EDITORIAL - Waiting for reimbursement

This has been a problem even before the pandemic: the reimbursement of claims filed by hospitals with the Philippine Health Insurance Corp. The Private Hospitals Association of the Philippines Inc. says PhilHealth owed about 700 of its member hospitals over P28 billion as of December 2020. PHAPi said the slow reimbursement was forcing its members to borrow from banks or else lay off personnel and reduce capacities. The group says the unpaid claims could balloon to P50 billion if government hospitals and other healthcare facilities are included.

PhilHealth said it had already reimbursed 87 percent or P24.9 billion of the claims, with another P1.07 billion being processed. The state health insurer said P2.4 billion of the claims were either denied or returned to the hospitals because of various deficiencies. This was last April at the height of the COVID surge when hospitals were being overwhelmed with patients. PhilHealth has implemented a debit-credit payment method to speed up reimbursements.

As the country confronts the spreading threat of the more virulent Delta variant, however, PHAPi says PhilHealth owes more to its member hospitals and the slow reimbursement problem persists. Smaller hospitals are the hardest hit and have been forced to let go of healthcare workers as well as reduce capacities, according to PHAPi.

Corruption scandals in PhilHealth in recent years led to its closer scrutiny of claims for reimbursement. Increased scrutiny, however, need not be at the expense of efficiency. Since the early months of the pandemic, even the Philippine Red Cross has complained about slow PhilHealth reimbursement for COVID testing.

Hospitals especially the smaller ones need funds for day-to-day operations, especially with the increased demand for health care arising from the pandemic. Consultations and treatment for non-COVID care have reportedly gone down as people worried about infection put off going to hospitals unless for emergencies or maintenance procedures for chronic afflictions.

Many hospitals in fact need to hire more personnel particularly for specialized COVID critical care facilities. Instead their liquidity problems are forcing them to downsize. Authorities will have to step in to reconcile the stories of the hospital owners and PhilHealth. With Delta continuing its spread, all health facilities must be at their optimum capability to respond to the threat.