Cayetano slams outdated PhilHealth rates, calls for action on No Balance Billing policy

PHILIPPINES, November 21 - Press Release
November 21, 2024

Cayetano slams outdated PhilHealth rates, calls for action on No Balance Billing policy

Senator Alan Peter Cayetano on Wednesday criticized the outdated Philippine Health Insurance Corporation (PhilHealth) packages, which he said no longer account for high inflation and rising healthcare costs.

Cayetano directly raised this issue with Health Secretary Teodoro Herbosa during the Senate plenary debate on the Department of Health's (DOH) 2025 budget in the early hours of November 20, 2024, arguing that the government's commitment to a No Balance Billing policy had not been fulfilled.

"As Health Secretary and PhilHealth chairman, you should know this issue. When was the last time na nagkaroon ang PhilHealth ng comprehensive survey para sa case rates?" Cayetano asked Herbosa at the plenary floor.

Herbosa replied that the survey was last accomplished a decade ago. In response, Cayetano said, "Napag-iwanan na tayo ng presyo... I envy 2013 and 2014 where the case rates were close to the real price and people actually started believing in No Balance Billing. But now it's a joke!"

The senator also scored PhilHealth for increasing its coverage rates by 30 percent earlier this year despite having an P89-billion excess fund, which he said could have been used to implement the No Balance Billing policy.

"The idea is that if I'm a patient and my treatment is covered by the case rate, I shouldn't have to pay anything extra. I should be able to use my PhilHealth and go in and out of the hospital with no additional charges," he said.

"But because the case rates are outdated, No Balance Billing is almost impossible," he added.

Cayetano also pressed the DOH's increased allocation of funds for the Medical Assistance to Indigent Patients (MAIP) when the department has stated that its priorities are to address the low rates of immunization, stunting of children, and maternal mortality.

He also lamented how the current DOH budget reflects more of the opinion of politicians rather than of scientists and doctors.

"Napopoliticize tayo. Politicians would rather have patients ask for help at may maibigay sila. Pero kung aayusin ang presyo (sa PhilHealth) at No Balance Billing, hindi na natin kailangan ng ganyang kalaking MAIP. The technocrats and doctors shouldn't see it that way. You should fix it," he said.

Cayetano urged Herbosa to update the PhilHealth case rates to reflect current healthcare costs and to shift focus from increasing MAIP funding to ensuring the effectiveness of No Balance Billing.

"You are the Secretary of Health and Chairman of the PhilHealth board. If you move the PhilHealth board to do the survey for case rates, kung aayusin natin sa taong ito, it's going to be less hassle for everyone," the senator told Herbosa, who agreed to look into the matter.

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Cayetano pinuna ang 'outdated' rates ng PhilHealth, nanawagan ng aksyon sa No Balance Billing policy

Pinuna ni Senador Alan Peter Cayetano nitong Miyerkules ang "outdated" o luma nang packages ng Philippine Health Insurance Corporation (PhilHealth) na aniya'y hindi na angkop sa mataas na inflation at tumataas na gastos sa pangangalagang pangkalusugan.

Direktang inilabas ni Cayetano ang isyung ito kay Health Secretary Teodoro Herbosa sa plenary debate ng Senado tungkol sa 2025 budget ng Department of Health (DOH) noong madaling araw ng Nobyembre 20, 2024.

Giit ng senador, hindi natutupad ang pangako ng gobyerno sa No Balance Billing policy.

"As Health Secretary and PhilHealth chairman, you should know this issue. When was the last time na nagkaroon ang PhilHealth ng comprehensive survey para sa case rates?" tanong ni Cayetano kay Herbosa sa plenary floor.

Sumagot si Herbosa na isang dekada na ang lumipas mula nang huling isinagawa ang survey.

Tugon naman ni Cayetano, "Napag-iwanan na tayo ng presyo... I envy 2013 and 2014 where the case rates were close to the real price and people actually started believing in No Balance Billing. But now it's a joke!"

Pinuna rin ng senador ang PhilHealth sa pagtaas ng coverage rates nito ng 30 porsyento ngayong taon sa kabila ng pagkakaroon ng P89-bilyong sobrang pondo, na aniya'y maaaring nagamit upang maipatupad ang No Balance Billing policy.

"The idea is that if I'm a patient and my treatment is covered by the case rate, I shouldn't have to pay anything extra. I should be able to use my PhilHealth and go in and out of the hospital with no additional charges," wika niya.

"But because the case rates are outdated, No Balance Billing is almost impossible," dagdag niya.

Idiniin din ni Cayetano ang pagtaas ng alokasyon ng pondo ng DOH para sa Medical Assistance to Indigent Patients (MAIP) sa kabila ng pahayag ng departamento na ang mga pangunahing prayoridad nito ay tugunan ang mababang antas ng pagbabakuna, stunting o pagkabansot ng mga bata, at maternal mortality.

Dismayado din aniya siya na mas pinapakita ng kasalukuyang budget ng DOH ang opinyon ng mga politiko kaysa sa mga siyentipiko at doktor.

"Napopoliticize tayo. Politicians would rather have patients ask for help at may maibigay sila. Pero kung aayusin ang presyo (sa PhilHealth) at No Balance Billing, hindi na natin kailangan ng ganyang kalaking MAIP. The technocrats and doctors shouldn't see it that way. You should fix it," wika niya.

Hinikayat ni Cayetano si Herbosa na i-update ang PhilHealth case rates upang masalamin ang kasalukuyang gastos sa healthcare at ilipat ang pagtuon mula sa pagtaas ng pondo para sa MAIP patungo sa pagtiyak ng pagiging epektibo ng No Balance Billing.

"You are the Secretary of Health and Chairman of the PhilHealth board. If you move the PhilHealth board to do the survey for case rates, kung aayusin natin sa taong ito, it's going to be less hassle for everyone," diin ng senador hay Herbosa, na sumang-ayong pag-aaralan ang isyu.