EDITORIAL - PhilHealth to OP?

The Philippine Health Insurance Corp. was created under Republic Act 7875, the National Health Insurance Act of 1995. Section 14, Article IV of RA 7875 states that PhilHealth “shall have the status of a tax-exempt government corporation attached to the Department of Health for policy coordination and guidance.” On top of the list of its functions, as defined by RA 7875, is “to administer the National Health Insurance Program.” By law, the DOH secretary chairs PhilHealth in an ex officio capacity.

For reasons that are supposed to improve efficiency in the state health insurer, the government appears set to transfer supervision of PhilHealth from the DOH to the Office of the President. Whether this can be done without legislation may face a legal challenge, and adversely affect services in an agency that already faces a mountain of problems and controversies.

Among the most affected by any policy involving PhilHealth are hospitals. The Private Hospitals Association of the Philippines Inc., however, has said the group was not consulted on the plan. PHAPi believes the move requires an amendment of RA 7875. And if an amendment is in the works, PHAPi wants to change the quasi-judicial powers that make PhilHealth the investigator of suspected errant claims, prosecutor, judge and implementer of penalties, all rolled into one.

In imposing penalties such as fines as well as suspension, revocation or restoration of the accreditation of a health care provider, PhilHealth, according to RA 7875, “shall not be bound by the technical rules of evidence.”

Certain doctors have also expressed concern about transparency and accountability in an agency that has been hounded by corruption and malversation issues even before the COVID pandemic. The doctors ask how well probers can investigate the Office of the President in case of fund misuse allegations. If the intention is to give President Marcos a direct hand in streamlining and cleaning up a scandal-plagued agency, the doctors have noted that the President already has enough on his plate as concurrent secretary of agriculture – a sector that has been hit by multiple crises in the past year.

If efficiency is the goal, health service providers have suggested that a nationwide digital network, interoperable across government agencies and health service providers, for filing and processing PhilHealth claims would work better.

Their common suggestion to boost PhilHealth efficiency is for Malacañang to consult key stakeholders – starting with the plan to transfer the agency from the DOH to the Office of the President.