The Philippine Health Insurance (PhilHealth) has expanded the coverage of its benefit packages for heart diseases by as much as 1,629%. The enhanced benefit packages have come into effect from 2 January 2025. The details have been notified vide its circular 2024-0032 issued on 21 December 2024.
Cardiovascular diseases are the top cause of death in the Philippines. According to the Philippine Statistics Authority (PSA) during 2023 ischemic heart disease was the top killer with 85,192 cases or 19% of total deaths in the country during the period January – September 2023.
Under the expanded scheme for inpatient admissions, Filipinos with ischemic heart disease — a condition caused by reduced blood flow to the heart — and acute myocardial infarction, or heart attacks, can now avail of increased coverage under two enhanced benefit packages.
The reimbursement rate for percutaneous coronary intervention, a non-surgical procedure to clear blocked arteries and remove plaque buildup, has been raised to PHP523,853 ($9021) — about 17 times higher than the previous coverage of PHP30,300.
Patients may avail of this procedure at any of the 70 accredited Cath labs in the country.
The second enhanced package covers fibrinolysis, a treatment for dissolving blood clots. It now has a case rate of PHP133,500, or a 341% increase from the previous amount of PHP30,290.
The state insurer also increased the benefit package for emergency medical services with coordinated referral and interfacility transfers to PHP21,900 and cardiac rehabilitation to PHP66,140.
The total value of the benefit packages covers both the payment to the healthcare institution and the fees for healthcare professionals. Benefit packages also cover services such as emergency care, medications, laboratory tests, medical supplies, equipment and other administrative fees.
They will apply to accredited public and private health facilities classified as levels 1 to 3, equipped to provide the necessary medical treatments and procedures. The levels correspond to the range of services each hospital can offer.
PhilHealth President Emmanuel Ledesma Jr. hope this will assist patients, including those who suffered from heart disease during the 2024 holiday season, following a reported rise in cases by the Department of Health (DOH).
The health maintenance organisation in Philippines chalked up losses of PHP4.269bn ($75m) in 2023, nearly triple the losses of PHP1.433bn in 2022, due to a substantial increase in claims and benefits paid, says a report released by WTW, a leading global advisory, broking and solutions company.
WTW, in one of its its Global Medical Trends Survey report has stated that medical claims frequency has significantly rebounded, now surpassing the pre-pandemic levels of 2019, with the cost per claim rising primarily due to higher costs of medical services and procedures.