The Philippine Health Insurance Corporation (PhilHealth) plans to expand its coverage to include additional laboratory tests and early disease detection programs starting next year. PhilHealth President and Chief Executive Officer Edwin Mercado outlined these upcoming benefit enhancements and ongoing reforms aimed at streamlining patient care from primary health centers to hospital admissions.

Under the YAKAP (Yaman ng Kalusugan Program), the state insurer is working to bridge services between primary care and hospital admission. The expanded coverage for blood tests will include tests for kidney, liver, and thyroid diseases, as well as hepatitis B.

Mercado noted that the agency is integrating preventative interventions, such as smoking cessation medications, to address root causes before conditions escalate into severe illnesses like lung cancer.

Expanded support for developmental disabilities

Following an announcement by President Ferdinand R. Marcos Jr. to double the PhilHealth package for children with developmental disabilities, Mercado confirmed that maximum coverage for therapy sessions will increase significantly. Mercado cited data showing an increase in the prevalence or incidence of developmental disabilities, including autism and cerebral palsy, which he noted may stem from environmental changes.

To address these needs, PhilHealth is expanding coverage for occupational therapy, physical therapy, consultations with developmental pediatricians and child psychologists, and increasing therapy sessions from 90 to 150 maximum per year.

Growth in beneficiaries and provider accreditation

PhilHealth reported that beneficiary families increased from over 5 million in 2022 to more than 7.5 million recently. This growth was driven by improved public awareness and expanded healthcare provider networks. Mercado explained that the expansion of Z-Benefit packages for catastrophic illnesses helped encourage more hospitals to seek accreditation.

To support this expansion, PhilHealth has reduced claim processing times for hospitals and healthcare providers from a previous range of 45 to 60 days to the current 15 to 18 days.

Future initiatives and sustainability

Moving forward, PhilHealth is engaging private hospitals to expand the no balance billing scheme. This involves negotiating dedicated basic accommodation spaces so that patients do not have to pay out-of-pocket expenses.

Mercado urged active PhilHealth members to continue their contributions to maintain program sustainability through social solidarity.