a new provider payment mechanism and to improve kidney transplant benefits.
The government’s Universal Health Care (UHC) mandates PhilHealth to shift to paying healthcare providers in advance, using diagnosis-related groupings (DRGs).
DRGs account for additional patient characteristics, apart from other medical diagnoses and procedures performed during the episode of care. The current PhilHealth All Case Rates (ACR) system pays only for the top two most resource-intensive diagnoses or procedures, even if a patient has more than two conditions or needs more than two treatments at the same time. Ralph Harvey Rirao
The BenCom also tackled ways to increase PhilHealth benefit packages for kidney transplantation (KT) and the services needed after a patient undergoes the treatment. The KT benefit package was launched in 2012 and among the first set of catastrophic care packages, the initial package rate has stayed at P 600,000 since then.
“The gold standard of treatment for patients with end-stage renal disease is still a kidney transplant or KT. Post-KT patients have a better quality of life, and are more productive than those kept on hemodialysis,” Herbosa said.
