In a groundbreaking move, the Philippine Health Insurance Corporation (PhilHealth) has scrapped its long-standing Single Period of Confinement (SPC) policy, opening the door for patients to claim benefits for readmission due to the same illness within 90 days.
This policy change, announced on October 31, 2024, marks a noteworthy step in improving healthcare access for millions of Filipinos facing recurring medical conditions.
A Long-Overdue Shift
PhilHealth Chief Emmanuel Ledesma emphasized the need to prioritize patients’ welfare, citing this revision as a response to extensive evaluations of the SPC rule.
“Health is not just a privilege but a fundamental right for every Filipino,” Ledesma said. “By lifting the SPC rule, we are ensuring continuous coverage for patients who face recurring illnesses, aligning our efforts with their needs.”
Previously, the SPC policy restricted benefit claims for readmissions related to the same illness or procedure within a 90-day period, resulting in numerous denied claims.
In 2023 alone, 26,750 claims were denied under the SPC rule. Common conditions impacted included community-acquired pneumonia, acute gastroenteritis, urinary tract infections, and chronic kidney disease—conditions often requiring prolonged or recurrent hospital care.
What the Policy Update Means for Filipinos
The removal of the Single Period of Confinement (SPC) rule by PhilHealth has significant implications for members and their dependents:
- Multiple Admissions Coverage: Members can now claim benefits for multiple admissions caused by the same condition within a 90-day period, provided they fall under PhilHealth’s All Case Rate payment scheme. This ensures continuous coverage for recurring conditions without the previous restrictions.
- Alignment with Universal Health Care Act: This policy update aligns with the Universal Health Care Act of 2019, which aims to make healthcare more affordable and accessible for all Filipinos. It reflects the government’s commitment to improving healthcare services and ensuring that all citizens receive the medical attention they need.
- Enhanced Member Benefits: According to PhilHealth President and CEO Emmanuel Ledesma, this adjustment ensures that members receive the benefits they deserve, especially during challenging times. It underscores PhilHealth’s dedication to providing comprehensive healthcare support to its members.
Better Tools, Stronger Protections Against Fraud
The SPC policy was initially introduced in 1969 under the Philippine Medical Care Act to combat fraudulent benefit claims. However, Health Secretary Teodoro Herbosa noted that advancements in technology now offer robust tools to detect and prevent fraud.
“With these modern safeguards in place, we can confidently revise outdated policies like SPC without compromising integrity,” Herbosa stated.
This development complements other reforms under the Universal Health Care Act, which continues to enhance the accessibility and affordability of medical services for Filipinos.
Key Details for Members
PhilHealth members and their dependents are reminded that the updated policy still adheres to the 45-day annual limit for hospital room and board coverage. This rule applies to all eligible medical conditions and surgical procedures.
Notably, this 45-day limit does not affect hemodialysis benefits, which allow for up to 156 sessions per year under PhilHealth’s specialized package.
Advocating for Better Health Access
This policy shift is part of PhilHealth’s broader mission to address long-standing gaps in the country’s healthcare system. The decision comes at a time when many Filipinos face financial strain due to rising healthcare costs, compounded by recurring illnesses that demand extended care.
Advocates for universal healthcare have hailed this development as a win for patient rights and an important step toward more inclusive health coverage.
Video: Single Confinement Policy, aalisin na ng PhilHealth
Previously, this policy restricted members from receiving benefits for the same illness if readmitted within 90 days. With the SPC policy abolished, members readmitted for the same condition within this period are now eligible for PhilHealth benefits. This change aims to enhance healthcare access and support for members facing recurrent health issues.
PhilHealth is also set to introduce an updated benefit case package by the end of November 2024. This package will expand coverage to include dental services, addressing a broader range of healthcare needs for its members. The inclusion of dental packages signifies PhilHealth’s commitment to comprehensive healthcare, ensuring members have access to essential medical and dental treatments.
These developments reflect PhilHealth’s ongoing efforts to improve the quality and accessibility of healthcare services for all Filipinos. By removing restrictive policies and broadening benefit packages, PhilHealth continues to strive towards a more inclusive and supportive health insurance system.
What’s Next?
PhilHealth’s move to eliminate the SPC rule demonstrates its commitment to adapting to the evolving healthcare landscape. As the agency continues to align its policies with technological advancements and public demand, it sets a precedent for prioritizing patients over procedural constraints.
For patients and families across the Philippines, this change offers hope and tangible relief. Recurring illnesses often bring not just physical strain but significant financial burdens—a reality this updated policy aims to ease.
With continued reforms and efforts to expand healthcare coverage, PhilHealth is poised to strengthen its role in realizing the promise of universal health care in the Philippines.