Edwin Mercado’s first 30 days at the helm of PhilHealth

MANILA, Philippines – Edwin Mercado has been at the helm of the Philippine Health Insurance Corporation (PhilHealth) for over a month now.

He took the place of Emmanuel Ledesma Jr. who stepped down amid issues with the state insurer’s finances. President Ferdinand Marcos Jr. said Ledesma was not used to being exposed to politics.

The first month of Mercado’s appointment comes as the Supreme Court is scrutinizing PhilHealth over the P89 billion fund transfer to the National Treasury.

But here’s how Mercado’s first month in office fared and what his plans are.

Technical advisory group

Mercado said he has formed a technical advisory group to help with fixing up systems and processes within the state insurer.

“May mga ekspertong galing dito sa atin, dito sa Pilipinas — on health economics, on IT, on finance, on data analytics, on doctor and hospital management, on health laws — na gagabay sa buong PhilHealth team kung paano gagawin itong mga pinaplano namin,” Mercado said in a press briefing on March 6.

(There are experts from the Philippines — on health economics, on IT, on finance, on data analytics, on doctor and hospital management, on health laws — who will guide the whole PhilHealth team on how to do what we’re planning to implement.)

He added that they are also “recruiting key officers” to join his team.

Mercado’s plans include improving PhilHealth’s coverage to help lower the out-of-pocket expenses of Filipinos.

“‘Yun ay aming misyon — na ibaba to about 25% to 30% (That’s our mission — to lower expenses to about 25% to 30%,” Mercado said.

PhilHealth’s technical advisory group met for its second meeting on March 10, based on a statement from the state insurer. Among those discussed were how to improve the state insurer’s actuarial projections.

Actuarial estimates ensure that PhilHealth will have enough to cover for Filipinos’ healthcare needs on top of funding for operations.

“By improving our actuarial assumptions, we can better predict healthcare costs and utilization patterns,” said Mercado. “This means we can expand benefits in a sustainable way while ensuring members can actually access the care we’re promising.”

During the first Supreme Court oral arguments on the fund transfer, Deputy Treasurer Eduardo Anthony Mariño III pointed out that PhilHealth’s actuarial estimates are not accurate. (READ: How will PhilHealth’s fund transfer affect Filipinos’ access to healthcare?)

Meanwhile, Mercado said they are also working on fixing its member registration data to ensure that PhilHealth actuarial projections moving forward will be accurate.

New policies, enhanced benefits

In his first 30 days in office, Mercado oversaw the approval of new policies, and some existing benefit packages have also been enhanced. Ledesma previously told lawmakers that it took over a decade before PhilHealth benefits were improved and were only updated under his term.

Here are some of the policies:

• Increased coverage for coronary artery bypass graft (CABG) surgery: Previously at P550,000, the package rate now stands at P660,000 for standard risk and P960,000 for expanded risk (previously at P550,000).
• Increased coverage for the Z benefit on closure of ventricular septal defect (VSD): From P250,000, the package rate now stands at P498,000 for those with or without associated special conditions. Meanwhile, those with severe pulmonary stenosis will get a coverage worth P614,000.
• Increased package for the total correction of tetralogy of fallot (TOF), a heart ailment: From P320,000, patients will now get a coverage worth P614,000.
• Post-cardiac surgery services: The state insurer will provide those who had CABG surgery a P54,000-package (6 sessions) for cardiac rehabilatation and P12,140 worth of laboratory, diagnostic tests and medicines. Meanwhile, those who had VSD or TOF surgery will get P6,500 (4 sessions) for their cardiac rehabilitation.
• Z benefits for heart valve repair and/or replacement for valvular heart disease: PhilHealth is now at P810,000 from P642,000. Meanwhile, its cardiac rehabilitation packages are worth P6,500 for pediatric patients and P15,000 for adults.

Plans for the year

The state insurer said they will continue to improve its existing packages, while introducing new ones. These include a post-kidney transplant benefit package and coverage for 10 rare diseases.

PhilHealth spokesman Ish Pargas said PhilHealth will also introduce new benefit packages for catastrophic cases such as cancer. Among those mentioned are coverage for lung, liver, and ovarian cancers, as well as prostate, cervical, colon, and rectal.

“Aside from covering those with catastrophic cases, we will still continue to rationalize our case rates,” Pargas said, adding that they will also include the top burden of diseases or those that have increased mortality rates in the Philippines.

The state insurer has promised to review its maternal healthcare coverage and expand its benefits for children with disabilities — from those with developmental delays, speech problems, mobility problems, to those with hearing problems. – Rappler.com