PhilHealth moves to end ‘mafia’; fires erring execs

State social health insurer Philippine Health Insurance Corp. said on Tuesday it has filed cases against some of its officials as part of its corporate-wide efforts to end a “mafia” within the agency, which surfaced during a congressional hearing early this year.

PhilHealth moves to end  ‘mafia’; fires erring execs
Health Secretary Francisco Duque III testifies at the Senate hearing. Ey Acasio
The “mafia” is said to include officers, some of whom are being investigated for various violations of civil service rules and other pertinent laws.


In a statement, PhilHealth spokesperson Dr. Shirley Domingo said the Board and its management have promptly acted on the matter, conducted several investigations and filed cases against erring officials.

In line with this, a regional vice president has been found guilty of grave misconduct, gross insubordination, and gross neglect of duty and was meted a 90-day preventive suspension.

PhilHealth also said investigations are still ongoing and several others are currently being investigated over various allegations.

Another regional vice president has been recently charged and is up for suspension because of gross neglect of duty owing to his consistent poor performance that spanned at least three years. The official concerned is being investigated for his region’s inefficiency that left many hospitals complaining about delayed payments of their claims.

PhilHealth said the region has been the slowest in paying claims at an average of 150 days or 90 days overdue. An earlier Board action to augment processors from neighboring regional offices has greatly improved their turn-around time to 99 days to the delight of their partner health care providers.

The agency’s Board has also affirmed the charges against an officer, who has allowed his personnel to receive salaries for several years without submitting daily time records.

Domingo said this is just the beginning since their current acting president and CEO Dr. Roy Ferrer has vowed to institute reforms and do everything in his power to quash the “mafia” that seem to shun reforms, and resist needed officer reassignments designed to improve performance and to avert too much familiarity that breeds corruption.

PhilHealth said the reforms that have been in place starting this year are bearing better outcomes.

Among them are the improvement in claims processing time across the country to just 33 days, the agency’s consistent positive financial standing for three quarters in a row that recently ended with PHP9.8 billion in net cash (as of September 2018), and the introduction of new benefits, which include a package of benefits for children with disabilities and expanded primary care for the formal sector and the elderly.

Despite all these, PhilHealth may yet achieve its goal of universal health coverage for all Filipinos, with an increased budget of P67.4 billion for its National Health Insurance Program (NHIP) in 2019.

The proposed budget is 24.4% higher than the 2018 cash-based equivalent budget of P54.1 billion.

For 2019, the Program is expected to benefit 15.4 million indigent families, 5.4 million senior citizens, 25,514 families under the Payapa at Masaganang PamayanAn (PAMANA) Program, and 22,709 families under the Bangsamoro health insurance program.

According to Secretary Benjamin E. Diokno, the increased budget for Philhealth is an expression of the Duterte Administration’s commitment to achieve universal health coverage in the country.

As of March 2018, the country’s health insurance program recorded a coverage of 98.24 million Filipinos, or 92% of the entire Philippine population.

Of the total budget for the NHIP, P3.0 billion will be set aside for the Point-of-Service (POS) Program, which will target the remaining eight percent (8%) of the population that have not yet been covered by the health insurance program. Under this program, the PhilHealth premiums of indigent patients, specifically those in the poor (Class C3 or D) category, will be paid for by the government.

Through the POS Program, the government also aims to address the gaps in coverage of both financially capable and financially incapable Filipinos, and to ensure 100% availment rate of health insurance coverage, with special interest in covering the poor.

“Looking back at the health agenda of the Duterte Administration, which is to continue widening the coverage of the health insurance program, we can see that we are definitely on the right track,” the Budget Chief concluded.

Topics: Philippine Health Insurance Corp , mafia , Francisco Duque III , Benjamin Diakno , Payapa at Masaganang Pamayanan Program , Point-of-Service
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