What Are Hospital Levels, as Used by Philhealth?

August 28, 2011 by Nors | Filed under DOH, hospitals, philhealth.
Philhealth mentions Levels 1 to 4 in its Case Rates payment scheme?  What are these Levels?
For quick understanding, we can just say that a:
- Level 1  –  very small hospital
- Level 2  –  a small hospital
- Level 3  –  a big hospital
- Level 4  –  a very large hospital
The Department of Health (DOH) though has a more detailed description of these types of hospitals.  It’s even covered by administrative law, the DOH Administrative Order 205-0029.
Level 1 Hospital
- Emergency hospital
- initial treatment for cases that require immediate treatment and that provides primary care for prevalent diseases in the area
- general medicine, pediatrics, minor surgeries, and non-surgical gynecology
- primary clinical laboratory, pharmacy and first level radiology
- nursing care for patients needing minimal supervised care
Level 2 Hospital
- Non-departmentalized hospital
- general medicine, pediatrics, surgery, anesthesia, obstetrics and gynecology, first level radiology, secondary clinical laboratory, pharmacy
- nursing care for patients needing intermediate supervised care
Level 3 Hospital
- Departmentalized hospital
- all clinical services provided by Level 2 hospitals
- specialty clinical care
tertiary clinical laboratory, pharmacy, second level radiology
- nursing care for patients needing total and intensive care
Level 4 Hospital
- Teaching and training Hospital
- all clinical services provided by Level 3 hospitals
- specialized forms of treatments, intensive care and surgical procedures.
- tertiary clinical laboratory, third level radiology, pharmacy
-nursing care for patients needing continuous and specialized critical care
Hospitals can also be classified as:
1. General
2. Special
Other health facilities are:
- Birthing homes — maternity clinics that provide pre-natal and post-natal care, normal spontaneous delivery and newborn baby care
- Psychiatric care facilities — care of mentally ill patients

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27 Responses to “What Are Hospital Levels, as Used by Philhealth?”

  1. MeryTubio says:

    thank you very very much :)

  2. KC KRIS says:

    WHAT LEVEL OF HOSPITALS DO YOU CONSIDERED THAT A HOSPITAL IS A TERTIARY LEVEL.??,I want to know what is the difference between level 1,2,3,and 4 to a primary,secondary, and tertiary leveled hospitals.?,naguguluhan poh kasi ako,.How do you considered that a hospital is a tertiary level based on level 1,2,3,or 4..??

    • Nors says:

      Hi KC Kris, levels 1,2,3,4 are used in the Case Rate payment scheme. Basically, 1 refers to a smaller hospital, and 4 refers to a big hospital like Makati Med or PGH or East Avenue. Maternity benefits are lower in levels 2 to 4 hospitals. Also, major surgeries must be performed only in levels 2 to 4 hospitals in order for Philhealth to give benefits.
      Primary, secondary, tertiary are used in the old payment scheme. Primary refers to a smaller hospital while tertiary refers to big hospitals like PGH or Makati Med. Philhealth have higher maximum benefits for those confined in tertiary hospitals. Level 4 hospitals are tertiary hospitals. Some level 3 hospitals are tertiary; other level 3 hospitals are secondary. Level 2 hospitals are usually secondary. Level 1 hospitals are primary.
      https://sites.google.com/site/informationphilippines/philhealth/inpatient-coverage-fee-for-service-1

  3. Sophie Miles Ng says:

    Hi! How much is the salary of Radiologist per day or per visit does ultrasound reading as well? Thank you very much.

    • Nors says:

      Hi Sophie, sorry, I don’t know, it depends on the hospital. You can ask the accounting/collection dept.
      If you’re asking about payroll salary, I saw a new ad for a radiologist for a Las Pinas hospital and the monthly salary is 11k only. Some hospitals of course are paying much more.

  4. Jinelyn Villaver says:

    helo!

    may i know what is a cadaver holding room in hospital?

    • Nors says:

      Hi Jinelyn, it is the hospital mortuary or morgue. It’s where they store bodies of the dead awaiting identification, autopsy or transfer to funeral homes.

  5. Jhen says:

    I am confined in a hospital in China due to gastroenteritis. It will probably be for 2-3 days. Is this covered by Philhealth? If the level is 3 for confinements abroad, how much would be the estimated claim for this? My other problem is the original receipt or statement of billing written in English. I am not sure if they can provide an original in English language. Can the original documents be in Chinese, then supported with English translation? Thanks!

  6. Jhen says:

    Thanks for your reply. The hospital has provided me original documents written in English.

  7. alvin says:

    sir, ask ko lang po how much po kaya ang maire-reimburse samin ng philhealth for the IJ (internal Jugular)surgery of my dad today?Un po ung para sa dialysis na nilagay sa leeg ng pasyente. We paid a total of 14,500.00 (6.5k sa hospital and 8K sa doctor). I went to philhealth today din po,but the staff said i need to get a waiver from doctor and hospital stating that no philhealth deduction was made.Thanks po

  8. sha says:

    anong level po ba ng hospital nakapaloob ang mga geriatric hospitals?

    • Nors says:

      Hi sha, what’s the name of the hospital? Parang wala akong naririnig na hospital na identifying itself as exclusively geriatric. Nakahalo ang geriatric care section sa big hospitals (level 3 to 4). Siguro merong mga small private clinics specializing in caring for older people, pero wala akong alam as of now.

  9. jojo says:

    good day po! ang endoscopy po ba ay anong case type medyo naguguluhan po kasi kami sa mga cases na sinansabi sa philhealth. ginawa po ito sa Bulacan polymedic Hospital di ko rin po alam kung anong level ng hospital at 5 days po naconfine doon
    . thanks po

    • Nors says:

      Hi jojo, ang endoscopy ay diagnostic procedure. Ano ba ang nakitang sakit? At ano ang treatment? Kasama itong procedure na ito sa Philhealth coverage kung merong nakitang sakit at merong treatment. Ask the doctor kung ano ang sakit.

  10. Aira Eugenio says:

    Hi, pwede ba makahingi ng link ng naka categorize na hospitals dito sa pilipinas accdg to level? Like level 1, 2, 3, and 4. Mejo naguguluhan kasi akong i classify pagdating sa level 3 and 4 e. Thank you po. :)

  11. Nes says:

    Hi! My father undergo hemorrhoidectomy at Makati Medical Center yesterday, he was admitted last Oct. 23 and we were advise that he will be discharge tomorrow. Do you have any idea how much will be covered by philhealth in cases like hemorrhoidectomy? Thanks.

  12. grace says:

    hello po my daughter admitted December 23.2013 and diagnose moderate pneumonia.total bill po namin is 12,317.40 the deduction for the philhealth is 10,817.40 dba po 15k dapat ang deduction nila.and balance ko na dapat bayaran ay 1,500..pede ba ma refund nila sa akin ang 1.5k?please reply [po

    • Nors says:

      Hi grace, yong 15k is further divided into 10,500 for hospital and 4500 for doctor. Tanungin mo na lang yong hospital kung marerefund mo pa yong 1500 sa PF ng doctor. Usually, kasi idinadagdag pa sa PF ng doctor yong coverage na yon.

  13. yolanda alfonso says:

    is Level 1 Hospital the same as a Primary Hospital?

  14. Bing says:

    Hi, Just want to ask the following po. Why yung procedure at pf n ginawa ng radiologist-doctor for ultrasound guided biopsy using needle to get sample for possible cancer ay hindi included s billing ng patient. Ganun din po yun ibang pf ng histopathologist ay hindi included s billing. I have to pay them separately but they issued O.Rs.naman. another question po is pwede ko po b iclaim s philhealth lahat ng hindi isinama s bill at medicines n binili outside; yun pong pf ng nagcheck ng immunostain ng biopsy result also i paid separately. One last question po, un pong nagtake over while my pulmo doc is not around, i have to pay him also separately. Will all of these be refunded to me by philhealth? Im still confined here at the pgh while waiting for the result of immunostain or immunohistochemistry.
    Thank you and please enlighten me.

    • Nors says:

      Hi Bing, what I can advise is you file your Philhealth papers with PGH before discharge because Philhealth now rejects direct filing. Ask them if you can submit your PF and medicine ORs — usually sasabihin nila Case Rate system na so hindi na needed ang ORs. Basically kasi, dahil Case Rate system na, meaning fixed rates na ang coverage for any condition, isusulat ng doctor ang diagnosis and code, plus procedure and code (if policy allows certain procedure and condition to both be covered) with other details on the claim forms, and then Philhealth will refund the amount, based on the Case Rate chart — fixed na yong amount ng coverage for each specific condition and medical procedure.

  15. janet hantid says:

    hi po! gusto ko lang po malaman kung what level ang mga lying clinics?

    • Nors says:

      Hi janet, nasasama siya sa level 1. Hindi siya puede for CS, other surgeries and complex medical conditions. Pero 6500 ang coverage ng normal delivery sa level 1. 5k lang pag level 2 and up

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