PhilHealth links up with Philippine Orthopaedic Association to ramp up public awareness on Z Benefits Package for Selected Orthopedic Implants & Joint Replacement
CAGAYAN DE ORO CITY- PhilHealth Regional Office 10 and the Philippine Orthopedic Association (POA) held a press conference on May 9, 2025, at Limketkai Luxe Hotel, Cagayan de Oro City, to promote PhilHealth’s Z Benefits for Selected Orthopedic Implants, aimed at supporting patients needing joint replacement and other orthopedic procedures.
PhilHealth Region X Vice President Delio Aseron II, disclosed that effective January 2025, PhilHealth has been aggressive in increasing the scope of its benefits, together with significant upgrades to the coverage of their Z Benefit Packages like Kidney Transplant (now with P2M coverage), Breast Cancer (with P1.4M coverage), and new benefits such as their Outpatient Emergency Care Package, Oral Health Services, and many more.
“These transformative changes are not just about enhanced benefits. They are about building a stronger foundation for universal health care, prioritizing every Filipino’s right to quality, equitable health care,” Aseron stressed. “That’s why we urge all our kababayans to join us in promoting the importance of social health insurance and work together to ensure everyone has access to necessary health care.”
The Philippines has adopted a social health insurance system to achieve Universal Health Coverage. Through Republic Act (RA) 7875, as amended RA 9241 and 10606, and RA 11223, PhilHealth aims to cover all Filipinos and provide access to a comprehensive set of benefits without causing members financial hardship. The primary policy objective of healthcare financing is protection against the financial risks of ill health.
While PhilHealth covers hospitalization expenses for surgical procedures, the prohibitive cost of orthopedic implant devices is not entirely covered, and members have to shell out additional out-of-pocket expenses. The high prices of orthopedic implant devices are not affordable to most patients. Delayed surgeries are the consequence. Thus, patients or their families seek medical assistance from other sources which leads to extended and expensive confinements in medical facilities. Delays in surgery increase productivity losses and mortality in elderly patients by 30 percent.
Joint Replacement Awareness Project
To generate increased public consciousness about PhilHealth’s Z Benefit packages for knee and hip replacements, PhilHealth Region 10 together with the Philippine Orthopaedic Association (POA) conducted the May 9th press conference with the Philippine Information Agency Region 10 (PIA-010) focusing on its Joint Replacement Awareness Project to appeal to mainstream and social media to help spread the word to the people who would benefit the most from their assistance.
The POA team was headed by President Dr Justinian Aquilino Cyril “Jac” Pimentel IV, who is also the chairman of the NMMC Orthopedic Dept, and ASEAN Orthopaedic Association president as well. Joining him were Dr Herminio Valenzuela, President of the Hip and Knee Society of the Philippines (HKSP), NMMC Medical Director Dr Jose Chan, POA Secretary Dr Peter Quiaoit, and ASEAN Orthopaedic Association Council Member, and HKSDP Vice President Dr Michael Muñoz, POA Trustee, and Project Head of the POA Joint Replacement Awareness Project.
“My task is to raise awareness about the Z Benefits Package from PhilHealth because it’s here already, but very few know about it,” Muñoz said. “Thus, very few also benefit from it. The Z Package has been there but under-utilized. That’s why we want to increase the awareness, so the utilization of this Z Package will increase.”
“We thought about this project because we know that there are many Filipinos suffering from arthritis because they do not know there are orthopedic surgeons who are capable of doing this, plus the very good program of PhilHealth that provides for the implants,” Pimentel said. “We appeal to those suffering from arthritis to consult their nearest orthopedic surgeon if they need surgery or rehabilitation to alleviate their conditions, and enroll as members of PhilHealth so they can avail of these benefits.”
Pimentel added that POA has around 1,000 members strong who are experts in musculoskeletal conditions with sub-specialist groups that specializes in knee and hip, spine and hand, among others.
“We are trying to really make the management of osteoarthritis or whatever arthritis at the NMMC, we have many ways of treating arthritis aside from surgery, and NMMC can provide a wide spectrum of how to manage these conditions,” Quiaoit, who recently took over as OIC NMMC added.
“Since January 12, 2016, NMMC has been the sole contracted hospital in Region 10 for orthopedic implants,” said Merlyn Ybañez, PhilHealth 10 Public Relations Head. “More recently, it was also accredited as a contracted facility for Physical Therapy and Rehabilitation Medicine, which is a major step forward in making quality orthopedic care accessible and affordable”.
There are other Z Benefits packages for heart, breast, kidney transplant and others that are also available for patients. Even if they don’t qualify for Z Benefits, they are other PhilHealth benefits they can avail of at NMMC like specialized outpatient benefits packages for Rheumatic Fever/Rheumatic Heart Diseases (RF/RFD) and Physical Medicine, Rehabilitation Services, and Assistive Mobility Devices.
“It democratizes joint replacement care. It will now be possible for all Filipinos to avail of it, regardless of income level and where you come from. And because of the regional medical centers all over the Philippines, we can assure you that we, both the POA and the Hip and Knee Society, will be able to provide the specialists to do these surgeries. It’s also our moral obligation as doctors to give back to society,” Valenzuela said.
Recent data show that the top ten diseases in the Philippines account for 40% of our disease burden, with the top 10 causes of death and disability caused by diseases requiring rehabilitation. Data from DSWD data (December 2016) revealed that there are 823,014 households caring for PWD members. Arthritis, particularly osteoarthritis, is a significant health concern in the Philippines, affecting an estimated 4.2 million Filipinos.
These facts stress the need for better rehabilitation services supported by a strong network and financing mechanisms. However , despite the availability of the Z Benefits Package to all qualified PhilHealth members, Valenzuela rued how the output for joint replacement remains small.
“As we calculated we should be doing around 100,000 joint replacements per year in this country and yet, we’re doing just 15,000. There’s a wide gap we have to fill and rest assured we will all be there to help our countrymen,” he assured.
According to Outgoing NMMC Medical Director Dr. Jose C. Chan, since the start of the Z Benefits Package at NMMC in 2016, only 2 patients each year availed of it from 2016 to 2019, none in 2022, seven in 2023, sixteen in 2024 16, and to seven date in 2025.
Z Benefits for Selected Orthopedic Implants
Aceron said all Filipinos are automatically entitled to avail of this benefits package but will first have to be assessed and undergo pre-authorization process to determine if they are qualified to avail of it.
Physiatrist Assessment
To start with, Physical medicine assessment typically involves a comprehensive evaluation of a patient’s physical function, mobility, and overall health status. This includes patient history (gathering information about the patient’s medical history, current symptoms, and any previous treatment and interventions), physical examination ( conducting thorough physical exam to assess strength, range of motion, posture, and any areas of pain or discomfort), functional assessment (evaluating the patient’s ability to perform daily activities and tasks, which may involve standardized tests or observational assessments), diagnostic tests (utilizing imaging studies like x-rays or MRIs or lab tests if necessary to gain further insight into the patient’s condition), goal setting (collaborating with the patient to establish realistic and achievable goals for rehabilitation and recovery), and treatment planning (developing a personalized treatment plan that may include physical therapy, medication, or other interventions aimed at improving the patient’s physical function and quality of life).
Assessments by PT, OT and SLP
Each professional focuses on different aspects of a patient’s health and functional abilities:
Physical Therapy assessment: Physical exam (evaluates strength, flexibility, balance, coordination, and range of motion through various tests and exercises), functional mobility assessment (observes the patient’s ability to perform movement s such as walking, climbing stairs, and transferring from one position to another), pain assessment (identifying areas of pain and understanding the nature and intensity of the pain experienced by the patient), and goal setting (collaborating with the patient to establish rehabilitation goals focused on improving physical function and mobility.
Occupational Therapy assessment: patient history (understanding the patient’s daily routines, roles, and activities that are impacted by their condition, functional assessment ( evaluating the patient’s ability to perform activities of daily living such as dressing, bathing, cooking and other self-care tasks), cognitive and perceptual assessment (assessing cognitive functions and perceptual skills that may affect the patient’s ability to engage in daily activities), environmental assessment (analyzing the patient’s home and work environments to identify barriers to participation and areas for modification), goal setting (working with the patient to set achievable goals that enhance their independence and quality of life.
SLP assessment: patient history (collecting information about the patient’s communication abilities, swallowing function and any relevant medical history), communication assessment (evaluating speech, language, voice and fluency through standardized tests and informational observations), swallowing assessment (to determine the safety and efficiency of swallowing, which may include clinical evaluations or instrumental assessments (e.g., videofluoroscopic swallow study), cognitive-communication assessment (assessing cognitive functions related to communication such as attention, memory and problem solving skills), goal setting (collaborating with the patient to establish communication and along goals tailored to their needs).
These assessments are often conducted in a collaborative manner, where the findings from each professional inform a holistic treatment plan. This interdisciplinary approach ensures that all aspects of the patient’s health and functional abilities are addressed, leading to more effective rehabilitation outcomes.
The Z Benefits Package for qualified patients are as follows:
These benefits packages cover the following services:
Following are the benefits available for the following services:
To avail of the Z Benefits Package for Hip and Replacement, patients can proceed to NMMC’s Outpatient Orthopaedics for assessment and screening. If deemed qualified, NMMC will refer the patient to PhilHealth for preapproval of preauthorization and once granted, they can then be scheduled for surgery by NMMC.
Dr Villanueva also encouraged arthritis patients and their families to avail of the Z Benefits Package, especially surgeries which often have positive outcomes with patients walking on their own as early as two days after their operation, and especially the relief from the chronic pain these procedures bring to their beneficiaries.
“We are here as members of the Hip and Knee Society with 110 members all over the country, to show that outcomes are not always bad. They are exceptions, not the rule.”
In conclusion, Aceron reiterated PhilHealth President and CEO Edwin Mercado’s call on their Rise 30 Mission- isang PhilHealth na Mabilis, Patas, at Mapagkakatiwalaan.
Mabilis – Ensure hospitals are paid on time; Patas – Ensure hospitals deliver better care; and, Mapakakatiwalaan – Filipinos feel secure in their health insurance coverage.
