PhilHealth Lifts 45-Day Benefit Limit: A New Era in Philippine Healthcare

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In a landmark decision that promises to revolutionize healthcare accessibility for Filipinos, the Philippine Health Insurance Corporation (PhilHealth) has announced the removal of the 45-day hospitalization benefit limit, effective April 4, 2025. This pivotal change aligns with the Universal Health Care Act and follows the directive of President Ferdinand R. Marcos Jr., aiming to ensure continuous and accessible health benefits for all citizens. ​

A Shift Towards Comprehensive Healthcare Coverage

Historically, PhilHealth's 45-day hospitalization cap served as a cost-containment measure. However, with evolving healthcare needs and payment mechanisms, this policy has been deemed outdated. Dr. Edwin M. Mercado, PhilHealth's acting president and CEO, acknowledged that while the cap was initially instituted for cost control, the dynamic nature of medical requirements necessitated its removal. He emphasized that medical needs are unpredictable, and many conditions require hospitalization beyond 45 days. ​

Government and Public Reception

The government's initiative has garnered widespread support. Senator Christopher Go lauded PhilHealth's move, describing the lifting of the hospitalization cap as a long-overdue step that aligns healthcare policies with the actual needs of Filipinos. ​

Similarly, House Deputy Majority Leader and Manila 6th District Representative Bienvenido "Benny" Abante Jr. welcomed the policy change, stating that it would provide significant relief to Filipinos, especially those with chronic illnesses or severe health conditions requiring extended hospital care. ​

Ensuring Quality and Accountability

While the removal of the 45-day limit enhances coverage, PhilHealth emphasizes that benefit availment should be based on proper medical indications and align with patients' treatment plans. The organization will adhere to Department of Health-approved Clinical Practice Guidelines and maintain rigorous monitoring of patient admissions and benefit utilization exceeding 45 days. Health facilities are also encouraged to implement comprehensive policies focused on quality and performance improvement to ensure the best patient outcomes. ​

Looking Ahead

The abolition of the 45-day benefit limit marks a significant milestone in the Philippines' journey towards universal health coverage. By removing this cap, PhilHealth reaffirms its commitment to providing accessible, comprehensive, and quality healthcare services to all Filipinos, particularly those facing serious illnesses or chronic conditions that require extended care. This policy shift not only alleviates financial burdens but also enhances the overall healthcare experience for countless individuals across the nation.​

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