imyeyes-banner-sqIn My EyesBy Edward B. Antonio

Philhealth and Tolentino Hospital (Part I)

One of the best government programs on health is membership to the Philippine Health Insurance Corporation (PHIC) or more popularly known as Philhealth.

What’s this Philhealth, fellas?

Created in 1995, Philhealth is a tax-exempt, government-owned and controlled corporation (GOCC) and is attached to the Department of Health. Its goal is to “ensure a sustainable national health insurance program” for all. In 2010, it claimed to have achieved “universal” coverage at 86% of the population. This social insurance program provides a means for the healthy to pay for the care of the sick and for those who can afford medical care to subsidize those who cannot.

In 2010 and 2015, reform efforts were outlined to make decentralization and health insurance work more effectively, including an expanded government subsidy for the enrollment of the poor.

Since 1996, the benefits package and delivery system have improved. Philhealth now has an Outpatient and Diagnostic Package limited to indigent beneficiaries. This addition creates nearly comprehensive coverage for indigents. Some key reform indicators to date include: estimated coverage is 100% as of June 2013 and that average period for payment of providers is estimated at 70 to 75 days. The law requires Philhealth to reimburse providers and/or members within 60 days. A recent move as of December 1, 2009, implemented a “simplified reimbursement scheme” wherein 95% of the claims amount is reimbursed after a rapid assessment of member and provider eligibility and the remaining 25% follows after detailed review of the claims.

On average, 90 out of every 100 claims are paid; 3 to 4 are denied; 6 to 7 are returned to health care providers for more information; 28% of claims were submitted by public providers and 72% by private providers.

Philhealth and beneficiaries have access to a comprehensive package of services, including inpatient care, catastrophic coverage, ambulatory surgeries, deliveries, and outpatient treatment for malaria and tuberculosis. Those identified as indigent and OFW are also entitled to outpatient primary care benefits.

Inpatient care includes room and board, medicines, diagnostic and other services, professional fees and operating room services under the “all case rate” payment scheme. The case rate amount will depend upon the final diagnosis and each diagnosis has corresponding fix amount or package.

Outpatient benefits include day surgeries, radiotherapy, dialysis, outpatient blood transfusion, TB-DOTS, malaria treatment, HIV/AIDS treatment, animal bite treatment, cataract operations and vasectomy and tubal ligation.

These are some of the basic info a Philhealth card holder should know, fellas.

Now, you might be wondering why the title of this column includes Tolentino hospital.

This October, a little child was confined to the Tolentino Clinic and Hospital in Sto. Domingo, Ilocos Sur. He had cough, fever and often vomitted whenever he ingested something. He was getting dehydrated. X-Ray results revealed that the child had pneumonia bilateral. His Complete Blood Count (CBC) examination result was normal, so dengue was ruled out. The child’s father is a government employee, hence, the child was covered with Philhealth benefits.

Prior to confinement, the child’s pediatrician prescribed antibiotics for his lingering cough.

“But if the child vomits the medicine, I advise he should be confined,” she said.

Tolentino Clinic and Hospital, the child’s father said, is not that small. It’s a big hospital. It is situated just north of Sto. Domingo Public Market, east of the national highway. It’s a 2-storey hospital with wards and air-conditioned private rooms. It has X-Ray and other medical services.

“The hospital is not congested and is very clean,” he said. “The utility staff regularly cleans the rooms. The private room where we stayed is very nice. It has a table, chair and a long bench. It’s comfort room is very clean and has an ample water supply. It’s a comfortable room. If one is bored inside, he can come out of the cubicle and enjoy the spacious front. Internet signal is great outside the room.”

How about the nurses and staff?

“Very courteous and polite,” he said. “But unlike other private hospitals, the hospital doesn’t serve meals to confined patients, so you have to buy your food outside. But that’s no problem. The town market is almost a stone’s throw away.”

And so, in those 4 days, he and his wife had to buy their food and drinks outside.

“However, the hospital provides a centralized water dispenser there at the nurses’ station, so we did not have problem with our early morning hot water for our coffee. For every glass or mineral bottle of water, payment is voluntary,” he said.

He said that overall, Tolentino Clinic and Hospital is an excellent hospital – clean, fresh, ordely, serene and comfortable.

“It’s more than a home away from home, at least, if you stay there in one of the private rooms, he said.

The child got better day after day. After only a day, he stopped vomitting. He started to take in one of his antibiotics orally. Little by little, his appetite returned to the delight of his parents. Indeed, the child’s doctor, Dr. Benjamin Tolentino is a very good doctor.

After 4 days of confinement, it was time to go home. The staff prepared the necessary papers and billing before the release.

The father expected that if he didn’t get a zero balance, he would just be paying a little amount. As a government employee, he was aware that the Philhealth package for pneumonia is P15,000 for moderate risk and P32,000 for high risk pneumonia.

But it did not turn out to be like this.