FOLLOWING BONG GO’S RECOMMENDATION AND PERSISTENT APPEALS TO SCRAP ILLOGICAL RULE, PHILHEALTH POISED TO REMOVE SINGLE PERIOD OF CONFINEMENT POLICY

In response to Senator Christopher “Bong” Go’s relentless advocacy for pro-people healthcare reform, PhilHealth’s Benefits Committee (BenCom) has officially recommended the removal of the controversial single period of confinement rule. This rule, which restricts PhilHealth benefits for recurring admissions within 90 days, has been a major obstacle for many Filipinos seeking consistent healthcare coverage they need.

This recommendation will be presented to the PhilHealth Board en banc during its meeting on September 27, according to a press release from the Department of Health.

Go, chairperson of the Senate Committee on Health, has been vocal about the urgent need to abolish this policy which he claims to be anti-poor and illogical. He emphasized the heavy burden it placed on families, especially those dealing with chronic or recurring illnesses. His consistent calls for reform culminated in a significant commitment from PhilHealth officials during a Senate hearing held on September 10.

“Take the case of anyone who suffered on several occasions from diarrhea or pneumonia. Under the said policy, if a second confinement happens within the next 3 months, it will no longer be covered by PhilHealth. I find such a policy anti-poor and illogical!,” he cited.

Criticizing the policy for being out of touch with the realities faced by ordinary Filipinos, Go questioned: “Mapigilan mo ba ‘yung sakit? Pneumonia. After two weeks, pneumonia ka uli, mapigilan mo ba?”

“Tulad ko, kumakain ako kahit saan, d’yan sa mga tabi-tabi, dahil tinatangkilik ko po ‘yung mga maliliit na vendors. Hindi maiwasan sumakit ang tiyan, kung ma-admit ako bukas… after two weeks, pag na-admit ako uli, bawal na i-cover ng PhilHealth kung parehong sakit. Unfair naman ‘yung gano’n,” he commented.

The single period of confinement rule, as outlined in PhilHealth’s All Case Rates Policy No. 2 (PhilHealth Circular No. 0035, s. 2013), has resulted in the denial of thousands of claims every year. In 2023 alone, 26,750 claims—many of which involved cases of pneumonia, acute gastroenteritis, and chronic kidney disease—were denied due to the policy, as stated in the press release.

“We are now in the era of the Universal Health Care Act of 2019. It is time to fix outdated policies to ensure that Filipino families no longer face unnecessary out-of-pocket expenses,” Health Secretary Teodoro Herbosa stated.

During the Senate public hearing presided by Go, PhilHealth’s COO, Atty. Eli Santos confirmed that the health insurance agency would comply with Go’s appeals.

“We will remove this provision immediately, independently of other planned adjustments,” he said, referring to additional reforms such as increasing case rates by 30 to 50 percent.

Meanwhile, Go commended PhilHealth’s decision but pushed for immediate action. “Bakit hindi na lang natin tanggalin agad itong single confinement policy habang pinag-aaralan pa ‘yung ibang adjustments? Maraming Pilipino ang naghihintay,” he said, underscoring the urgency of implementing the changes.

Go has consistently highlighted the unpredictability of illnesses, noting that diseases like pneumonia can reoccur within short periods, and patients should not be denied benefits simply because they were hospitalized within the arbitrary 90-day limit. “Kapag nagkasakit ka, hindi mo naman kayang kontrolin ang panahon,” he pointed out.

This victory for Filipino patients and their families is just one of several healthcare reforms that Go is advocating for. As the end of September approaches, all eyes are on PhilHealth to ensure that this policy, and other reforms, are implemented without delay.

“Masaya ako na nakikinig ang PhilHealth sa ating mga hinaing. Maraming Pilipino ang matutulungan sa pagtanggal ng patakarang ito,” Go said, adding that this is only the beginning of a series of healthcare reforms he is pushing for.

Go also reminded PhilHealth officials of their obligation to ensure tangible results from their promises, including increasing case rates, expanding benefits packages, and recommending the reduction of premium contributions for direct members.

He has also co-sponsored and co-authored Senate Bill No. 2620, which aims to amend the Universal Health Care Law to lower contribution rates for direct PhilHealth members.

“Sa kapwa ko lingkod bayan, tandaan natin na ang mga pangako ay dapat may kasamang aksyon at resulta. Buhay at kalusugan ng ating mga kababayan ang nakataya dito,” Go reiterated.

The expected removal of the single period of confinement rule is expected to provide significant relief to patients and their families, especially those suffering from chronic and recurring conditions. As PhilHealth moves to implement these reforms, Go’s ongoing efforts to improve the country’s healthcare system continue to be recognized.

“Kung tuluyang aalisin na ang single period of confinement rule, asahan natin na mas maraming pasyente ang makakatanggap ng sapat at nararapat na tulong mula sa PhilHealth. Ito ay isang hakbang patungo sa mas abot-kayang serbisyong pangkalusugan para sa lahat,” Go concluded.