THE 800 percent hike in service rates at the Cebu City Medical Center (CCMC) is seen as a lifeline for the facility’s financial stability, but questions linger over the recent legislation behind the increase and its potential impact on patients.
The City Council approved the amendments to Section 67, Chapter 18, of the Omnibus Tax Ordinance on Nov. 20, 2024, mandating the increase of the City’s medical facilities, including CCMC, by the range of up to 800 percent.
CCMC medical director Peter Mancao, in an interview on Wednesday, Nov. 27, assured that patients will not feel the financial burden, emphasizing that the increase will boost the hospital’s sustainability.
Mancao stressed the zero-billing or no-balance billing (NBB) policy of the Department of Health (DOH) and the Philippine Health Insurance Corp. (Philhealth) will remain in place.
He explained that the policy allows their patients to enjoy zero billing of the medical and health services rendered to them by the city hospital, as it will be charged to PhilHealth insurance coverage.
This is on top of the medical and financial assistance from the Malasakit Center and the City Hospitalization Assistance and Medicines Program (Champ), said Mancao.
Mancao said the city hospital needs the rate increase, noting that it has been 14 years since the last adjustment.
However, he assured that the new rates were set to match Philhealth’s insurance coverage limits, which will be reimbursed to the hospital.
Exception
Mancao said that there are exceptions to the zero-billing policy.
“Generally, for all Filipinos who will be admitted to the government hospital, the zero-billing policy takes place. It is mandated by the DOH,” said Mancao.
In most circumstances, patients involved in vehicular accidents, particularly with a responsible party, will not avail themselves of the policy. The responsible party refers to the individual or entity who likely caused the accident, as all medical bills will be charged to them.
Another case is if the patient is a foreign national, for which Philhealth has no coverage.
However, if the patient is financially capable and opts to pay their medical expenses, the policy could be waived, Mancao said.
“If they cannot wait, they could pay out of their own pocket as the policy will take time to process,” said Mancao.
He added that if ever the patient is indigent, marginalized and has not been enrolled as a Philhealth member, then they can be registered immediately.
“Once admitted, if it is an emergency, with or without Philhealth, we will take necessary services to help the patient. After which, it will be the time to process their Philhealth,” he said.
He added, “Philhealth has a friendly process as they are obligated to cover all Filipinos.”.
Under Philhealth Circular 2017-0006, all government-owned hospitals are mandated that no other fees or expenses shall be charged or paid for by qualified members beyond the package rate, particularly those admitted at the ward facility.
If the patient opts to avail of a private room, then the NBB policy shall not apply.
Qualified members and dependents who can avail themselves of the NBB include kasambahay, indigent, sponsored, senior citizens and lifetime members.
Packages and reimbursement
Mancao explained that the CCMC rate is stipulated and mandated by a city ordinance with the approval of the City Council.
Mancao said that because the rates were last adjusted 14 years ago, the fees and charges at the hospital remain “very low” compared to the market.
For a Complete Blood Count (CBC) test, CCMC charges P60, but instead of requiring patients to pay out of pocket, the cost is covered through their Philhealth coverage.
Once Philhealth reimburses the charges, the hospital receives P60 per test. However, Mancao said this amount is far below Philhealth’s maximum coverage rate of over P300 for a CBC test.
He added the new rate hike ordinance simply raises the CCMC’s CBC rate comparable to the Philhealth coverage rate.
“We only raised it to the level of Philhealth, as there is a guaranteed reimbursement and we could also maximize Philhealth’s rate,” said Mancao.
“Our rate is still much lower in comparison to other places and hospitals,” he added.
Mancao said Philhealth has introduced the Konsulta Package, in which the members will enjoy free doctor consultations and even medicines.
He added that state insurance covers the costs of almost all hospital services, including fees for doctors and medical professionals, as well as payments for ward rooms, though private rooms are excluded.
“The people have nothing to worry about as these have just been politicized,” said Mancao.
Subsidy
Due to the high cost of operating a hospital, Mancao said the City Government subsidized at least P500 million per year for the CCMC operation alone.
Once implemented, the new rate will allow the CCMC to be financially sustainable due to higher reimbursement returns from Philhealth, said Mancao.
Mancao estimated that while the hospital operates on an annual budget of P1 billion, its revenue amounts to only P500 million.
It leaves the city hospital to rely on the City Government subsidy to continue operations.
”If we increase our rate, they will increase our revenue by at least P700-P800 million per year, and it might lessen the City’s subsidy to at least P200 million,” said Mancao.
”If an LGU (local government unit) tries to open up their own hospital, they are always at a loss. That is why only a few have opened up their own hospital,” said Mancao.
Generally, LGU-owned hospitals or medical facilities are subsidized by their own LGU, said Mancao, adding that if the hospital is earning a profit, then there is something wrong.
Mancao said that LGUs with limited financial capability typically do not operate their own hospitals, as seen in the case of provincial and district hospitals in Cebu Province, which are owned and managed by the Provincial Government or the DOH.
In Metro Cebu, only the cities of Cebu, Lapu-Lapu and Mandaue operate their hospitals, said Mancao.
Mancao said CCMC currently has a maximum capacity of 180 beds, but city-owned hospitals are allowed to accommodate at least 250 beds.
He added the hospital is working on increasing its ward capacity to accommodate more patients.
Some patients endure waiting for a long time, even sitting in the hallway, to avail themselves of CCMC’s services rather than paying more at private hospitals, said Mancao.
“They are really forced to wait so as not to spend more; that is why we really need to finish the hospital,” he said.
Services
Currently, the CCMC offers almost all basic services; however, specialized services are not yet offered, said Mancao.
”Neurosurgery, we do not have it. Cardiac surgery, we don’t have it. If you only asked for medicines, ob-gyne, among others,” said Mancao.
At times of unavailability of certain services, Mancao said the patient could avail himself of the Champ program, where the patient is sent to other hospitals with the program guaranteeing payment.
Councilor Jocelyn Pesquera, the proponent of the recently approved legislation, earlier said it would standardize the fees and charges for various medical and health services offered by the City Health Department, CCMC and Guba Community Hospital.
The new rate will also be utilized to improve the equipment, facilities and service of the city hospital and medical facilities, Pesquera said.
Mayor Raymond Alvin Garcia also supported the ordinance, noting that the City Government subsidized around P500 to P700 million to cover CCMC’s operational costs and expenses.
Under the new rates, significant increases will be applied to laboratory services and routine tests: routine urinalysis will cost P263, from P30; pregnancy tests will cost P385, from P100; CBC will cost P368, up from P60; and routine stool exams will cost P255, from P30.
The new rates also include higher fees for imaging services. X-rays will now range from P120 to P290, from P120; CT scan fees will range from P5,769 to P23,748.45, while MRI procedures will cost between P8,249.38 and P186,280, particularly for advanced imaging techniques.
Charges for dialysis treatments have also increased, with fees for AV fistula dialysis now at P7,447.02 and CVC dialysis at P8,347.32.
The revised rates also include higher costs for maternity and newborn services. Emergency room delivery will cost P5,000, forceps-assisted delivery, P8,000; newborn care packages, P1,800; package delivery, P10,140; and institutional delivery, P6,500.
Fees for ward stays start at P600 per day, intensive care unit (ICU) stays at P2,500 per day and neonatal/pediatric ICU stays at P1,200 per day.
Dental fees for various procedures will also see increases, along with higher charges for medical certificates, affidavits, and other administrative services.
Philhealth packages will continue to cover doctor’s visits and professional fees.
