Pneumonia, hemodialysis top PhilHealth 6 payouts

By Mariela Angella Oladive

Pneumonia classified as moderate risk and hemodialysis recorded the highest benefit payouts released by the Philippine Health Insurance Corp. Region 6 in 2025.

PhilHealth 6 Acting Regional Vice President Lazaro Tabsing presented the data during the Kapihan sa Philippine Information Agency Western Visayas on Tuesday, Feb. 10.

Agency records showed that moderate-risk pneumonia logged 41,306 paid claims amounting to PHP 1.065 billion to hospitals and accredited facilities across Western Visayas, making it the top illness in terms of total payouts.

Moderate-risk pneumonia is a lung infection that requires hospital treatment but does not involve life-threatening complications and typically necessitates hospitalization and antibiotic therapy.

Acute gastroenteritis ranked second with 17,362 paid claims totaling PHP 181.17 million.

Hypertensive emergency or urgency followed with 16,771 claims amounting to PHP 264.35 million.

Dengue fever recorded 12,471 claims with payouts reaching PHP 210.75 million.

Urinary tract infection, classified as admissible, registered 11,218 claims totaling PHP 142.45 million.

Other illnesses with high paid claims included peptic ulcer disease without hemorrhage, chronic kidney disease, stroke infarction, anemia, upper respiratory tract infection, and fluid and electrolyte disturbances.

“These conditions are not only among the most frequently claimed. They are also the very illnesses that PhilHealth aims to prevent and manage early through our YAKAP (Yaman ng Kalusugan Program) services,” Tabsing said.

Formerly known as Konsultasyong Sulit at Tama, YAKAP seeks to promote preventive and primary care services to keep Filipinos healthy.

The program includes the enhanced PhilHealth Guaranteed and Accessible Medications for Outpatient Treatment, or GAMOT, which covers 75 types of medicines with an annual limit of PHP 20,000 per member and dependent.

In terms of medical procedures, hemodialysis registered the highest payout at PHP 3.629 billion, covering 484,367 paid claims.

Hemodialysis is a life-sustaining treatment for patients with kidney failure and is among the most availed outpatient benefits of PhilHealth.

The Expanded Newborn Care Package ranked second among procedures with 51,133 claims totaling PHP 260.47 million.

Animal bite treatment followed with 35,910 claims amounting to PHP 320.05 million.

Routine obstetric care in hospitals, including antenatal services, normal spontaneous delivery, and postpartum care, recorded 33,675 claims totaling PHP 226.43 million.

Chemotherapy administration logged 24,634 claims with PHP 226.43 million in payouts.

Intensity-modulated radiation therapy generated 20,793 claims with similar total releases.

Facility-based emergency benefits reached PHP 25.2 million from 8,335 claims.

Other procedures included maternity care packages in non-hospital facilities, outpatient HIV and AIDS packages, selected diagnostic testing, and primary cesarean section.

Although tuberculosis under the TB-DOTS program did not make the top 10 list, Tabsing said it remains a priority initiative aligned with the Sustainable Development Goals.

The TB-DOTS program recorded 8,518 claims, with more than PHP 18 million released to support tuberculosis treatment and control.

Field Operations Division Chief Junie Sabusap said that as of Dec. 31 last year, about 3.08 million of the region’s more than 8 million residents had enrolled in the YAKAP program.

Nearly 1 million enrollees have already availed themselves of their first patient consultation.

Sabusap said the agency expects the rollout of the GAMOT program to further boost enrollment.

As of end-November 2025, 96.74 percent of the region’s projected 8.09 million population were registered with PhilHealth.