The PCCP hosted a meeting with the Philippine Health Insurance Corporation (Philhealth) represented by Dr. Galvez and Mr. Balaoing last April 6, 2013. In attendance were Dr. Vince Balanag, and Council heads: Dr. Trinidad (COPD), Dr. Tanchuco (OILD), Dr. Samson (DATS) , Dr.Nolido (Lung Infections), Dr. Tan (Lung Malignancies) and myself. The goals of the meeting were as follows:
- To discuss the concept of Universal Health care (UHC) also known as Kalusugan Pangkalahatan (KP)
- To be updated regarding Philhealth Reimbursement Schemes
- To review the present state of case rate schemes for the top respiratory conditions
The meeting concluded with the following policies understood by those in attendance:
- The UHC or KP is of utmost importance to promote quality of care for all, including the underserved or “poorest of the poor.” It also recognizes the importance of improving the efficiency of payment for healthcare providers, which includes the hospital facility and the medical doctor.
- The No Balance Billing Policy (NBB) will be applied to patients who:
- Have an income of <7,000 pesos/month
- Are admitted to government hospitals
- Are admitted to the ward
All these must be present, to apply.
- We are moving from Fee for service to Case Rate Packages or Partial case rate Packages where co-payment by the patient is added.
- Combination of Medical Case Rates – New forms for the CF2 will be released soon
- For the Primary or Main Condition, 100% Case Rate will be applied
- For the Secondary Condition, not more than 50% of the case rate will apply
- Remind all members to update their Philhealth Accreditation status
- Through the councils:
- Review the case rates and make suggestions/proposals for adjustments, if any, for the 5 respiratory conditions listed among the Top 20 medical conditions in the Philippines
- Prepare the Qualifier Form for the 5 conditions:
- Pneumonia – moderate risk and high risk
- Lower respiratory tract infection
- Pulmonary Tuberculosis
- Chronic Obstructive Pulmonary Disease
- I propose that, as a collegial body, we will endorse and support the Universal Health Care or Kalusugan Pangkalahatan.
The PCCP will do the following:
Please review the attached document and inform the Secretariat of any comments or suggestions.