Sen. Sonny Angara on Monday warned of a possible health system failure as he called on the Philippine Health Insurance Corp. (PhilHealth) to expedite processing the claims of hospitals.
Sen. Grace Poe also urged the Commission on Audit (COA) to release the 2020 Audit Report on PhilHealth to give legislators a clear picture of the state of its finances while discussion on the 2022 national budget is ongoing.
“We need to know exactly how much PhilHealth owes hospitals and healthcare workers. They must be paid soon, and the government must figure out where to get the funds,” Poe said.
The Private Hospitals Association of the Philippines Inc. (PHAPi) had threatened to withdraw from the PhilHealth system due to the delayed reimbursements of claims.
“They have long been complaining about the slow paced reimbursement of expenses incurred by hospitals to patients (PhilHealth beneficiaries),” said Angara.
If PhilHealth continues to fail to settle their obligations, Angara said hospitals might shut down operations and the public and those needing health services will be prejudiced.
He related that every year, millions of Filipinos are paying PhilHealth contributions automatically deducted from their salaries,
Angara said this is in addition to the P70 billion subsidy of the national government to the funds of PhilHealth the previous year.
The Senate Finance committee chairperson also said the Anti-Red Tape Authority should inquire into the process of PhilHealth to determine the reason for the delayed health insurance claims of the hospital.
“We are under a public health emergency so that this occurrence is inexcusable or unacceptable,” said Angara.
Poe, meanwhile, pointed out that the COA report will render a credible audit of PhilHealth’s financial condition and see to it that funds are effectively used for the people’s health needs.
“The operations of hospitals are at risk. We are still in a pandemic and people are still dying. PhilHealth must not hide or sugarcoat its numbers,” Poe added.
In COA’s 2019 Annual Audit Report on PhilHealth, benefit claims have totaled P75.57 billion, close to double the P39.79 billion benefit claims reported at the end of 2018.
PHAPi said they are still awaiting PhilHealth’s action to pay the COVID-19 claims from 2020 even as some hospitals said they are contemplating not renewing their accreditation.
“This will make it difficult for PhilHealth members to reap the full benefits of their membership as they will have to pay for their medical expenses from their own pockets and hope that the state health insurer will reimburse them,” Poe said.
“PhilHealth cannot resort to delaying and scare tactics to discourage hospitals from pursuing what’s due them,” Poe added after PHAPi reported that some hospitals have received summonses from the National Bureau of Investigation concerning their claims.
PhilHealth received 35,147 COVID-19 claims from hospitals in 2020 but only 10,265 of the claims were paid, amounting to P2.5 billion.
Of the 2,859 claims for critical COVID-19 cases, PhilHealth only paid 642 claims or P505.6 million. It refused to pay for 309 cases amounting to P243 million. PhilHealth returned 1,179 claims of hospitals for critical cases costing P927.15 million and 729 claims for critical cases were still under process as of July 31, 2021.
For critical COVID-19 cases, PhilHealth ought to have shouldered P786,384 of a member’s hospitalization.
The 2019 COA report had concerns on PhilHealth’s actuarial estimates and assumptions and sought an improvement in its actuarial valuation process.
“We at the Senate need to examine PhilHealth’s finances and take that into consideration in the discussions for the 2022 government budget,” Poe said.
“Before COVID-19, COA already had concerns on PhilHealth’s actuarial valuation process. COVID-19 would have made it more urgent for PhilHealth to get an actuarial study of the fund to come up with a set of recommendations that would make the fund viable and sustainable,” Poe added.