PhilHealth to broaden primary care, NBB policy

The Philippine Health Insurance Corporation (PhilHealth) is moving to expand primary care services and strengthen financial protection for members through wider implementation of its No Balance Billing (NBB) policy under a unified agenda with the Department of Health (DOH).

At a press briefing Thursday, PhilHealth President and Chief Executive Officer Beverly Ho said the Unified National Agenda (UNA) is focused on improving health outcomes, increasing access to healthcare facilities and expanding benefit packages for Filipinos.

“Our job now is to ensure that we continue to progress by increasing access points, improving benefit packages, and ensuring that every member receives quality care,” Ho said.

She said PhilHealth would build on existing gains rather than start over, with greater focus on implementation and addressing concerns raised by members, physicians and healthcare providers.

Ho outlined five priorities under the shared agenda with the DOH: bringing primary care services to schools and workplaces; integrating public health programs into primary care; expanding NBB to ease concerns over hospital costs; streamlining DOH and PhilHealth processes through a unified information technology system; and strengthening the organization through a smooth reorganization, fair compensation and greater responsibilities for health workers.

For children with developmental disabilities, Ho said PhilHealth is enhancing its benefit package and increasing the number of therapy sessions.

Implementation is expected within the year after PhilHealth revalidates the package’s original 2017 costing with healthcare professionals to ensure that reimbursement rates remain adequate.

PhilHealth is also working with the Department of Education and the Department of Social Welfare and Development to streamline referrals and facilitate therapy sessions in selected schools, Ho said.

Meanwhile, 21 medicines currently covered under the Yaman ng Kalusugan (YAKAP) program will be transferred to the Gamot program, integrating them into the annual ₱20,000 benefit under the Guaranteed and Accessible Medications for Outpatient Treatment (GAMOT) program.

Ho also stressed the need to ensure that higher benefits translate into real value for members without triggering increases in healthcare prices.

PhilHealth, she said, will work closely with healthcare providers to ensure that members see tangible benefits from their contributions and that participation in the national health insurance program remains consistent.