DEMAND AND SUPPLY - Boo Chanco (The Philippine Star) - August 19, 2020 - 12:00am

Health is wealth. But it seems in our current situation, the only ones getting wealthy on the pretext of caring for our health are the crooks.

Overpriced supplies to help us deal with the covid epidemic is one thing. The outright raid on the funds intended for our health care system through PhilHealth is another.

The blog Heneral Lunacy observed:

“The Senate hearings on PhilHealth confirm what we already suspected: The agency is a criminal enterprise posing as universal health care. It is organized crime. It is a protection racket. It is a Ponzi scheme built on the monthly sweat of hard working Filipinos.”

What we are missing is the sense of outrage from our Great Leader. After all, it was he who more than once said, even a whiff of corruption is enough for him to fire any official he has appointed.

The whiff has become a stench, but nothing is happening to suggest our Great Leader feels bad about scandals at DOH and PhilHealth. He seems to have lost his sense of smell like some Covid patients.

Ok, his spokesman said our Great Leader doesn’t want to aggravate the health condition of his PhilHealth president who is battling cancer. All the more this former general should be relieved to allow him to go through whatever anti-cancer therapy is called for.

A fresh appointee with no ties to the past mess and satisfies the qualification stipulated in the PhilHealth Charter should help quiet down public outrage.

I was covering the Senate when former Sen Freddie Webb sponsored the original PhilHealth Bill. There were a lot of expectations then.

Some decades later, PhilHealth has been proven to be a big disappointment. Rather than being a financial pool to help Filipinos pay health care bills, it has become the target of scammers. Worse, no administration even attempted to clean it up.

Now we are being told by Marikina Rep. Stella Quimbo that PhilHealth coffers bled over P15 billion from 2014 to 2018 due to fake pneumonia claims. That does not include fake dialysis cases, overpriced cataract operations and now, fake covid cases.

In a statement, Quimbo detailed the extent of fund leakages due to supposedly fraudulent PhilHealth claims for respiratory illness, whether due to ghost claims from non-existent pneumonia patients or “upcasing.”

Upcasing refers to the alleged collusion between hospitals and PhilHealth, with the facility submitting claims for pneumonia—amounting to P15,000 to P32,000 for each patient, depending on the severity— even if the patient simply had a cold or cough.

“On the average, PhilHealth paid P14,445 per claim in 2018, hence, the value of ghost and upcased claims is estimated at P3.6 billion in 2018... This amount, if not lost by PhilHealth, would have been sufficient to fund hospital admissions for PhilHealth’s total projected COVID-19 cases for 2020,” the lawmaker said.

Quimbo said that in 2018, the number of PhilHealth claims for pneumonia totaled 757,266, or 253,382 more than the estimated number of pneumonia patients based on the Department of Health’s morbidity data.

This congresswoman can be depended upon to check her facts and crunch her numbers before talking. She is a trained economist, a PhD and professor from the UP School of Economics and a senior official of the no nonsense Philippine Competition Commission before she was elected a member of Congress.

She has also done extensive research in the field of health economics and public policy among others.

Rep. Quimbo isn’t the only one bringing PhilHealth anomalies to light. A couple of high officials in the agency have resigned, with one of them claiming massive fraud which his superior, the agency president, supposedly instructed him to smooth over at the Ombudsman.

Duterte’s anti-corruption office has also publicly denounced so-called systemic corruption at PhilHealth, which the current PhilHealth president confirmed when he said, even Superman cannot clean the mess.

But the only thing our Great Leader did was to form another investigation committee as if his regular anti corruption unit didn’t do a good job.

What we need to know quickly is whether the agency can be salvaged, or if we have to abolish it and start all over.

Maybe the concept is wrong for a corrupt government like ours. This is where we are interested to hear if experts like Rep Quimbo can offer fresh ideas.

A public health insurance system is not such a novel idea. Scandinavian countries have been enjoying their successful systems for decades. Canada is another good example of a country that is able to take care of their people’s health needs. That’s one big worry off their people’s minds.

The public-private partnership in the health insurance of Americans is more messy because powerful business interest lobbyists have been able to hold US lawmakers captive.

But even in their case, what they have seems to be somewhat helpful. The last time I read something about massive US Medicare fraud, some Filipino doctors were involved. But that seems an isolated case.

My point simply is, there are good models of effective health insurance we can use. But we must make it more difficult to corrupt.

I am not sure that’s possible but that’s the challenge. We have experts like Rep Quimbo and the PIDS think tank of government to help us.

What this pandemic showed us is the fragility of what we call our health system. We need to put our minds together and come up with a self checking public private partnership.

We need a better system that is more useful for all Filipinos, not just the crooks among us. Perhaps if the private health care plans can work with government that will be a better approach.

Let us remember that PhilHealth funds are private funds managed by government like the SSS. If government can’t do the job, we need a way to get private health insurance plans to take over.

In the meantime we need to clean up the PhilHealth mess and send some scoundrels to jail. Unless that happens, the whiff of corruption will become a perpetual stench.

Boo Chanco’s email address is Follow him on Twitter @boochanco

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