BY: HAZEL F. GLORIA
CEBU CITY, March 12 (PIA) --- The
Philippine Health Insurance Corporation (PhilHealth) adopts the new
classification of hospitals and other health facilities of the Department of
Health (DOH).
Due to the reassessment of these facilities'
capabilities, PhilHealth can pay only those services within its licensed
functional capacity to provide such as those members may still avail of the
Maternity Care Package provided that the pregnant woman has had at least four
pre-natal visits in the facility, and the Newborn Care Package for the
medically necessary care of healthy newborns.
PhilHealth, as a general rule does not pay for
conditions or procedures treated or performed beyond the licensed functional
capacity of a facility.
With the reclassification and downgrading
brought about by the new DOH policy, some conditions and procedures are no
longer within certain facility's licensed functional capacity.
Pursuant to Administrative Order 2012-0012 on
the New Classification of Hospitals and Other Health Facilities in the
Philippines, DOH now classifies health facilities as hospitals (Levels 1 to 3),
specialty hospitals and other facilities, such as primary care, custodial care,
diagnostic/therapeutic, and specialized out-patient.
With these changes, some hospitals previously
classified as Level 1 or Level 2 are no longer considered hospital facilities
based on their functional capacity. Hence, these are now classified as primary
care facilities.
As stated in Rule V .B. 2. a. of DOH AO
2012-0012, a primary care facility offers basic services including emergency
service and provision for normal deliveries.
It can have in-patient beds where patients can
be admitted for a short period of one to three days (e.g. infirmary, birthing
home), or without bed where medical treatment and minor surgical procedures are
rendered without confining the patient (e.g. medical out-patient clinic).
Members may also avail of select medical case
rates in primary care facilities, such as Dengue I (P5,600), Pneumonia I
(P10,500), Essential Hypertension (P6,300), Acute Gastroenteritis with
moderate/sever dehydration (P4,200), Asthma (P6,300), and Typhoid fever
(P9,300). The new rates started on January 1, 2014.
Cases that need further management must be
referred by the primary care facility to hospitals, except in emergency cases
when immediate management is needed or transfer to another facility is not
possible due to the unstable condition of the patient.
In Cebu province, there 26 hospitals that are
no longer classified as hospitals but primary care facilities, namely: Balamban
District Hospital, Badian District Hospital, Baking Medical Center, Barili
District Hospital, Bantayan District Hospital, Brig. Gen. Benito Ebuen Airbase
Hospital, Carmen Copper Corporation Hospital, Cebu Provincial Hospital (Carcar
City), Cebu Provincial Hospital (Danao City), Daanbantayan District Hospital,
Deiparine Medical Clinic, Dr. Jose Ma. V. Borromeo Memorial District Hospital,
Dumdum Medical Clinic, Guba Community Hospital, Isidro Kintanar Memorial
Hospital, Juan B. Dosado Memorial Hospital, Mariano Jesus Cuenco Memorial
Hospital, Minglanilla District Hospital, Oslob District Hospital Our Lady of
the Rule Maternity & Gen. Hospital, Reinhard Wirtgen Memorial Hospital,
Ricardo L. Maningo Memorial Hospital, Severo Verallo Memorial Hospital, Tojong
Inc. Maternity & General Hospital, Toledo City General Hospital and Tuburan
District Hospital.
In Bohol province at least 13 hospitals were
also affected, eight in Negros Oriental and one in
Siquijor.(mbcn/HFG/PIA-7/PHIC)