MANILA, Philippines – The Philippine Health Insurance Corporation (PhilHealth) is set to pay its Konsulta package providers up to P750 per patient annually, the Department of Health (DOH) announced on Monday, January 19.

This is meant as a boost for the facilities to provide primary care to Filipinos without having to wait for reimbursements.

The Konsulta package is PhilHealth’s primary healthcare program that makes consultation, laboratory tests, and medicines available to the agency’s members.

In his first press conference as DOH chief, recently appointed Secretary Ted Herbosa signed the agency’s service level agreement with PhilHealth on Monday, with both parties identifying the five local government units (LGUs) and two private sector groups of clinics and doctors that would form the first seven primary care networks (PCNs) in the country.

Around two million Filipinos across Bataan, Guimaras, Quezon, South Cotabato, and Baguio City are included in the new PCNs. Meanwhile, 300,000 Filipinos under the care of the LiFE group and QualiMed will benefit from the program.

Under the new setup, PhilHealth will pay a P500 and P750 capitation fee per registered patient in public and private Konsulta package providers, respectively, every year. For providers in the public sector, the P500 serves as a top-up amount on what the local government would provide.

Marikina 2nd District Representative Stella Quimbo, who was also present in Monday’s press conference, further explained that the capitation fees would still be spent for each person registered in the PCN even if not every person will avail themselves of services.

“The P500 spent for that person [who did not get sick or avail himself of primary health services] will still be given to the health center. Why? Because they will use it for those who do get sick…and, in actuality, P500 is not enough,” said Quimbo in a mix of English and Filipino.

PhilHealth typically operates on a reimbursement setup, where services are rendered first, and then institutions charge PhilHealth for payment.

“The important thing is we have created a system to pay before [service-rendering]. This is what we are celebrating today…. It’s better, because imagine if you get a cold or cough, and that’s only [the time] when you go to PhilHealth – ‘I had a check-up, can you please reimburse me?’ That’s hard. But here it’s like you are enrolled for the entire year,” said Herbosa in a mix of English and Filipino.

The DOH calls the arrangement with the PCNs a “sandbox” or on testing basis by allowing advanced payments before services are rendered, which Herbosa claims the Commission on Audit (COA) has cleared. The seven PCNs catering to 2.3 million Filipinos are projected to be paid around P1.2 billion, which can be used to improve infrastructure, equipment, and staff compensation, the DOH said in a release.

Included services, medicines

Primary care includes the following services:

• Consultation and case management for conditions that “can be managed by a primary care physician and team”
• Provision of individual health education
• Assisting beneficiaries in accessing services in subcontracted or partner facilities
• Referral to specialty and higher-level care institutions

The following laboratory and diagnostic examinations may be provided by Konsulta providers, as needed:

• Complete blood count
• Urinalysis
• Fecalysis
• Sputum microscopy
• Fecal occult blood
• Pap smear
• Lipid profile (cholesterol, triglycerides, HDL cholestorol)
• Fasting blood sugar
• Chest x-ray
• Creatinine
• Hemoglobin A1C

Meanwhile, the Konsulta package may provide the following drugs and medicines as needed:

• Anti-microbial:
  • Amoxicillin
  • Co-Amoxiclav
  • Nitrofurantoin
  • Ciprofloxacin
  • Clarithromycin
• Fluid and electrolytes:
  • Oral rehydration salts
• Anti-asthma:
  • Prednisone
  • Salbutamol
  • Fluticasone + Salmeterol
• Anti-pyretics:
  • Paracetamol
• Anti-diabetic:
  • Gliclazide
  • Metformin
• Anti-dyslipidemia:
  • Simvastatin
• Anti-hypertensives:
  • Enalapril
  • Metoprolol
  • Amlopidine
  • Hydrochlorothiazide
  • Losartan
• Anti-thrombotics:
  • Aspirin
• Anti-histamine
  • Chlorphenamine

Herbosa said that PhilHealth shelling out more money for primary care would help ease the burden of hospitals.

“Kasi kung naggagamot ka, kung nag-chronic medicines ka, eh hindi ka mai-stroke, hindi ka maha-hypertension, at maa-ICU (intensive care unit), which is more expensive,” he said. (Because if you’re taking chronic medicines, then you won’t get a stroke, you won’t get hypertension, and you won’t have to go to the ICU, which is more expensive.)

The Universal Health Care Act mandates the DOH and LGUs to ensure that every Filipino has access to a primary care doctor assisted by other health workers.

PhilHealth has faced corruption allegations in the past. In February, The Supreme Court affirmed the COA ruling disallowing the grant of P15.2 million worth of unauthorized benefits to PhilHealth employees, as they were flagged as irregular expenditures.

Representative Quimbo said on Monday that ensuring registered beneficiaries would serve as a safeguard in the new program. – Rappler.com