Written By: Ricardo A. Francisco, Jr.
Sometime in November 2013, the Benefits Development and Research Department of Philhealth, through its OIC Manager, Dr. Jennifer S. Raca, sought a meeting with the Philippine Society of Nephrology to consult the society on its plan to expand the hemodialysis treatment coverage. The plan is in response to the increasing clamor from the different dialysis stakeholders, particularly the patients, to increase the quantity of dialysis treatment from 45 to 90 sessions but with a reduced rate at P2,500 per treatment.
The PSN, through its Committee on Hemodialysis, conducted a series of meetings to consult its past presidents, chapter presidents and members on this new development. The members all agreed that these changes will have significantconsequences in the delivery of HD not only in the services that can be provided with the reduced case rate but also in the finances of the various stakeholders: Philhealth itself, the dialysis facilities, the nephrologists and the patients. Patients will have to contend with co-payments to maintain the services (epoetin, monthly labs) that they are currently receiving under the old case rate. The society maintained that while the increase to 90 sessions is a very attractive proposal, the drastic reduction of the coverage from Php4,000 to P2,500 will result in the decline in the quality of care because such amount is not likely to cover for the full treatment cost. Services like anemia management, high flux dialysis treatment and adequacy measurements will most likely be compromised.
After the consultation with its members, the PSN submitted its recommendations to Dr. Raca on December 19, 2013 which include among others the mandatory services that must be delivered under the proposed new case rate.
The society also recommended that the case rate be pegged at P3,000 for every dialysis session inclusive of the nephrologist’s professional fee that must be maintained at its present rate. Dr. Susan Annonuevo-de la Rama, PSN President, explained to Philhealth that this feels commensurate with the services being rendered by the nephrologist to his patients.
She further said that the service is not limited only to the dialysis procedure itself as they also act not only as its as primary physician but also as a multispecialist doctor taking caring for most if not all of the other medical concerns of the patients. The Philhealth Board of Directors however deferred the implementation of this expanded coverage to give way to its long delayed peritoneal dialysis treatment package which has been in the pipeline for the longest time.
