Where have all the PhilHealth funds gone?

"PhilHealth must commission financial experts and managers with actuarial acumen to replace physicians doubling as accountants."

 

Where have all the flowers gone?

This is the opening line of a classic song written in 1955 by American singer and political activist Peter “Pete” Seeger who died in 2014.

Using the principle of alliteration, the song enunciates the futility of war juxtaposed on the cycle of life.  It is so simple and powerful cycle many an artists including the trio Peter, Paul and Mary have immortalized it down the line.

The song inspired me to write about the recurrent fund scandals that rock the state-run Philippine Health Insurance Corp. every now and then. With all due respect to the songwriter, I made some modifications to bring home the message in today’s column.

“Where has all the money gone, long time passing?

Where has all the money gone, long time ago?

Where has all the money gone?

The thieves pocketed them everyone

When will they ever learn?

When will they ever learn?”

Over time since its creation, PhilHealth has shown us it is the bedrock of corruption in high places…involving mind-boggling amounts of money that belong to its marginalized members, notably senior citizens who have lost their capacity to earn by reason of age.

Last year alone, the agency reportedly paid out a total of P12.69 billion in claims by accredited hospitals representing bills of pneumonia patients across the country.

On the surface, it looks just fine and dandy. But a closer scrutiny would reveal something is rotten and stinks to high heavens.

Experts figured it out. According to them, the PhilHealth report indicated that some 810,000 patients, representing one out of nine who sought hospitalization, were stricken with the life-threatening lung ailment last year. Put another way, there was a pneumonia outbreak and the Department of Health didn’t say anything about it, obvPhilHealth was previously rocked by a similar scandal involving mounting bills pertaining to cataract removal.

In Iloilo, an eye doctor allegedly claimed an incredibleP16 million, representing his professional fees for equally unbelievable 2, 071 eye surgeries performed in 2006 alone.

Investigations showed that the shenanigan was replicated in various parts of the country.

In 2007, a ranking PhilHealth official testified at the congressional inquiry that the agency lost P4 billion in fraudulent claims starting in 1995.

PhilHealth was also the epicenter of a P10.6-billion fund diversion scandal to bankroll a failed barangay-based health center building program.

The scheme involved enrolling families  in PhilHealth at P1,200 per family member, chargeable to PhilHealth and the Philippine Charity Sweepstakes Office.

In 2017, PhilHealth reported a P4.9-billion in operating cost, as well as a P250-million deficit during the previous year.

The negative figures are getting bigger and bigger every year. If this is not disturbing, I don’t know what is.

Experts traced PhilHealth’s burgeoning  financial woes to its allegedly flawed All Case Rates payment scheme.

Introduced in 2011, the ACR guarantees definite amounts in claims for hospitalization or surgery among the agency’s 85-million members.

The Commission on Audit computed the ACR overpayments at 20 percent of total benefits disbursed last year. In absolute terms, PhilHealth paid out P114 billion. Of this amount, P22.8 billion represented overpayments to accredited hospitals.

If the ACR is that problematic, the least PhilHealth can do is amend it if not lop it off altogether like physicians would do to a cancerous tissue to prevent the whole body from being infected.

Regrettably, the agency’s past and present managers have been uncharacteristically indifferent to suggestions for fiscal and administrative reforms.Why? Your guess is as good as mine.

Last year, the state auditors served notice that PhilHealth  Regional Office 2 incurred overpayments totaling P56 million in members’ benefits for a two-month period (November and December) alone. Without doubt, the amount would exponentially multiply if the COA probe were expanded to cover the whole year and all the regions nationwide.

But of course, these anomalies, unchecked as they have been, could only be committed through unholy alliances between the accredited hospitals and PhilHealth officials and employees with insatiable appetites for ill-gotten wealth.

With President Duterte’s enactment of the Universal Health Care Law that enriches the PhilHealth by additional P275 billion, there will be more where the thieves’ source of loots would come from.

PhilHealth’s basic mandate is to provide a healthcare fund for the people. Necessarily, it must develop and implement a comprehensive insurance coverage plan for all Filipinos.

To ensure stability of its operations, PhilHealth must commission financial experts and managers with actuarial acumen to replace physicians doubling as accountants.

Nowadays, the trend among corporations and agencies is to upgrade their systems through computerization to stay in the race.

PhilHealth needs to rethink its position. Maintaining the status quo is more of an exception to the rule. When will they ever learn?