Catastrophic hospitalization

After reading about my three days in the ICU, a good friend sent me this email to share her family's catastrophic experience with a private hospital: "When my father recently suffered a stroke and was hospitalized, I saw firsthand the systemic failures that every Filipino family faces when serious illness strikes. So let me lay them out clearly, with the hope that this message reaches those in power.

- CITO BELTRAN

#1: Outdated PhilHealth policies that undermine the spirit of UHC. When a patient is confined for an extended period due to a stroke and develops complications, the current policy is shockingly rigid: PhilHealth only pays for the illness with the highest case rate, ignoring all other treatments.

Imagine a stroke patient who also develops pneumonia and undergoes catheter placement, tracheostomy or dialysis. PhilHealth will only pay P76,000 to P80,000—the case rate for stroke—even though each of those procedures has its own case rate. For long-term hospitalization of over two months that could cost P3M-5M, this is a devastating blow, similar to the experience of Supreme Court Justice Lopez, who revealed that PhilHealth covered only P50,000 of his P7M bill.

The Philippines has one of the highest out-of-pocket (OOP) health care spending rates in Asia—45 percent, compared to the global average of 16.3 percent, Indonesia's 28.6 percent and Thailand's 7.7 percent. In our case, we didn't just pay 45 percent; we paid 98 percent.

PhilHealth benefit packages are still grossly inadequate for catastrophic illnesses. What if PhilHealth allowed multiple condition claims and simply capped the total benefit—say, at P500,000—to prevent abuse?

The PhilHealth circular no. 0031, S. 2013, specifically highlights that for patients with multiple medical conditions, co-morbidities or requiring multiple procedures per confinement, PhilHealth shall endeavor to pay for all admissible medical conditions and/or procedures subject to the limits as set by the PhilHealth Board. Therefore, the Board has the authority—it just needs the will.