PhilHealth Introduces Enhanced Primary Care Package
The Philippine Health Insurance Corporation (PhilHealth) recently launched an expanded promotive, preventive and diagnostic package designed to improve financial risk protection for its members, particularly the less privileged.
Dubbed “Tamang Serbisyo sa Kalusugan ng Pamilya” (Tsekap),” the benefit package is an expansion of the Primary Care Benefit Packages 1 and 2 that were implemented in 2012 and 2014, respectively.
“Tsekap shall be initially rolled out to the indigent and sponsored members, but eventually it will be offered to all other sectors” said PhilHealth President and CEO Alexander A. Padilla.
Included in the Tsekap are drugs and medicines for ten (10) common conditions that can be managed at a primary care set up such as asthma, acute gastroenteritis, upper respiratory tract infection, pneumonia, urinary tract infection, diabetes mellitus, hypertension, dyslipidemia, deworming and ischemic heart disease.
Also available are comprehensive health profiling upon enlistment, consultations, regular blood pressure and body measurement, periodic clinical breast examination, cervical cancer screening, digital rectal examination, risk profiling for hypertension and diabetes, counselling for smoking cessation and lifestyle modification and oral check-up and prophylaxis for children 12 years old and below.
“When clinically necessary, sponsored and indigent members can also avail themselves of diagnostic examinations such as complete blood count, blood typing, urinalysis, stool exam, chest x-ray, sputum microscopy, lipid profile, fasting blood sugar, creatinine, electrocardiogram, peak expiratory flow meter testing and blood glucose monitoring through blood glucose meters,”Padilla added.
Indigent and Sponsored members may choose either a private or public Tsekap provider that is most accessible to them. The chosen provider shall enlist the family and make the individual health profiling, which is an essential component, to ensure that the health status of the eligible PhilHealth beneficiary is established and monitored.
The No Balance Billing shall also apply both in private and public facilities where the Tsekap services are provided.
“To help deliver the Tsekap services, we are tapping government and private health care facilities that can assure us that the range of indicated benefits in the package can be made available to enlisted families. At the same time, we have set the standards for the accreditation of drug outlets that can participate in the provision of drugs and medicines under the Tsekap package,” Padilla said.
Among Tsekap’s unique properties is the use of the EMR or Electronic Medical Records that will be generated by the provider-facilities whose IT systems should be in sync with PhilHealth. “We are quite excited about the prospect of seeing our members being profiled for health, their medical records maintained electronically, and the physician’s prescription dispatched electronically to our partner-pharmacy where our members will just pick up their medicine packs,” he added.
To date, there are 15,068,028 Indigent and Sponsored Program families enrolled in PhilHealth. (END) (Pinky G. Aragones)