A patient undergoing a breast mass excision under local anesthesia and outpatient can easily be covered by the PhilHealth Case Rate for Health Care Institution or Hospital (P5500) in Manila Doctors Hospital as of December 2016.
This has been my experience during the past 2 years when PhilHealth started implementing the case rate system in 2014.
So far still good as of December 2016 as shown by the following statement of account. If the basic operating room fee increases as well as the cost of surgical supplies and histopath, then it will be another story.
As of December 2016, the total expense of a patient whom I operated on for a breast mass under outpatient and local anesthesia was only P4715.23 inclusive of laboratory (histopath), pharmacy (local anesthestics) and operating room use and surgical materials. With P5500 benefit from PhilHealth, there is still an excess of P784.77 (which will be credited to the hospital).
The case rate of PhilHealth will be enough to cover for a patient’s hospital expense if the charges of the hospital are relatively low and the surgeon / physician is conscientious in controlling the expenses of the patients.