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PhilHealth’s reckoning

"The agency and its programs need to be straightened out and strengthened."

 

In rapid time, the Department of Justice’s Task Force PhilHealth has identified the PhilHealth officials to be criminally and administratively charged for violating the Anti-Graft Law and the Revised Penal Code, in connection with the reported loss of some P15 billion in agency funds through fraud.

President Rodrigo Duterte announced in his live public address Monday night that the DOJ-recommended charges be filed against resigned PhilHealth president and CEO Ricardo Morales and Executive Vice President and COO Arnel de Jesus (now concurrently OIC-president and COO).

Also recommended to be charged were three out of five senior vice presidents listed on the agency’s website -- Senior Vice President and CIO Jovita Aragona, SVP- Fund Management Sector Renato Limsiaco Jr., and SVP-Health Finance Policy Sector Israel Pargas -- as well as Acting Senior Manager-Information Technology and Management Department Calixto Gabuya Jr. and ICT Planning, Policy, and Standards Division Chief Bobby Crisostomo.

Task Force PhilHealth also recommended that Department of Health Secretary Francisco Duque III, who is the ex-officio chairperson of the Philhealth board, and other members of the board be “strongly admonished and reminded” by the President for failing to keep a closer watch on the state health insurer’s finances.

Woes not over

However, the agency’s woes are not over. In a recent TV interview, Deputy Majority Leader and Bagong Henerasyon Rep. Bernadette Herrera identified another fraudulent scheme connected to Philhealth.

She said a hospital had called her brother, who had undergone a home COVID-19 swab test, asking for his PhilHealth ID number so that the hospital could reimburse the test fee. However, Herrera’s brother had paid for the test with his own money, and when he asked the person who called him whether he would be reimbursed for the expense, they stopped talking to him.

Herrera later said that PhilHealth members who have paid for their COVID-19 swab tests themselves are entitled to a refund, citing a PhilHealth circular “that allows members who are eligible for testing to file reimbursement claims for COVID-19 polymerase chain reaction test.”

She added: “Unfortunately, the public is not fully aware of this benefit,” pointing out the lack of a campaign to inform the public. Obviously unscrupulous people are taking advantage of this, and the DOJ should investigate further.

This connects to something I’ve said time and again – that many government agencies not only are unaware how to communicate effectively with the public, they refuse to do so. “Pwede na ‘yan (That’s fine as it is),” they say, and “walang (no) budget” and “walang tao (no manpower)”.

As a consultant, I’ve heard these excuses for incompetence in external communication many times. One agency I know of doesn’t even have a plantilla item for public information officer, nor does it see any urgency for one.

And who pays the price for this lack of foresight and knowledge about the fundamentals of organizational communication on the part of government agencies? The public, yet again.

Public health insurance vital to the state

The role of public health insurance is so important and vital to the wellbeing of the state that any trace of corruption or mismanagement should be deemed a failure on the part of their officials to perform their duty to the country and people.

Leslie Reed, Missouri Foundation for Health vice president for health policy, writes in the preface to the paper “Consequences of the Lack of Health Insurance on Health and Earnings” (2006): “Research broadly documents the serious health and financial consequences associated with being uninsured.

“The uninsured live sicker and die younger than those with insurance. They forego preventive care and seek health care at more advanced stages of disease. Society then bears these costs through lower productivity, increased rates of communicable diseases, and higher insurance premiums.”

The report also found that “the uninsured are more likely to postpone or fail to receive needed medical care; the uninsured are less likely to be screened for serious illnesses; the uninsured are more likely to enter the

health care system in poorer health or more advanced disease stage; the uninsured receive less therapeutic care, even for serious acute or potentially life-threatening chronic conditions; and the uninsured have worse health outcomes than the insured, both in general and for specific diseases.”

Cited in the paper were the following internal or private costs: “greater morbidity and premature mortality, developmental losses for children, family financial uncertainty and stress, depletion of assets including bankruptcy, lost income of uninsured breadwinner in ill health… [and] lower business productivity (e.g., absenteeism, reduced efficiency on the job).”

If the state fails to provide adequate health insurance for its citizens, particularly the poor, the economy will be negatively impacted by, among other things, “diminished population health,” “higher public program costs connected with worse health,” “diminished workforce productivity,” and lower tax payments.”

These are among the reasons the state needs to develop a strong program of health coverage for its people, especially those who cannot afford insurance. So PhilHealth and its programs need to be straightened out and strengthened.

As it is, the assistance it offers hospitalized patients is pitifully inadequate, but people rationalize that it’s better than nothing – when in fact, if its funds were properly managed, it could benefit the people more.

As taxpayers, we need to demand the higher standard of services from the government that we deserve.

By the way, I haven’t forgotten about the P15 billion that was said to have been bled from PhilHealth. Where is it? Who has it?

FB and Twitter: @DrJennyO

Topics: Jenny Ortuoste , Department of Justice , PhilHealth , COVID-19 swab test
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