June 3, 2023

One now does not have to be sick to be able to avail PhilHealth services. As long as one is a PhilHealth member, he or she can enlist to avail of consultations with physicians to check on one’s blood pressure, cholesterol levels, and the like in order to avoid having serious illnesses.

The Philippine Health Insurance Corp. Cordillerais encouraging members to enlist in one of its outpatient benefit packages that promotes primary healthcare to avert serious illnesses and as a way of de-clogging hospitals of cases being attended to.

Through PhilHealth’s flagship program called Konsultasyong Sulit at Tama or Konsulta, the PhilHealth guarantees that each Filipino will be taken care of by a primary service provider, to promote primary health by identifying a member’s health risks and ensure early diagnosis, treatment, and care.

In this way, PhilHealth-Cordillera Health Care Delivery Management Division chief, Dr. Glenn Lamsis, said expenses on curative services will be lessened and would allow hospitals to focus on more complicated cases.

Lamsis explained theKonsulta provider package is also seen as a solution to increasing cases of non-communicable diseases due to lack of early consultation.

He said data shows many Filipinos, especially in the outskirts, die without having checked up by a health worker since most usually tended to endure sickness and would only seek medical help when it is already too late.

He added a World Bank data shows that in 2009, non-communicable diseases occupied only 40 percent of the top 10 causes of hospitalization, but in 2019, the number almost doubled.

“PhilHealth came up with Konsulta to raise our health-seeking behavior where instead of us waiting for health workers come to us, we should be increasing the level of importance we give to own health Tayong mga Pinoy mahilig sa pagtitiis,at kung kailan hindi na tayo pwedeng makabangon that’s the time that we seek help of a health worker,” Lamsis said.

Though not the total solution, Lamsis said Konsulta would provide every Filipino a primary healthcare provider.

But unlike existing hospitalization benefit packages that may be availed anywhere in the country, Konsulta may be availed from the primary care provider with which a PhilHealth member chose to enlist to ensure continuity of the primary care being provided.

Lamsis said the Konsulta package covers individual-based services such as consultation and case management on the primary level, provision of preventive health services, and assistance to eligible beneficiaries in accessing services or referral to partner facilities.

It also covers 13 laboratory procedures, but Lamsis clarified this does not mean all of these procedures may be availed of by a member, but only depending on one’s age and what needs to be done on the patient as per judgment of the attending physician.

Medicines such as antibiotics and those for anti-hypertension or anti asthma are also covered.

PhilHealth allots a maximum of P500 per beneficiary for government health facilities and a maximum of P750 for private facilities per year, while over-amount incurred will be shouldered by the patient.

To register for the package, a patient must be a PhilHealth member and have an identification number.

One may choose self-assisted registration through the PhilHealth website members’ portal to the primary health care provider, which must be accredited by PhilHealth, nearest to the applicant; or through the accredited Konsulta provider via the MyPhilHealth portal.

Once registered, the patient must get the transaction authorization code from the website, through members’ online services, or through the local health insurance office.

Once the package is availed of, the patient has to fill up a feedback form as evidence that he has availed of the Konsulta service.

All health facilities may apply for accreditation to offer Konsulta services, including hospitals and private clinics as long as they can meet the standards, although at the moment Lamsis said not all primary healthcare providers are fully equipped for the program.

PhilHealth Regional Vice President Dominga Gadgad said one of the major changes eyed under the Universal Healthcare law is that everybody should pass the primary healthcare facility or Konsulta provider for cases that can be handled at this level before going to larger health facilities.

She said at the moment, most of Konsulta providers are rural health units, government facilities, and still some outpatient departments of hospitals to cover those that cannot be catered in health centers.

For areas with big population center like Baguio City, Gadgad said they are encouraging family clinics or physicians to accredit and join the primary care networkin providing Konsulta services. – Hanna C. Lacsamana