The PhilHealth Konsulta Package is designed to cover essential primary care services, including consultations with primary care physicians, laboratory tests, and medicines, among others. The package is available to all eligible PhilHealth members, including those who are self-employed or unemployed, as well as their dependents.

To avail of the package, eligible PhilHealth members must have paid their premiums for at least three months within the last six months before availing of the package. Members may avail of the package once every six months, and the benefits are non-transferable.

The package is available in accredited primary care facilities, including barangay health stations, rural health units, and primary care clinics. To ensure quality of care, healthcare providers who offer the package must be duly accredited by PhilHealth and follow the prescribed fee schedule. The package is not available in hospitals, tertiary care facilities, or specialty clinics.

Under the implementing guidelines for the PhilHealth Konsulta Package, healthcare providers may offer additional services beyond the package's scope, but these must be covered by separate fees that are not included in the package. Providers must also ensure that the services are necessary and appropriate for the patient's condition.

The payment scheme for the package is based on the case rate system, which means that PhilHealth will pay a fixed amount for each case or illness covered by the package. The case rates vary depending on the type of illness or condition, as well as the type of healthcare facility where the services are rendered.

For example, for a case of acute gastroenteritis, PhilHealth will pay a fixed amount of PHP 2,800 for services rendered in a primary care facility and PHP 4,000 for services rendered in a community hospital. For a case of hypertension, PhilHealth will pay a fixed amount of PHP 1,200 for services rendered in a primary care facility and PHP 2,400 for services rendered in a community hospital.

To ensure the effectiveness and efficiency of the package, the implementing guidelines provide for monitoring and evaluation mechanisms. PhilHealth will monitor the utilization of the package, including the number of beneficiaries and the services rendered, to ensure that the package is reaching its intended target population. PhilHealth will also conduct periodic evaluations of the package's impact on the health outcomes of its beneficiaries.

In conclusion, the PhilHealth Konsulta Package is a welcome development in the Philippine healthcare system, as it provides much-needed primary care services to its members, particularly those who are from low-income families. The implementing guidelines for the package provide clear guidelines for its implementation, ensuring that the package is delivered in a timely and efficient manner, and that the quality of care is maintained. With proper implementation, the package has the potential to improve the health outcomes of its beneficiaries, contributing to a healthier and more productive population.

Source: PHILHEAL TH CIRCULAR 2020-022