‘PhilHealth mess can be traced to previous administration’

MANILA, Philippines — The alleged anomaly in the Philippine Health Insurance Corp. (PhilHealth) could be traced to policies of the state-run health insurer during the previous administration, a ranking lawmaker has said.

House public accounts committee chairman Mike Defensor said one of the biggest sources of corruption in PhilHealth is the “all case rates” system that was established in 2011 during the administration of former president Benigno Aquino III.

During inquiry of the panel on the controversy last Wednesday, he recalled that the system accumulated almost P154 billion since 2013 due to the system that led to overpayment to private hospitals.

“The issue persisted and eventually we are all surprised. This is where PhilHealth’s problems started, where funds started to go missing,” the Anakalusugan party-list representative stressed.

Defensor bared that another circular was issued in 2013 for implementation of the system, prompting PhilHealth to do away with its “fee-for-service” system where it only pays for the exact amount of the bill that a patient incurs from a hospital.

Quoting a 2017 Commission on Audit report, Defensor explained that a pneumonia case is charged P15,000, with over 700,000 claims every year; while acute gastroenteritis case is charged P6,600 and urinary tract infection P7,000.

“What is fee for service? If you get sick and spend P5,000, for example, pneumonia, you only spend P5,000 but because of the case rate or case-based payment, the hospital will be paid P15,000 (by PhilHealth),” the lawmaker explained.

Defensor urged the Duterte administration to end this system now.

“Let us abolish all case rates policy under the Duterte administration as this is the root of corruption in PhilHealth,” he said in Filipino.

With this, Defensor believes that PhilHealth president Ricardo Morales cannot be held accountable for this questionable scheme.

At the same hearing, Morales claimed that hospitals should be made equally accountable, as some healthcare institutions potentially colluding with their patients are not properly monitored, especially in other regions.

Morales added that they are potentially losing some P4.5 billion to that scheme alone.

“For usual coughs, it’s possible that they call it pneumonia in order to get bigger money,” he bared. “Next year, if we don’t improve the system, up to P18 billion will be lost. We can only prevent this by investing on information technology.”

Sen. Risa Hontiveros described allegations raised against her and other former PhilHealth officials as mere fake news and a diversionary tactic.

Hontiveros was responding to criticisms that she failed to dismantle the alleged “mafia” and merely used the agency to propel her senatorial bid in 2016 when she served as member of the board from November 2014 to October 2015. –  Paolo Romero