doh z package

7/28/2019 DOH Z Package

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WHAT IS A CATASTROPHIC ILLNESS? WHY THE NEED FOR A BENEFIT PACKAGE?

MEDICAL CATASTROPHEA condition or disease

state that can lead to

disability or death.

ECONOMIC CATASTROPHEWhen the cost of care is

too high that patients

affected are pushed into

poverty.

CATASTROPHIC ILLNESSFor the purpose of

benefits development,

defined as both medically

and economically

catastrophic.

Yearly, the Philippine Health Insurance Corporation (PhilHealth) pays about 7 billion in premiumpayments for catastrophic diseases categorized as type C and D. However, support value remains

low. Thus, in line with its goals of financial risk protection for all Filipinos, PhilHealth is developingan initial set of benefits that comprehensively cover catastrophic conditions.

7 billion

Lack of reliableinformation onincidence rates

Limited financialresources of theNational HealthInsurance Program

Limited availability of equipment andfacilities, and of healthcare workers with thespecialized skills and knowledge necessaryto providing the services required to achieve

the desired health outcomes.

The country has thescience and facilitiesto address theconditionsconsideredcatastrophic

Identifiedconditions havehigh or acceptablesurvival rates aftertreatment withlocally-validatedprotocols

WHAT ARE THE DIFFICULTIES INDEVELOPING THE BENEFIT PACKAGE?Challenges encountered during benefitsdevelopment are:

WHAT WERE THE PROPOSED ANDAPPROVED INITIAL BENEFITS?Based on the following premises:

PhilHealth can negotiate for No BalanceBilling for sponsored members (those withno capacity to pay) and a fixed co-payment

for non-sponsored program members(those with capacity to pay).

THE Z BENEFIT PACKAGE OF PHILHEALTHsynopsis of the PhilHealth Catastrophic Benefit: Case Type Z


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WHAT WERE THE PROPOSED AND APPROVED INITIAL BENEFITS?The following are the first set of PhilHealth catastrophic benefits, with the

corresponding package cost and entitled services

Disease/Condition Cost Entitled Services

EARLY STAGEBREAST CANCER(Stage 0-3a)

PHP 100,000

PHP 100,000

PHP 210,000in 3 years

Standard riskCHILDHOOD ACUTELYMPHOBLASTICLEUKEMIA ALL

Low to intermediate riskPROSTATE CANCER

Cardiopulmonary (CP) clearanceand surgery, the whole session ofchemotherapy, and radiationtherapy (if necessary)

Complete course of chemotherapy,essential laboratories, and bloodsupport

CP clearance and surgeryand other laboratories,hormone therapy or radiationtreatment (if indicated only)

WHY THE AFOREMENTIONED DISEASES AND WHY ONLY THOSE SPECIFIC STAGES?

WHY DO WE NEED THE COPAY?

As the fund manager of the National Health Insurance Program, PhilHealthmust efficiently and effectively use the funds to cover the most number ofbeneficiaries. As such, only diseases that have around 80% chance of 5-yearsurvival have been included in the initial set of benefits. In the next months,PhilHealth shall continue to expand the diseases covered under this benefitpackage.

Since the contracted facilities must ensure No Balance Billing for all sponsoredprogram members, they will need to recoup any losses they might encounter.As such, for non-sponsored program members, facilities shall be allowed tochange fixed negotiated rate as co-payment.

PhilHealths reserve funds have gone down to Case Type Z shall cost the corporation

HOW MUCH WILL THE ENTIRE COVERAGE OF THE SAID ILLNESSES COST PHILHEALTH?

which will be charged to

the reserve funds.

3 billion90 billionfrom 107 billion pesos

2 years ago


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HOW MUCH WILL THE ENTIRE COVERAGE OF THE SAID ILLNESSES COST PHILHEALTH?

COST PER PACKAGE TARGET NO. OF CASES TOTAL COSTBreast Cancer Php100,000 10,000 Php1 billionChildhood Leukemia Php210,000 1,000 Php210 millionProstate Cancer Php100,000 1,000 Php100 million

WILL THE SAID BENEFIT BE AVAILABLE IN ALL PHILHEALTHACCREDITEDINSTITUTIONAL HEALTHCARE PROVIDERS IHCPS?

WHO CAN AVAIL?

WHY IS IT CALLED THE Z BENEFIT?

Since not all IHCPs have the heathcare workers and the equipment esssentialto providing specialized care to cancer and transplant patients, the said benefitswill not be available in all IHCPs. Moreover, not all IHCPs are willing to applyNBB for the sponsored members or negotiate co-payment at a fixed rate notexceeding the package cost.

Thus, in the initial implementation,

In the alphabet of PhilHealth case types for diseases, disease conditions are classified from type A to D.

Any and all eligible PhilHealth members or their qualifieddependents that shall be admitted to the designated

rooms in the identified hospitals may avail.

have been contracted to provide the services. Eventually, this set of providersshall be expanded.

22 GOVERNMENT HOSPITALSINSTITUTIONALHEALTH CARE

PROVIDERS IHCPS

Thus, case type Z describes the disease conditions at the far end of thespectrum. However, as mentioned, the set of benefits for Case Type Z willhighlight the need for continuity of care and better outcomes.

The simplest andcheapest conditions.

The more severe andcostly conditions.

doh z package

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