September 30, 2023

Baguio City has been chosen as one of the first seven primary care networks (PCNs) in the country who will implement on a “sandbox” or experimental basis Philippine Health Insurance Corporation (PhilHealth)’s Konsultasyong Sulit at Tama (Konsulta) program innovation aimed at improving primary care finan-cing.

The program innovation will allow Baguio, four provinces and two private health providers “to have advanced payments or frontloading of funds even before services have been rendered,” according to the joint press statement from the PhilHealth and the Department of Health.

“Konsulta PCPN will also only pay networks of primary care doctors and cli-nics, instead of the individual clinics like the regular Konsulta benefit.”

As Konsulta primary care provider network (PCPN), Baguio together with Bataan, Guimaras, Quezon, South Cotabato, and private health care provi-ders LiFE group and QualiMed, which care for 2.3 million Filipinos are projected to be paid a total of P1.2 billion, which may be used to improve infrastructure, equipment, and staff compensation even before the first patient starts using services, the health agencies said.

Mayor Benjamin Magalong thanked PhilHealth for choo-sing the city as pioneer PCN citing the program’s benefit for the city’s populace in view of the rising costs of medicines, laboratory and medical procedures in private hospitals.

The mayor together with Acting City Health Officer, Dr. Celia Flor Brillantes and Acting Asst. Health Officer, Dr. Maria Lourdes Pakoy attended the program for the signing of the PCPN Service Level Agreement held in June 19 in Manila.

The program was attended by PhilHealth Acting President and Chief Executive Officer Emmanuel R. Ledesma Jr. and Health Secretary and PhilHealth Chair of the Board, Dr. Teodoro J. Herbosa.

PhilHealth and DOH said the PCN innovation is in line with Republic Act 11223 or the Universal Health Care (UHC) Act which defines “primary care” to be first-contact, accessible, continuous, comprehensive and coordinated; accessible at the time of need; with a range of services for all presenting conditions; and able to coordinate referrals to other doctors, clinics and hospitals in the healthcare delivery system, when needed.”

“The UHC Act makes it the main responsibility of the DOH and local government units to make sure that the health care delivery system will make a primary care doctor, assisted by other health workers, available to each and every Filipino. 

Meanwhile, Filipinos have the right to choose primary care doctors, either from public or private clinics,” the agencies noted.

“The current PhilHealth (Konsulta) primary care benefit package covers patient consultations, any of 13 laboratory and diagnostic tests as ordered by the doctor, and 21 common medications that can be prescribed according to medical needs. PhilHealth pays its Konsulta Package Providers an amount ranging from P500-750 per patient per year, on a reimbursement basis after services have been rendered,” the agencies added. – Aileen P. Refuerzo