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Avail DOTS Package using NHIP

 Tuberculosis as defined by CDC (Centers for Disease Control and Prevention), “is a disease caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as kidney, spine and brain.”

            Here are the facts published by WHO (World Health Organization) about tuberculosis in the Philippines: (1) according to the latest report on Global TB Control, Philippines ranks seventh (7th) worldwide after India, China, South Africa, Indonesia, Pakistan and Bangladesh. (2) It ranks sixth (6th) on the other hand, for the most common cause of death. (3) On average, more than seventy (70) Filipinos die every day. (4) Our country is one of the top twenty-two (22) high-burden TB countries in the world out of one hundred ninety-six (196) countries. (5) Fifty-eight (58) countries are been confirmed by the World Health Organization where XDR-TB (extensively drug resistant TB) cases is prominent; Philippines is one of them.

            There are various indicators for its high predominance here. Its reported cases often include those individuals or families who are in the poverty line; malnutrition, lack of awareness, increase number of population and other social factors are also seen to be evident. It is mostly seen on elderly, smokers, and urban poor. Patients with a compromised immune system, i.e. persons with HIV (Human Immunodeficiency Virus), diabetes, and/or (extreme) malnutrition are likely to be included in the list.

To prevent children from acquiring tuberculosis, it is mandatory that they received BCG (Bacillus Calmette-Guerin) vaccine. It is administered to all infants which gives them fifty percent (50%) protective efficacy against any TB disease, sixty-four (64%) percent against TB meningitis and seventy-one (71%) percent against death brought by tuberculosis.

            A patient will be suspected of having TB and will be considered as TB symptomatic if he will manifest at least three of these symptoms: (1) cough/wheezing of two (2) weeks or more; (2) unexplained fever of two (2) weeks or more; (3) loss of weight/failure to gain weight/weight faltering/loss of appetite; (4) failure to respond to two (2) weeks of appropriate antibiotic therapy for lower respiratory tract infection; and (5) failure to regain previous state of health two (2) weeks after a viral infection or exanthema (e.g. measles).

            The success of controlling TB (tuberculosis) cases relies on the capability of our government in providing quality health care delivery system. The Department of Health (DOH) never stops in adopting a standardized TB management guidelines and protocols for an effective implementation.

            Under the National Health Insurance Program, DOTS (Directly Observed Treatment Short course) Package is included. It is believed that it is the most precise and compelling approved treatment protocol for tuberculosis (TB) worldwide. It covers: (1) all members of NHIP and all their dependents who meets the criteria and are not disqualified; and (2) for employed and IPP members, i.e. they already paid three (3) months contribution within the immediate six (6) months prior to enrollment at DOTS centers.

The criteria for eligibility are categorized into two:

I New cases

  • A patient who never had treatment or tuberculosis (TB)
  • A patient who has taken anti-tuberculosis drugs for less than a month
  • Smear positive pulmonary TB
  • Smear negative pulmonary TB
  • Extrapulmonary TB

II Tuberculosis disease in children

However, tuberculosis DOTS package will not cover the following types of TB cases:

  1. Failure cases (i.e. on previous treatment)
  2. Relapse
  3. Return after default (RAD)

Treatment outcome of DOTS package:

  1. Claims for completed DOTS shall be covered regardless of treatment outcome.
  2. Claims for patients who defaulted shall be denied.

Claims filing will be as follows:

  1. Claims with incomplete requirements shall be returned to the facility and must be complied within sixty (60) days.
  2. Non-compliance shall cause denial of claim.

Through DOTS Package of NHIP, members who suffer from tuberculosis will experience an uninterrupted supply of anti-tuberculosis drugs. There will be also a supervision of outcomes by a health care worker or a family member. For more details, check out DOTS Package of NHIP online.

Sources: PhilHealth_Subic_Forum_BenefitsPkg.pdf
              National Tuberculosis Control Program (NTP_MoP2004.pdf)

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