Capitation rate for PhilHealth's Konsulta package raised; new screening services added

MANILA, Philippines — The board of directors of the Philippine Health Insurance Corp. (PhilHealth) approved on Wednesday an increase in the capitation rate for its outpatient benefits package called Konsulta, along with the inclusion of more screening services.

The Department of Health (DOH) said the capitation rate of the PhilHealth Konsulta will increase to P1,700 per patient seen annually. Capitation payment is a healthcare reimbursement model where providers receive a fixed sum per patient, paid in advance.

Konsulta is PhilHealth's primary care benefit package that provides free annual check-ups, select diagnostics, and medications to the insurer's members.

"Private Konsulta package providers (KPPs) will also be allowed to collect a co-payment of up to P900, while patients seen in public KPPs will not be charged extra," the DOH said.

The PhilHealth board also added mammography and ultrasound screenings to their services, enabling earlier detection of breast cancer and other abdominal conditions.

"It is the pleasure of the Board to now bring up primary care benefits with mammogram and ultrasound services not just in sandbox sites, but nationwide," Health Secretary Teodoro Herbosa, who chairs the PhilHealth board, said.

According to a 2023 study of the Philippine Institute for Development Studies (PIDS), breast and cervical cancer screening was "extremely low" in the country. Breast and cervical cancer top the list of cancers affecting Filipino women.

According to the DOH, the increased payments are targeted for implementation by June 2024, or earlier if operational details like IT system upgrades are completed sooner.