ABOUT 25 percent of Philippine Health Insurance Corp. (PhilHealth) payouts go to dialysis, its acting president and CEO, Dr. Beverly Lorraine Ho, said during the signing of a memorandum of understanding between the state-run health insurer and health maintenance organizations on Thursday, Oct. 1.
“Twenty-five percent of what we spend in terms of payout goes to dialysis,” Ho said, referring to around P400 billion in total disbursement.
Roughly P100 billion, she added, accounts for dialysis.
Ho said early treatment of hypertension and diabetes could help prevent kidney disease requiring dialysis.
“So we don’t need to spend P100 billion plus just for dialysis,” Ho added, noting regular dialysis procedures hinder a patient’s ability to work.
“Granted, their PhilHealth coverage makes it free, but because they undergo dialysis four times a week, they can no longer work. Not productive in their own way,” she added.
Ho described PhilHealth’s investment in primary care as a “strategic bet” for the long-term sustainability of the PhilHealth fund.
Asked whether PhilHealth had a target for reducing beneficiaries’ out-of-pocket expenses under the new benefit-complementation framework, Ho said the impact would vary depending on the patient’s condition.
“I think this is really case-to-case. It really depends on what the condition of the patient is,” Ho said in Filipino and English.
She said reducing out-of-pocket expenses is only one part of the intended impact, alongside preventing costly illnesses and helping patients remain productive.
Under the PhilHealth Yakap-HMO/PHI Benefit Complementation initiative, PhilHealth will provide initial coverage for primary care through Yakap, while private insurers may cover eligible expenses beyond the PhilHealth package.
Yakap covers consultations, 13 laboratory tests, selected outpatient medicines under the Gamot package and outpatient services for six cancer screening tests.
