The country’s state health insurer urged hospitals on Tuesday not to push through with a proposed five-day “PhilHealth holiday” – quickly branded by a senator as a “major cause of concern.”
PhilHealth spokesperson Dr. Shirley Domingo told a government public briefing that the agency was continuously paying hospital claims, and it was meeting with other hospitals to reconcile unpaid claims.
Senator Nancy Binay said the situation merited an emergency meeting of the Philhealth board and all members “that are cabinet secretaries. Not just representatives should attend.”
According to the senator, it was sad that some hospitals had to resort to this. “It’s a dismay Since we have repeatedly raised before the Senate committee hearings the issue with Philhealth and until now, there is no clear solution to the problem.”
“A ‘Philhealth holiday’ is a major cause of concern. Is it right that a patient should work first to raise money for his hospital bill and he should later chase Philhealth?”
Binay said COVID was not yet over and “we need to prepare for a possible surge.”
Domingo said: “We hope they will rethink this call because in the end, it’s our members who will suffer.”
The Private Hospitals Association of the Philippines said Monday it was encouraging its members to not accept PhilHealth deductions for their services on Jan. 1-5, 2022.
This would result in PhilHealth members having to directly ask the agency to reimburse them for their expenses instead.
“It will be more difficult for PhilHealth and the members, too,” Domingo said.
“Members will still have to put out money. So what about those who can’t shell out any money but will still need to visit a hospital?”
According to Domingo, PhilHealth already met with PHAPI and its president Dr. Rene De Grano, while PhilHealth President and CEO Dante Gierran met with hospitals in Iloilo.
Meanwhile, Binay added: “We also do not want the arrears of Philhealth to pile up,” she said.
Sen. Grace Poe said it made perfect sense for PhilHealth to be headed by one who must also be adept in finance.
“We have no lack of brilliant experts who have a background in both public health and finance, particularly those with Masters in Public Health,” she said.
More than re-arranging the bureaucracy, she said it might be more beneficial to just appoint the right person for the job.
“A true public health and finance expert must be at the helm of PhilHealth, not just any bureaucrat with close ties to the appointing authority,” she said.
“But the question we have been asking since the start of the pandemic is: who will take over a sinking ship? Surely, this country has no shortage of men and women who can run PhilHealth properly. But it is hard to find a true expert if we will continuously just look at the usual pool of recycled appointees.”
Poe said the move for a PhilHealth holiday has long been coming “ever since we found out about the anomalies last year.”
“We can hardly fault the private hospitals for taking more drastic measures this time around. Instead of getting better after the revamp, the agency’s finances took a turn for the worse,” noted the chair of the Senate committee on public services.
In related developments, presidential aspirant Sen. Panfilo Lacson stressed “everything is wrong” with Philhealth.
He said Philhealth should be headed by somebody who knows accounting and fund management, not a health practitioner, much less a former law enforcer or a retired general.
“Therefore, it should be chaired by the Secretary of the Department of Finance, not of the Department of Health,” he added. “PhilHealth deals with health insurance, not health.”
Meanwhile, Philhealth will receive an increased taxpayer subsidy of nearly P80 billion next year, Anakalusugan Rep. Mike Defensor said Tuesday.
“The money is for the insurance coverage of millions of so-called indirect contributors, including indigent citizens, the elderly and unemployed persons with disability,” Defensor said providing insurance cover for these sectors of the population was part of the mandate of the universal health care program.
He added next year’s Philhealth subsidy amounting to P79,990,995,000 was contained in the proposed P5.024-2022 national budget Congress approved last Dec. 15 before the legislature went on its Christmas recess.
He pointed out that next year’s financial infusion was P8.368 billion higher than this year’s P71.353-billion subsidy.
In other developments, PhilHealth said Tuesday it was still checking the unpaid claims of seven Iloilo hospitals that would no longer renew their accreditation with the state insurer starting January 1.
“Actually, we are reconciling the figures, because they gave us a figure which is more than our actual in-process claims,” said Domingo.
“They have included figures or amounts that were, of claims that were returned to hospitals and denied. And, on our side, we cannot pay for claims that are returned to the hospital unless they refile it with us.”
“So we’re still hoping that this reconciliation of figures will be recognized and will push through,” Domingo added in an interview with ANC’s “Rundown.”
Earlier this month, Metro Iloilo Hospital & Medical Center Inc., Iloilo Doctors’ Hospital, Iloilo Mission Hospital, Medicus Medical Center, Qualimed Hospital Iloilo, St. Paul’s Hospital of Iloilo and The Medical City of Iloilo said they are severing ties with PhilHealth over unpaid claims amounting to P895 million.
Metro Iloilo Hospital & Medical Center president Dr. Danny Encarnacion said they had a meeting with the state health insurer on Dec. 20 but nothing came of it.
Domingo called on private hospitals to reconsider their plans of holding a “PhilHealth holiday” in early January in support of hospitals protesting unpaid claims.
Domingo also appealed to hospitals not to disengage with PhilHealth, as she assured the public that they were addressing issues to prevent this from happening.
Domingo hopes the FEU hospital will also be amenable to availing itself of the 3rd wave of the DCPM, which would allow PhilHealth to pay an initial 60 percent to health facilities even while their reimbursement claims are still being processed, while the remaining 40 percent will be settled upon completion of requirements.
With the DCPM, PhilHealth has been able to pay P11.6 billion in claims to health facilities, Domingo said. The state insurer has also released a total of P155 billion in COVID-19 related claims this pandemic year, she added.
Encarnacion said the Iloilo hospitals are now working on adjusting their rates to mitigate the impact of their disengagement with PhilHealth.