PhilHealth's Developmental Disability Benefits Underutilized, Citing Facility and Specialist Shortages

The Philippine Health Insurance Corporation (PhilHealth) has paid only 482 claims under its benefit package for individuals with developmental disabilities since the program was introduced in 2017, citing the limited number of contracted facilities as a major reason for the low utilization. PhilHealth president and CEO Beverly Ho disclosed the figure during the Senate Finance Committee’s briefing on the Department of Health’s proposed 2027 budget. Ho was responding to Sen. Joel Villanueva, who asked whether the National Health Insurance Program’s proposed funding would cover individuals with autism spectrum disorder (ASD) and other developmental disabilities. "Since 2017, PhilHealth has already had a benefit package for this. Unfortunately, over these years, we have only paid 482 claims on this," Ho said. Ho said one reason for the low number of claims was that only five facilities were contracted to provide the covered services, and that PhilHealth’s rules were very stringent. PhilHealth to ease accreditation requirements Ho said PhilHealth was preparing to change its accreditation rules to allow more facilities and professionals to participate in the program. She said a policy to decouple accreditation standards was expected to be released by the end of the week, allowing more providers to participate. PhilHealth was also looking at allowing occupational and physical therapists and other professionals to obtain practice-based accreditation rather than being limited to facility-based accreditation. Ho added that many therapists operate in freestanding clinics, which may not meet the existing facility-based accreditation setup. She said PhilHealth had already begun discussions with professional groups and expected these changes to be addressed before the end of the year. Ho also said PhilHealth was working with developmental pediatricians to expand early screening for children with developmental concerns. She noted that developmental pediatricians could not personally screen children in every school and community. The Philippine Society for Developmental and Behavioral Pediatrics had already piloted a training module for barangay health workers (BHWs) and daycare center workers to serve as the first level of screening, she said. Training is also being prepared for primary care physicians and general pediatricians before patients are referred to developmental pediatricians. Ho said the approach was necessary to ensure that specialists would receive patients who had already undergone initial screening. Villanueva flags specialist shortage Villanueva earlier asked about available DOH programs to increase the number of healthcare professionals and specialists serving individuals with ASD and other developmental disabilities. He said there was a serious shortage of occupational therapists, physical therapists and speech therapists, with many Filipino healthcare professionals leaving the country for better pay and opportunities. Villanueva said the shortage could discourage students from pursuing these courses if there were not enough facilities and opportunities for them to practice after graduation. Acting Health Secretary Edwin Mercado said the DOH was looking at short-term measures, including task shifting and strengthening primary-level screening and referral systems, while recognizing that producing specialized professionals could take four to five years. He added that the planned expansion of PhilHealth benefits and potentially higher professional fees could also encourage more professionals to enter these fields. —LDF, GMA News