Solon wants PhilHealth coverage to include outpatient medical & surgical care

A lawmaker is seeking to expand the benefits under the National Health Insurance Program (NHIP) to cover even outpatient medical and surgical care.

Rep. Scott Davies S. Lanete (3rd District, Masbate), a medical doctor, said his proposal embodied in House Bill 5265 seeks to recognize that the benefits available under the current NHIP are not sufficient to perform PhilHealth’s mandate to provide health insurance coverage to all Filipinos.

Secondly, he said his proposal seeks to provide all citizens of the country with the mechanism to gain financial access to health services.

Thirdly, Lanete said the measure aims to serve as the means to help the people pay for health care service.

Lastly, the measure aims to prioritize and accelerate the provision of health services to all Filipinos, especially that segment of the population who cannot afford such services.

“The approval of the bill will not only aid in the effective implementation of the NHIP but will also make universal care a reality in our country. Pangkalahatang Kalusugan will now become possible,” said Lanete, a vice chairman of the Committees on Poverty Alleviation, and on Public Order and Safety.

Lanete said his proposal is in line with Section II, Article XIII of the 1987 Constitution, declaring that the State shall adopt an integrated and comprehensive approach to health development, which shall endeavor to make essential goods, health and other social services available to all the people at affordable cost. Priority of the needs of the underprivileged, sick, elderly, disabled, women, and children shall be recognized. Likewise, it shall be the policy of the State to provide free medical care to paupers.

House Bill 5265, to be known as the “National Health Insurance Act” and now pending at the Committee on Health chaired by Rep. Eufranio C. Eriguel, M.D. (2nd District, La Union), seeks the amendment of Section 10 of Republic Act No. 10606, otherwise known as the “National Health Insurance Act of 2013,” amending RA No. 7875, otherwise known as the “National Health Insurance Act of 1995,” as amended.

The amendment to Section 10 pertaining to Benefit Package provides that “Members and their dependents are entitled to the following minimum services, subject to the limitations specified in this Act and as may be determined by the Corporation:

(a)  Inpatient hospital care:
(1) room and board;
(2) services of health care professionals;
(3) diagnostic, laboratory, and other medical examination services;
(4) use of surgical or medical equipment and facilities;
(5) prescription drugs and biologicals, subject to the limitations stated in Section 37 of this Act;
(6) inpatient education packages; and
(7) post-inpatient hospital care rehabilitation services.

(b) Outpatient surgical care:
(1) services of health care professionals;
(2) diagnostic, laboratory, and other medical examination services;
(3) personal preventive services;
(4) prescription drugs and biologicals, subject to the limitations described in Section 37 of this Act and
(5) post-outpatient surgical home and rehabilitation services.

(c)  Outpatient medical care:
(1) services of health care professionals;
(2) diagnostic, laboratory, and other medical examination services;
(3) personal preventive services;
(4) prescription drugs and biologicals, subject to the limitations described in Section 37 of this Act and
(5) post-outpatient surgical home and rehabilitation services.

The bill also seeks to amend Section 11 of RA 10606, pertaining to Excluded Personal Health Services. It provides that the benefits granted this Act should not cover expenses for the services enumerated hereunder except when the Corporation, after actuarial studies, recommends their inclusion subject to the approval of the Board:

(a) non-prescription drugs and devices;
(b) out-patient psychotherapy and counseling for mental disorders;
(c) drug and alcohol abuse or dependency treatment;
(d) cosmetic surgery;
(e) optometric services;
(f) normal obstetrical delivery; and
(g) cost-ineffective procedures, which shall be defined by the Corporation.” (Source: Philippines Congress)