The horror that is PhilHealth

"Mr. President, yariin mo na talaga."

“Yayariin ko kayo…” The President did not mince words as he warned erring officials involved in the recent PhilHealth corruption scandal. The national health insurance agency is in hot water after an exposé of the alleged widespread corruption in the agency in its procurement of new information and communications technology (ICT) systems. A number of PhilHealth officials have already tendered their resignation amid the controversy. However, this does not mean the end of the institution’s long-standing problem.

Over the last ten years, PhilHealth has been a wellspring of corruption and fraud allegations, either claimed to be committed by the state-run insurance agency or health service providers. Annual reports of the Commission on Audit (COA) since 2011 show inconsistencies in their records, inadequate documentation, and poor financial management of the agency.

To start off, the accuracy of PhilHealth’s member database remains questionable as members who have long died were found to be still registered, as we have seen in the many occasions that PhilHealth gets investigated. This makes the agency vulnerable and open to fraudulent transactions and claims, as what occurred in the ghost dialysis controversy reported in 2019. The incomplete database also led to millions worth of unclaimed benefit refunds as reported by COA in 2012, 2013, and 2018.

Moreover, the case-rate payment scheme implemented since the previous administration led to alleged overpayments made to health care institutions for the full amount of case rates regardless of the actual hospital charges, as seen in the audits of 2011, 2012, 2013, 2014, 2016, 2017, and 2018 where COA recommended the review of the said payment policy. This flawed scheme perhaps emboldened health care institutions to “seek” unnecessary treatments and procedures for patients as what happened in the cataract surgery scam reported in 2015 where certain eye clinics performed unnecessary cataract removal surgeries to claim higher reimbursements.

Previous COA reports (2012, 2013, 2014, and 2018) also noted that the agency gave its officers and employees bonuses, allowances, and other benefits despite the issuance of notices of disallowance and the lack of legal basis for such grant. It can be recalled that in 2018, former PhilHealth President Celestina Dela Serna was investigated in both the Senate and the House for her lavish expenditure on accommodations and poor leadership and management during her stint in the agency.

The list of alleged irregularities goes on, but what is certain is that millions of Filipinos rely heavily on PhilHealth. As mandated by Republic Act No. 7875, PhilHealth serves to provide health insurance coverage that will help Filipinos pay for health care services, especially those who cannot afford such services. The intention is to benefit Filipinos and ensure that health care services are affordable, available, and accessible to all, especially in this time of pandemic. COVID-19 inarguably exhausts economic resources of afflicted patients, particularly the indigents. PhilHealth then provides the financial breathing space of these COVID-19 patients. It is appalling that we are not spared from corruption controversies despite the ongoing crisis faced by the country.

With the enactment of the Universal Health Care (UHC) law, the role of PhilHealth becomes more relevant as it deals with expanded coverage and increased amount of member contribution and benefits. The agency manages an unfathomable amount of money as its fund is subsidized by the sin tax. Given these, restoring the integrity of the agency must be given utmost attention and importance. Hence, I urge the administration to strengthen and expand the auditing process on PhilHealth and to establish additional safeguards in the management of PhilHealth funds to leave no stone unturned.

At the end of the day, those liable must be held accountable. This long-standing corruption must be put to an end. I hope the President meant well when he said, “Yayariin ko kayo.” Mr. President, yariin mo na talaga.