Amid concerns over its funding for 2025, the Philippine Health Insurance Corporation (PhilHealth) has approved a 50% adjustment in the case rates of selected medical benefits to reduce out-of-pocket expenses for its members.
According to Circular 2024-0037, the adjustment applies to accredited health facilities and PhilHealth regional offices nationwide. Among the medical cases covered are urinary tract infections (UTI), acute gastroenteritis, influenza, cholecystectomy, and craniotomy.
However, certain cases such as acute stroke, high-risk pneumonia, neonatal sepsis, severe dengue, ischemic heart disease, and COVID-19 are excluded as they are being rationalized separately. Z Benefits packages and newly approved benefit packages are also excluded as they undergo re-costing and adjustments.
PhilHealth stated that the adjustments aim to increase financial risk protection, reduce out-of-pocket payments, and ensure the effective delivery of quality health services. These new rates will apply to hospital admissions starting January 1, 2025.
The move comes as the bicameral conference committee rejected PhilHealth’s proposed ₱74 billion subsidy for 2025, urging the agency to utilize its ₱600 billion in excess funds instead. Currently, the National Health Insurance Program (NHIP) covers less than 40% of total hospital service costs, highlighting the need for improved financial support for members.