PhilHealth’s Top 10: Claims mostly for hemodialysis

MANILA, Philippines — Coverage for hemodialysis treatments accounted for the biggest share of claims made at the Philippine Health Insurance Corp. (PhilHealth) during the first six months of the year, amounting to P48.76 billion.

In a report posted on its Facebook page on Friday, PhilHealth said the kidney treatment was the highest among the top 10 procedures in terms of claims payment as of June.

Second was cesarean section, for which PhilHealth paid P4.88 billion; followed by chemotherapy sessions that amounted to P3.5 billion.

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For facility-based emergencies, PhilHealth paid P3.15 billion, while for intensity modulated treatments, the state-run insurer had them covered to the tune of P3.11 billion.

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Other procedures included in the list were animal bite treatments at P2.93 billion, followed by expanded newborn package, P2.81 billion; normal spontaneous delivery package, P2.73 billion; outpatient HIV/AIDS package, P2.46 billion; and maternity care package, P2.24 billion.

Medical cases

In another post on Thursday, PhilHealth listed the top 10 medical cases with the biggest share of claims payment from January to June this year.

Topping this list was community acquired pneumonia 3, which accounted for P12.76 billion in claims payment.

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Community-acquired pneumonia refers to cases where a person acquires the disease in the community, not inside the hospital.

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Cerebral infarction, or stroke, accounted for the second-largest share in claims payment, with PhilHealth paying a total of P2.76 billion. It was followed by acute gastroenteritis with P1.96 billion, dengue with warning signs with P1.78 billion, and urinary tract infection with P1.6 billion.

Other medical conditions included in the list were Stage 2 hypertension, which accounted for P1.1 billion in claims payment; chronic kidney disease stage 5, at P1.05 billion; bronchial asthma, P978.18 million; malignant hypertension, P975.2 million; and acute gastritis, P910.34 million.

‘Z benefits package’

PhilHealth also reported its payment of around P1.82 billion for its “Z benefits package” claims as of June this year, benefitting 34,268 members. The Z package is intended for patients with severe conditions that require expensive and long-term treatments.

Based on the PhilHealth website, some of the conditions covered under the Z package include acute lymphocytic/lymphoblastic leukemia, with a coverage of up to P500,000; breast cancer, up to P1.4 million; and prostate cancer, up to P100,000.

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In total, PhilHealth said it has paid P210.09 billion in benefit claims as of June. /cb