Giving hope for a better life

PhilHealth Circulars 29 & 30, s.2012

PhilHealth Circular 02 & 19, s.2013

Case Type Z Benefits

Outline

Milestones of the Z Benefits

What is Z benefit?
Features of the Z Benefits
Next set of Z Benefits

Milestones
July 2011
The DOH and the PMS recommended the setting up of a
catastrophic fund coined as the catastrophic illness relief
fund (CIRF)

Aug 15, 2011

Pres Benigno Aquino III approved the CIRF and P10 M from
the Presidents Social Fund was apportioned to start
operation
Tapped to be funding sources for the establishment of the
CIRF officePCSO, PAGCOR, PhilHealth, other GOCCs

Nov 2011
PhilHealth began its own development of benefit
packages for catastrophic and special conditions

Milestones
July 2, 2012
Pres. Benigno Aquino III officially announced to the public the 1 st
set of Z Benefits (breast CA, acute lymphocytic leukemia and
prostate CA) and the historic patients who availed of the Z
package for ALL and prostate cancer

Feb 14, 2013

Pres. Benigno Aquino announced the 2nd set of Z Benefits for
coronary artery bypass graft surgery, surgery for tetralogy of
Fallot & ventricular septal defect, and cervical CA

Milestones
July 2013
The President reiterated in his State of the Nation Address that
the Z Benefits gave the privilege for the free hospitalization of the
poor and sick patients admitted in government hospitals because
PhilHealth has already paid for it. Z also gives dignity to the sick
and poor, when in the past, these patients had only hopes for
medical care under charity.

Oct 31, 2013

President Benigno Aquino III announced the Z benefit package for
external lower limb prosthesis below the knee (Z MORPH). The Z
MORPH is the very first benefit package of Philhealth for PWDs.

Why call it the Z benefits?

Under the fee-for-service payment

mechanism
case typing

ABCD

Focused on claims and

disease entity

Gradual shift from fee-for-service to

case payment

Focus is the patient

Patient empowerment
Better health outcomes
Payment for quality care
Financial risk protection

Shift from FFS to case payment

paradigm shift
Evidence-based guidelines
Clinical pathways
Treatment protocols
Incentives /better reimbursement for quality services
At par with current technology
Better health outcomes
High survival rates
Patient participation

What is Case Type Z?

The PhilHealth Z benefit package covers
primary disease conditions that are
perceived
as
economically
and
medically "catastrophic".

Objective

to achieve value for money

Features of the Z Benefits

Features of Z 1st time in PhilHealth

No balance billing (NBB) for indigents & sponsored members*

Fixed co-pay for the non-sponsored members

Pre-authorization
Patient Empowerment & multi-stakeholder involvement
Contracting with tertiary govt hospitals

Patient tracking for clinically relevant outcomes (survival, death,

loss to follow-up, adverse events, benefit utilization, etc) thru the Z
benefit information & tracking system (ZBITS)

under

development
*

*indigents identified by the NHTS of DSWD; premiums paid by LGU or national govt

Z packages as of CY 2013
1. Breast CA proposed rates adjustment for
approval
2. Acute lymphocytic leukemia proposed rates
adjustment for approval
3. Prostate CA
4. Kidney transplantation
5. CABG
6. TOF
7. VSD
8. Cervical CA
9. Z MORPH

Next Set of Z Benefits

Z Benefits for specialized medical devices

(Board Resolution No. 1787 s. 2013)
Z Benefit

Description

Implants for hip arthroplasty

Total hip prosthesis:

Cemented
Cementless
Partial hip prosthesis
Cemented
Cementless

Implants for hip fixation

Implants for pertrochanteric
fracture

50,000
120,000
45,000
90,000

Multiple screw fixation

15,000

Compression hip screw set

Proximal femoral locked
plate

30,000
30,000

Implants for femoral shaft

fracture
Ventriculoperitoneal (VP)
shunts

Proposed
Rate (Php)

20,000
(for congenital conditions)

Ongoing staff
work

New Z Benefit for implementation soon

Z package

Rate (Php)

PD FIRST Z Benefits
(Z package for peritoneal dialysis)

P270K/patient/year

New Z Benefits for approval of management

Z package

Z Benefits for the

premature newborn
Z Benefits for colon &
rectum cancer

Proposed Rate (Php)

P120K-150K
(for actuarial projection)

P150K-P300K (colon)
P150K-P400K (rectum)
(for actuarial projection)

Giving hope for a better life

Thank you!
The Product Team for Special Benefits

Contact us
PhilHealth

Dr. Mel C. Santillan

Merla Rose D. Reyes

rcs_93@yahoo.com
0917 7567888

merlarose@yahoo.com
0929 6191596