PhilHealth bares higher utilization of claims and benefits
The Philippine Health Insurance Corporation (PhilHealth) said that utilization of claims and benefits by indigent and sponsored members under the PhilHealth program increased tremendously this year.
In a quarterly “Kapihan with the PCEO” held on Friday at the City State Tower Hotel in Pasig City, PhilHealth President and CEO Alexander Padilla said that 32 percent or one-third (1,210,668) of such claims from the sector belonging to indigent or non-paying and sponsored members were processed from Jan. 1 to June 30, 2015.
“In terms of percentage distribution in claims processing, we are now averaging about 1.2 million claims coming from the National Household Targetting System (NHTS) and sponsored groups as compared to an overall claim of 3.8 million,” he said.
Padilla noted that claims and benefits utilization among lifetime members had also increased.
He said they are happy to note that the level of utilization of PhilHealth package of benefits among the poor sector is now in an upward trend.
“That is why we are encouraging more utilization in 2015 and we hope to continue it in the coming years,” the PhilHealth official added.
He noted that information dissemination on the advantages of PhilHealth membership has somehow contributed to the increase in number of benefits and claims utilization among the poor.
Indigent or poor and near-poor PhilHealth members are identified under the NHTS of the Department of Social Welfare and Development (DSWD).
Their premium contributions are paid under the Sin Tax revenues collected from tobacco and alcohol products.
The indigent or poor sector includes indigent senior citizens who have less in life and cannot afford the high cost of treatment in hospitals and are the ones that should reap the benefits of taxes collected from cigarette and alcohol products.
Sponsored PhilHealth members, on the other hand, are those whose premium contributions are shouldered by the local government units (LGUs) and private institutions as part of their corporate social responsibility.
This sector enjoys “no balance billing” once admitted in government hospitals accredited by PhilHealth.
As of June 2015, Padilla said that nine out of 10 Filipinos are already covered with PhilHealth.
This translates to 89.4 million members, including their qualified dependents, or 88 percent of the projected Philippine population of 100 million.
“PhilHealth paid more than P44 billion in the first six months of this year. If the trend continues, we will be paying roughly around P88 billion for this year as compared to around P78 billion last year,” Padilla said.
About P55 billion went to benefit payments in 2013 and P44 billion in 2012.
In comparison, the P44 billion benefit payments in the first six months of this year was equivalent to the P44 billion benefit payments in 2012, or four years ago.
About P43.43 billion budget for PhilHealth was approved for 2016 compared to P37.03 billion this year.
PhilHealth’s projected collection for 2016 is P105.3 billion. (PNA)