Lawmakers urge PhilHealth to review primary care benefit package

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Metro Manila (CNN Philippines, August 24) — Two members of the House of Representatives have asked the state health insurer to revisit its primary care benefit package, dubbed Konsulta, after noting that the program has a "very dismal" number of beneficiaries and few participating doctors.

During a House hearing Tuesday on the implementation of Universal Health Care law and other health policies, Rep. Helen Tan said that some medical facilities find it difficult to convince doctors to participate in the Philippine Health Insurance Corp. (PhilHealth) program, possibly because of professional fee issues.

Tan said that PhilHealth pays P500 per capita to health facilities authorized to offer the Konsulta package, and it is up to them how much will be set aside for a doctor's professional fee.

"Ang feedback ng mga health facilities, wala silang makitang (According to feedback from health facilities, they cannot find) doctors who will participate in the program. And maybe that is the reason why currently, very few ang nag-participate sa inyong (have participated in your) program on Konsulta package," she told PhilHealth officials.

Konsulta so far has 118 accredited healthcare providers, with 30,084 registered beneficiaries, including 7,709 dependents, PhilHealth spokesperson Shirley Domingo said in the same hearing.

Rep. Stella Quimbo said this translates to a 0.027% coverage rate, which she described as a "very dismal number, considering that the [universal health care] law provides that every Filipino must be registered to any public or private primary care provider."

In response, Domingo said the registration documents of other beneficiaries were being validated.

Domingo also said: "The ratio we envisioned for a primary care provider to the population is 1:20,000, and therefore, we need 5,500 healthcare providers for the Konsulta."

This prompted Quimbo to ask PhilHealth to review the Konsulta package, saying this ratio implies that each doctor has to take care of 55 patients a day for one year, which is "way too much."

She said: "I think it has to be reviewed because that means seeing 55 patients only for PhilHealth kasi (because) doctors have other things to do, right?"

"Sana po ma-review natin (I hope we can review this) for a more realistic planning and rollout of Konsulta," she added.

PhilHealth officials said they will conduct a review as requested.

"We will be reviewing the package by the end of the year, and we will see if there is a need for adjustment," Rizza Herrera, PhilHealth's Quality Assurance Group vice president said.

She added they are already gathering information on how to improve the program's services.