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    Z Benefits Capsule Mar 19 2014

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    Richard Sonsing
    This document outlines the milestones and features of PhilHealth's Case Type Z Benefits program in the Philippines. It began in 2011 with the recommendation to establish a catastrophic illness relief fund. President Aquino approved in 2011 and the first Z Benefit packages for breast cancer, leukemia, and prostate cancer launched in 2012. Subsequent packages were added for conditions like heart surgery. Key features of Z Benefits include no balance billing for the poor, pre-authorization, and tracking health outcomes. The document concludes by outlining future planned Z Benefit packages.

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    Z Benefits Capsule Mar 19 2014

    Uploaded by

    Richard Sonsing
    89 views20 pages
    This document outlines the milestones and features of PhilHealth's Case Type Z Benefits program in the Philippines. It began in 2011 with the recommendation to establish a catastrophic illness relief fund. President Aquino approved in 2011 and the first Z Benefit packages for breast cancer, leukemia, and prostate cancer launched in 2012. Subsequent packages were added for conditions like heart surgery. Key features of Z Benefits include no balance billing for the poor, pre-authorization, and tracking health outcomes. The document concludes by outlining future planned Z Benefit packages.

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    This document outlines the milestones and features of PhilHealth's Case Type Z Benefits program in the Philippines. It began in 2011 with the recommendation to establish a catastrophic illness relief fund. President Aquino approved in 2011 and the first Z Benefit packages for breast cancer, leukemia, and prostate cancer launched in 2012. Subsequent packages were added for conditions like heart surgery. Key features of Z Benefits include no balance billing for the poor, pre-authorization, and tracking health outcomes. The document concludes by outlining future planned Z Benefit packages.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    89 views20 pages

    Z Benefits Capsule Mar 19 2014

    Uploaded by

    Richard Sonsing
    This document outlines the milestones and features of PhilHealth's Case Type Z Benefits program in the Philippines. It began in 2011 with the recommendation to establish a catastrophic illness relief fund. President Aquino approved in 2011 and the first Z Benefit packages for breast cancer, leukemia, and prostate cancer launched in 2012. Subsequent packages were added for conditions like heart surgery. Key features of Z Benefits include no balance billing for the poor, pre-authorization, and tracking health outcomes. The document concludes by outlining future planned Z Benefit packages.

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    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

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