Stem11f 2021 - Borromeo Dumadag Bael - Position Paper

EYE Rest My Case: Why PhilHealth’s
Suspension on Reimbursement for

People who Have Undergone Eye
Corrective Surgery (LASIK) is a Wrong
Move
(Comm 02 - Midterm PT)
Submitted by:
Francis Borromeo
Van Dumadag
Joannah Bael
Submitted to:
Ms. Sievney Klyze Quidet
EYE Rest My Case: Why Philhealth’s Suspension on
Reimbursement for People who Have Undergone Eye
Corrective Surgery (LASIK) is a Wrong Move
In recent years, gadgets and screen usage have increased rapidly, leading to an
increase in the number of people developing eye conditions. Many also experience
early age-related macular degeneration, leading to a loss of eyesight. Astigmatism, an
eye condition that may be present from birth or may develop after an eye injury,
disease, or surgery, is one of the many conditions that the LASIK procedure can correct.
LASIK procedure ensures better vision without corrective lenses. Nearsightedness and
astigmatism are some of the eye concerns that can be corrected by the LASIK
procedure, which begs the million-dollar question: why did Philhealth suspend
reimbursement for people who undergo LASIK surgery? It is evident how LASIK surgery
provides many benefits in terms of eye condition and health. Thus, we believe
Philhealth should set aside funds to cater to people with eye conditions wanting to avail
of the LASIK procedure.
Many are against Philhealth's move because the LASIK procedure is still a
solution to a health concern developed by many. Thus, PhilHealth should continue to
reimburse it. However, some argue that the LASIK surgery is simply a cosmetic
procedure (Seltman, 2022). There is no serious health concern circulating around the
surgery, as it is only an alternative to wearing glasses. While this is true, and people can
still live without the procedure, imagine being restricted by your eye condition when a
simple surgery that guarantees better vision is available.
First, Philhealth insurance aims to provide financial assistance and affordable
health services to the Filipino people. This means that PhilHealth should include eye
corrective surgery (LASIK). Suspending the reimbursement for eye correction surgery
would defeat Philhealth's mission to ensure affordable, acceptable, available, and
accessible health care services for all Filipino citizens (Republic of the Philippines
Congress of the Philippines MetroManila, n.d.). Since the LASIK procedure is one of the
most common healthcare services available to improve one's vision or to correct eye
conditions, Philhealth should reimburse people who want to avail of the said procedure
(Kozarsky, 2020). Albeit there are more severe conditions than astigmatism and
nearsightedness, the reimbursement shouldn't be based on which medical condition has
more priority or severity (Sabik & Lie, 2008).
Second, Philhealth has sufficient funds to provide financial aid even to people
who don't have life-threatening disabilities, as their beneficiaries make monthly
payments (Nisperos, 2016). Additionally, as of 2021, Philhealth requires its members to
pay higher contributions (Magcamit, 2021). The Filipino people are spending
hard-earned money on the insurance company in hopes of getting reimbursed for their
medical procedures when in turn, their money is getting pocketed by the company to
fund fraudulent schemes. In August 2020, news broke on how PhilHealth allegedly
pocketed 15 billion pesos worth of funds through atypical transactions (Romero, 2020).
PhilHealth should remain loyal to its mission, and that is to cater to people with medical
needs. Thus, beneficiaries should be reimbursed when they require financial assistance
for medical procedures, including LASIK.
Eye Corrective Surgery (LASIK) is considered a universal healthcare;

governmental organizations from other countries reimburse it. Medicaid, a government
program in the United States that provides health coverage for the less fortunate,
covers the cost of LASIK. Additionally, Blue Cross Blue Shield offers financial
assistance to patients availing the LASIK procedure through a private insurance
company. Bajaj Allianz, an insurance company from India, covers Lasik surgery after
four years (Research Desk, 2015). All of these have one common denominator—
citizens pay to get reimbursed when in need of medical treatment. PhilHealth advocates
for universal healthcare; refuses to compensate people for medical treatments that can
benefit them in the long run.
With the evident increase in the number of people suffering from eye conditions
and the practicality that the LASIK procedure offers to the people, we firmly believe that
the LASIK procedure should be reimbursed. PhilHealth should focus on prioritizing the
well-being of the Filipino people, especially those who need this assistance. Therefore,
we urge PhilHealth to set aside funds to cater to people with eye conditions wanting to
avail the LASIK Procedure.
References
Does Insurance Cover LASIK? The Update for 2021. (2021, April 12). Refractive Surgery
Council.
https://americanrefractivesurgerycouncil.org/does-insurance-cover-lasik/?fbclid=I
wAR1f5GnpY4QC2F77jEEXnxn_Zir0Ahd8Kta7SMaGG6BJmBPu1mHE-AKFSxQ
Does Medicaid Help Pay for LASIK Eye Surgery? (2019, July 12). Medicare & Medicare
Advantage Info, Help and Enrollment.
https://www.medicare.org/articles/does-medicaid-help-pay-for-lasik-eye-surgery/
Kozarsky, A. (2020, April 16). LASIK Eye Surgery. WebMD; WebMD.

https://www.webmd.com/eye-health/lasik-laser-eye-surgery
Magcamit, Y. (2021, January 4). Here’s how much you have to pay monthly as Philhealth
increases member contributions this year. NOLISOLI.
https://nolisoli.ph/91592/philhealth-monthly-contribution-rate-increase-bn-ymagca
mit-20210104/#:~:text=With%20the%20new%20rate%20hike
Nisperos, M. (2016, October 16). Monthly payment mode now available for PhilHealth
self-paying members. Www.philhealth.gov.ph.
https://www.philhealth.gov.ph/news/2016/payment_mode.html
Republic of the Philippines Congress of the Philippines Metro Manila. (n.d.).

https://www.philhealth.gov.ph/about_us/ra7875.pdf
Research Desk. (2015, September 15). Health insurance that covers lasik surgery | Value
Research. Www.valueresearchonline.com.
https://www.valueresearchonline.com/stories/28777/health-insurance-that-covers-l
asik-surgery/
Romero, P. (2020, August 5). “PhilHealth mafia pocketed P15 billion .” Philstar.com.
https://www.philstar.com/headlines/2020/08/05/2033035/philhealth-mafia-pockete
d-p15-billion-
Sabik, L. M., & Lie, R. K. (2008). Priority setting in health care: Lessons from the
experiences of eight countries. International Journal for Equity in Health, 7(1).
https://doi.org/10.1186/1475-9276-7-4
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EYE Rest My Case: Why PhilHealth’s

Suspension on Reimbursement for

Eye Corrective Surgery (LASIK) is considered a universal healthcare;

Kozarsky, A. (2020, April 16). LASIK Eye Surgery. WebMD; WebMD.

Republic of the Philippines Congress of the Philippines Metro Manila. (n.d.).

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