PhilHealth set to amend 24-hours confinement policy this year

The Philippine Health Insurance Corporation (PhilHealth) will amend its 24-hours confinement policy, or the required minimum hours of hospitalization or confinement of emergency outpatients, by December 2024.

Eli Dino Santos, PhilHealth Executive Vice President and Chief Operating Officer, on Wednesday told senators that the state health insurer is now crafting policies regarding its coverage of emergency outpatient cases without the required minimum number of hours of hospitalization or confinement.

Santos said PhilHealth currently does not cover confinements of less than 24 hours, except for emergency cases or when there is an indication to cover it due to cross-containment and fraud prevention measures.

"If we indiscriminately allow coverage, financial coverage for all visits to the emergency room, this might promote immoral hazard, abuse in short," Santos told the joint hearing of the Senate's committee on health and demography, and committee on finance.

According to PhilHealth Circular 2020-0007, the 24-hours confinement rule refers to "the compensability of a claim based on the required minimum number of hours of hospitalization or confinement for inpatient care in an accredited healthcare institution."

Senator Christopher "Bong" Go, who sits in the Senate committee on health and demography, then asserted that the 24-hours confinement policy is "anti-poor" and "anti-people."

"Itong outpatient services, hindi cino-cover ng PhilHealth? Bakit hindi niyo ito i-cover, napansin ko, kailangan i-admit muna ng isang araw para i-cover ng PhilHealth. Mas gastos 'yun, kasi magbabayad sila sa kuwarto,” he said.

(Are these outpatient services not covered by PhilHealth? Why don't you cover them? I noticed that patients need to be admitted for one day before they are able to avail of PhilHealth. It costs more because they pay for the room as well.)

Go also stressed that a patient would not pretend to be sick and go to the emergency room.

"Majority, almost all ng pupunta sa emergency, may sakit 'yan. Kaya kailangan natin dito, prevention, hindi lumala 'yung sakit, mas maagapan natin 'yung sakit, mas makakatipid ang PhilHealth, at malaking tulong 'yun sa mga ordinaryong miyembro ng PhilHealth," he said.

(Majority, almost all of those who go to the emergency room are sick. What we need here are prevention and medical care before the disease worsens. This is will allow PhilHealth to save more, and that will be a big help to the ordinary members of PhilHealth.)

Go then asked Santos for clarification regarding their timeline for amending their policies.  

"Itong emergency outpatient services, ico-cover na po ito ng PhilHealth? So 'pag pumunta sila sa ospital, hindi na nila kailangan magpa-admit, ng 24 hours para ma-cover ng PhilHealth ang kanilang babayaran sa ospital? Tama ba, ito co-cover na ba bago matapos ang taon?" Go asked.

(Will PhilHealth cover these outpatient services? So when they go to the hospital, they don't need to be admitted for 24 hours before PhilHealth covers their hospital expenses? Is this correct, the coverage policy will be changed before the end of the year?)

Santos then responded in the affirmative, saying "We committed already, and our President and COO have already presented a timeline for this year, and we committed to craft or develop an emergency care package by December of 2024."

Go added that PhilHealth must immediately craft and implement its new policies, as many Filipinos would benefit from this. — VDV, GMA Integrated News