How PhilHealth coverage protects the 4Ps beneficiaries from sinking deeper into poverty? PDF Print E-mail
Saturday, 06 September 2014 13:22



Getting sick or being hospitalized for certain illnesses usually “hurts the pockets” of most Filipino families, especially the poor or the vulnerable sectors of society.

In situations like these, whatever amount a poor family is allotting for basic necessities or the education of the children is used to pay the hospital bills and the costs of medicines.

Oftentimes, family members have no choice but to borrow money although there is no certainty when they can be able to repay the lender, assuming that there is one.

As a result, the poor family is plunged deeper into poverty.

Aware of such happenings, Department of Social Welfare and Development (DSWD) Secretary Corazon J. Soliman partnered in 2012 with the Department of Health (DOH) to provide free PhilHealth (Philippine Health Insurance Corporation) coverage to indigent beneficiaries of the Pantawid Pamilyang Pilipino Program (4Ps).

Since then, the poor 4Ps beneficiaries and their family members who get sick and hospitalized are provided with health care benefits and packages and therefore are protected from sinking deeper into poverty.

The free health coverage gives the poor some kind of relief from worries over the “painful hospital bills,” thus enabling them to concentrate on other things that matter much in their everyday life, like sending their children to school or being productive by availing of skills development and employment facilitation provided for them.

Under the DSWD-DOH partnership, the PhilHealth premiums of indigent 4Ps members are sponsored and paid under the six tax revenues, according to DOH Undersecretary Teodoro Herbosa.

“It’s a good thing there is free PhilHealth coverage for indigent members of Pantawid Pamilyang Pilipino Program (4Ps). I was able to use it when my 16-year-old son was operated due to a broken arm,” said Rizalyn Real, a 4Ps recipient in Oroquieta City, Misamis Occidental, in a letter to DSWD.

Real is one of the thankful beneficiaries of 4Ps who were able to experience the PhilHealth care benefits.She said they availed of the bone surgery in a government hospital wherein a steel plate was attached on the broken bone of her son.

The woman narrated that being a low-salaried utility worker, she was at first reluctant to bring her son to the hospital since she knew she could not afford to pay for the hospital bills, including the needed bone surgery operation.

“Pero may nakapagsabi sa akin na may PhilHealth benefits daw ang mga benepisyaryo ng Pantawid Pamilya. Dinala ko na rin siya sa ospital kaysa makita ang anak ko na hirap na hirap (Someone informed me that Pantawid Pamilya beneficiaries can avail of PhilHealth benefits. I then brought him to the hospital rather than just see him in so much pain),” she said.

“Dapat ay mga P25,000 ang aking babayaran para sa operasyon lang, pero dahil ako ay Pantawid Pamilya beneficiary, ay wala akong binayaran (I need to pay more than P25,000 for the surgery alone, but because I am a Pantawid Pamilya beneficiary, I was exempted from paying),” she added.

To date, some 14.7 million indigent individuals aged 21 years and above identified through the DSWD’s “Listahanan” (formerly National Household Targetting System for Poverty Reduction (NHTS-PR) database of the poor are PhilHealth card holders.

As part of their entitlements as sponsored members, they do not need to pay anything (no balance billing) when availing of any of the 23 medical cases and surgical procedures which are reimbursed by PhilHealth on a case-rate basis.

According to PhilHealth President Alexander Padilla, the “No Balance Billing” or “walang dagdag bayad” policy also applies to primary care benefits such as consultations, regular blood pressure monitoring, and promotive health education on breastfeeding and counseling on lifestyle modification and smoking cessation.

In addition, medicines for diseases like asthma and acute gastroenteritis with no or mild dehydration, upper respiratory tract infection/pneumonia and urinary tract infection are also provided for by accredited healthcare providers.