The Philippine Health Insurance Corporation (PhilHealth) is set to expand its coverage to include additional laboratory tests and early disease detection programs starting next year.

In a Bagong Pilipinas Ngayon interview on Tuesday, PhilHealth President and Chief Executive Officer Edwin Mercado outlined the state insurer’s ongoing reforms and upcoming benefit enhancements aimed at streamlining patient care from primary health centers to hospital admissions.

“Itinatahi namin mula doon sa primary care hanggang doon sa kapag ang pasyente po ay na-hospital, iyong mga uri ng laboratoryong mas magandang ma-cover natin dito po sa YAKAP [Yaman ng Kalusugan Program] (We are bridging services from primary care to hospital admission, ensuring that essential laboratory tests are covered under the YAKAP),” he said.

The expanded blood tests will cover kidney, liver, thyroid diseases and hepatitis B.

He noted that preventative interventions, such as smoking cessation medications, are being integrated to address root causes before conditions escalate into severe illnesses like lung cancer.

In response to President Ferdinand R. Marcos Jr.’s announcement to double the PhilHealth package for children with developmental disabilities, Mercado confirmed that maximum coverage for therapy sessions will increase significantly.

“Sa aming tala, tumataas din iyong prevalence or iyong incidence ng mga developmental disabilities, kagaya po diyan iyong autism, iyon pong cerebral palsy, iyong iba-iba pong mga global disability na maaari pong dulot ng pagbabago po dito sa ating environment (Based on our data, the prevalence or incidence of developmental disabilities is increasing such as autism, cerebral palsy and various global disabilities that may stem from environmental changes),” Mercado noted.

To address this, 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.

PhilHealth reported that beneficiary families grew from over 5 million in 2022 to more than 7.5 million recently, driven by expanded healthcare provider networks and improved public awareness.

Mercado explained that PhilHealth was able to encourage more hospitals to get accreditation as the state insurer expanded the coverage of Z-Benefit packages for catastrophic illnesses.

To sustain this expansion, PhilHealth has significantly reduced its claim processing times for hospitals and healthcare providers from 45 to 60 days, to current 15 to 18 days.

Moving forward, the PhilHealth is engaging private hospitals to expand the no balance billing scheme by negotiating dedicated basic accommodation spaces so patients no longer have to pay out-of-pocket expenses.

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