An official has filed a bill that aims to protect patients and their families and to plug the leaks in the state health insurance fund by banning “suprise medical billings” and the provision of “unexpected” services at inflated rates.
Albay Rep. Jose Clemente Sarte Salceda, Committee on Ways and Means chairman, has filed House Bill 8331 or the Medical Bill Transparency Act in the wake of reports of inflated and non-itemized medical bills charged to the Philippine Health Insurance Corp., the government-administered health insurance fund.
“Covid-19 has increased the medical bills for other medical services, primarily because of demand and lack of personnel and rooms. But there are also obvious instances of inefficiencies. Some hospitals are charging inflated prices for PPEs even when we already gave incentives to keep the prices of these items low. There are regular rooms in medium-sized hospitals costing upwards of P10,000 a day. And you don’t find that out until you get sick and are given the bill,” Salceda said.
He cited figures from the Family Income and Expenditure Survey from 2012 to 2018, which shows that up to 200,000 families per year fall into poverty because of out-of-pocket medical expenses.
“Millions of families are just one medical bill away from poverty. It is grossly immoral that the one bill that could send your family into poverty is inflated with opaque costs,” Salceda said.
HB 8331 would mandate the Department of Health to issue regulations “to require hospitals to publicly post standard charge information, including charges and information based on negotiated rates and for common or shoppable items and services in an easy-to-understand, consumer-friendly and machine-readable format.”
Salceda likens this to restaurants displaying their menus outside so that consumers can choose among various options. Salceda also wants the DOH to require “the detailed itemization of actual medical bills.”
Salceda’s bill would also require transparency in health insurance benefits, particularly for preventive care.
The bill would provide that “Secretary of Finance, to the extent consistent with law, shall issue guidance to expand the ability of patients to select health insurance plans that cover low-cost preventive care and/or medical care that helps maintain health status for individuals with chronic conditions.”
“There is plenty of opacity on the coverage of insurance for pre-existing conditions. It is unimaginable for a family to invest thousands every year on health insurance only to be told during an emergency that their plan does not cover the emergency due to pre-existing conditions,” Salceda said.
Salceda added that the provisions of his bill would also make Philhealth more sustainable.
“Right now, there is what we economists call tacit collusion between the hospitals and the corrupt officials in the Philhealth to inflate hospital bills so that claims can also be inflated. Some hospitals inflate their claims, and there is little incentive for corrupt officials to fight this. If medical prices are more transparent, there is less room for inflated costs,” Salceda said.
Salceda noted that hospital prices go upward when consumers do not have enough information to choose the best care at the best prices.
Under his bill, he says, consumers have greater control over their own choice of healthcare.