PIN44 Benefit Design Considerations during Emergencies: Lessons from Covid 19

The Philippines declared a public health emergency owing to the rapid increase in Corona Virus Disease 2019 (COVID 19) cases Given the highly infectious and severe nature of COVID 19, many individuals were infected and cost of care was higher compared to usual cases of influenza or pneumonia Majority of cases were admitted to private hospitals where balance billing is usually practiced, leaving many patients saddled with huge hospital bills The Philippine Health Insurance Corporation (PhilHealth) was tasked to cover for health care costs of COVID 19 cases in the country Objectives: Design benefit packages for COVID 19 Methods: Costing the benefit package involved defining a basic clinical profile and pathway for COVID 19 using available guidelines and consultations with experts Designing the package took into consideration the full continuum of care and available financing from government Cost estimates and design features were periodically reviewed as guidelines were evolving guidelines Development of the packages was also expedited Results: Benefit packages for testing, community quarantine and pneumonia (mild, moderate, severe and critical) were developed along with their corresponding case rates Cost drivers differed across package types (e g PCR procedure for testing;drugs and treatment procedures for pneumonia admissions) To deal with the uncertainty in costs and clinical profile of COVID 19 cases, PhilHealth initially decided to cover the full cost of care during the quarantine period prior to introducing case rates Rules on eligibility for benefits and claims processes were likewise relaxed to ensure access and adequate financial risk protection Conclusions: Benefit development during emergencies such as with the COVID 19 pandemic can be undertaken quickly even with limited information Given uncertainty in costs and clinical profiles, social insurance agencies may opt to be liberal in granting benefits Periodic reviews will be necessary to update the packages and ensure the sustainability of the fund