Christine Caparas,
Opinion: Philhealth’s Hindrances to Quality Health Services
Photo Credit: Yel Brusola
The Philippine Health Insurance Corporation (PhilHealth) made the right decision of suspending the hike in members' contributions that was supposed to take effect this month. An estimated P13-billion deficit is to come from this suspension, and they say that this will hinder PhilHealth’s operations and its members' access to health care aid.
However, is this deficit really the only hindrance to a good public health care system?
Under the Universal Health Care (UHC) Act, an increase of 0.5 percent in member premiums every year is to be implemented at the beginning of 2021 until it reaches the limit of 5 percent in the year 2025. This January, PhilHealth's monthly rates were scheduled to increase from last year’s 3 percent to 3.5 percent. This would have resulted in raising the minimum contributions from the current P300 to P350. This scheduled increase, however, was met with fierce opposition since the latter half of 2020 when multiple corruption allegations were brought about against the state health insurer.
Ricardo Morales, former PhilHealth chief, has admitted that in 2019, an estimated rate of 7.5 percent or 10 billion of PhilHealth’s budget was lost due to fraud. After this, he had the gall to argue that even in developed countries, corruption is still very prevalent with benefit claimants trying to acquire more than their rightful share; that this is considered the “norm.” This may be the norm, but it doesn't mean that we should ignore it, especially with even more allegations involving PhilHealth seemingly falling on deaf ears?
One of these allegations is the suspected exploitation of the Interim Reimbursement Mechanism (IRM), a system created primarily to assist PhilHealth in computing the exact amount of delayed reimbursements that the corporation owes to each hospital and clinic after dealing with various disputes and fraudulent claims.This system supposedly ensures that despite the irregularities, hospitals and clinics are still provided with financial aid during fortuitous events like calamities and the ongoing pandemic.
However this does not seem to be the case because "favoritism" also seems to be rampant in the system. In a House hearing, lawmakers pointed out that a number of dialysis and maternity clinics that do not cater to COVID-19 patients were the earliest recipients of monetary support. Meanwhile, COVID-19 referral hospitals waited months to receive their IRM allotment. This makes the implementation of IRM more questionable, given that it's supposed to provide aid during an unforeseen pandemic.
In addition to this, former PhilHealth senior vice president for the legal sector Rodolfo del Rosario Jr. admitted that the IRM releases from March to early June were “illegal.” According to him, PhilHealth released more than P14 billion as early as March, to different hospitals and clinics all over the country when the IRM should have taken effect only on June 11 which further proves that the suspended system was exploited and is indeed ineffective.
Another issue discussed during the hearing was the alleged overpricing of IT equipment. According to Alejandro Cabading, a member of PhilHealth’s board of directors, PhilHealth spent a P2.1-billion budget for the procurement of several pieces of IT equipment, or P734 million more than the amount prescribed by the Department of Information and Communications Technology (DICT).
Lastly, the notorious overpayments in all case rate systems, which summed up to as much as P102 billion from 2013 to 2018. The case rate is a fixed amount, depending on a patient’s illness, of reimbursement to the hospital. It includes payment for healthcare professionals and medical facilities based on the average costs of treatment for every common illness.
Ironically, the government implemented the case rate system to prevent fraudsters from bloating reimbursements of services given to PhilHealth members as the corporation would provide the standardized amounts of aid equivalent to whatever a patient's condition was. However, contrary to its initial objective, the case rate is now one of the most exploited systems, mostly used within the corporation for corruption due to the nature of how money is reimbursed. As previously stated, monetary support given to each member is fixed. Therefore, PhilHealth is often forced to pay this fixed amount even if a patient's actual medical bills are much lower.
Philhealth made the right decision to temporarily postpone the increase in its members’ contribution especially with all these corruption allegations and the difficulties the people are facing amidst the pandemic. However, with the expected deficit in the budget, the public is left asking, where exactly will the government get the funds needed to continue the operations of PhilHealth when most of the corporation’s budget have been lost due to corruption?
President Rodrigo Duterte was quick to reassure his citizens by releasing a statement in support of the postponement of the contribution hike. “May I just suggest to PhilHealth Chairman Dante Gierran, not now. No increase in contributions. I will look for the money to fill it up. We will look for money,” the president promised.
With millions of Filipinos still grappling with the effects of the pandemic, the public cannot afford to lose P500 from their already-limited budget, especially when most of them either have lost their jobs or are barely making enough money to provide for their families. Therefore, the government is expected to bear the burden of aiding its citizens. As the president himself stated, “Anyway, that is the job of the government--to make it easy for everybody at this time of our lives.” With that, this action is not commendable but rather a decision that we, as Filipinos, are entitled to expect of our government because it is their duty to provide for the country’s citizens.
With that said, why is there a need for PhilHealth to push through with its members' contribution hike? Why must the members of PhilHealth, why must the public be responsible for the wrongdoings and shortcomings of these public officials, especially amidst a pandemic?
Instead of temporarily postponing the contribution hike, isn’t it fair that our government seek justice and punish these corrupt officials? After all, the very root of the lack of budget is not the expected 13-billion deficit but its officials who have been alleged of multiple cases of corruption and fraud that goes all the way through the system.
PhilHealth has made the right decision to temporarily halt its members’ contribution hike. However, those who are proven to be involved in the agency’s corruption of funds must also be held accountable to ensure that PhilHealth’s budget is allocated and used solely for its monthly contributing members, the Filipino people. //by Christine Caparas
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