In the three years of the Duterte Administration, there has been a number of top executive and board changes in PhilHealth which indicates the inability to put honest, competent and visionary personnel to manage the state run national health insurance system. Patients, hospitals and physicians bear the brunt of PhilHealth anomalies, quirks and idiosyncrasies. Patients lose their lives for lack of basic medicines and diagnostic tools brought about by hospitals unable to replenish much needed pharmaceutical products or repair x-ray and ultrasound machines due to lack of funds as billions of pesos are locked in PhilHealth time deposits and unreleased to service providers because of convoluted, often changed, mazes to effect reimbursement for hospitalizations rendered ages ago. Even the accounting treatment of amounts payable to hospitals and physicians is HUGELY UNDER REPORTED since PhilHealth is the accuser, judge and executioner in terms of whether submitted claims should be rightfully paid by PhilHealth or not. In other words, filed claims still undergoing evaluation and/or appeal are not considered as ACCOUNTS PAYABLE thus effectively hiding large amounts of indebtedness to hospitals and physicians from their books. Considering PhilHealth has been with us for decades, BILLIONS of PESOS due service providers have been largely unrecognized and ignored. The last few years has seen the transfer of ownership of many big private hospitals from their original physician owners to corporate hospital chains that will only lead to increased hospital rates. PhilHealth largely contributed to the decision to sell out on the basis of mounting receivables and diminishing cash for badly needed rising personnel costs and inability to upgrade facilities and diagnostic machines.
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Mounting PhilHealth payables hurting hospitals, says exec demanding P204M
MANILA, Philippines — Unpaid obligations of Philippine Health Insurance Corp. (PhilHealth) have financially weakened many private hospitals in the country, including Chinese General Hospital and Medical Center (CGHMC), according to Dr. James Dy, president of the private hospital.
In a letter to PhilHealth branch manager Henry Almanon on July 17, Dy said the state insurance firm owed CGHMC P204.6 million for the medical services it provided to PhilHealth members from April to June.
In a text message to the Inquirer on Monday, PhilHealth acting president and chief executive officer Ricardo Morales declined to comment, saying he had yet to see Dy’s letter.
Due, demandable
Of the total unpaid amount, P61.7 million was already “due and demandable” since the hospital had already complied with all the documentary requirements imposed by PhilHealth, according to Dy.
“[Since] the medical services on this claim had long been served, it is grossly unfair for the state insurance system to put the financial burden of public health care on private hospital institutions, and then leave us hanging for months and years on end just to get paid,” he said.
Senate probe
He submitted a copy of his letter to Sen. Bong Go, chair of the Senate health committee, and Sen. Richard Gordon, chair of the blue ribbon committee, who will jointly head on Wednesday a legislative inquiry into irregularities in PhilHealth.
In a dialogue in May, Dy said PhilHealth officials had promised CGHMC to settle the debts within 10 days, but they failed to keep their word.
PhilHealth, a government-owned and -controlled corporation mandated to provide social health insurance to Filipinos, has been under the microscope after the Inquirer published a series of investigative reports on the alleged massive corruption involving its officials and unscrupulous owners of private health facilities.
In a privilege speech on July 29, Sen. Panfilo Lacson claimed PhilHealth had already lost as much as P154 billion to overpayments and other fraudulent schemes.
Lacson said the state insurance company was financially ill as it suffered a net operating loss of P29.1 billion from 2013 to 2017 due to fund mismanagement and corruption.
In his letter, Dy pointed out that the delay in PhilHealth’s payment “negatively impacts the provision of quality health care” for Filipinos.
Citing hospital records, he said PhilHealth paid a measly P14.9 million to CGHMC for the medical services it rendered from June 14 to July 17.
But this amount, he added, was just 7 percent of PhilHealth’s total unpaid obligations to the hospital.
He said PhilHealth’s latest filing system necessitated the hospital to have another program and “reprocess” all the forms it had submitted for insurance claims worth P142.9 million.
Moreover, he said, PhilHealth had sent back collection forms to CGHMC “based on unsubstantiated reasons,” such as the unreadability of statement of accounts.
Incompatible
This problem was caused by the “incompatibility” in the electronic processing systems of PhilHealth and its technology provider, Eurolink, according to Dy.
“Any incompatibility on both systems that results in poor readability is beyond the control of the hospital, and hence, should not be blamed on the hospital,” he said.
“Simply put, the hospital should not suffer the adverse consequence of poor data integration from Eurolink to PhilHealth,” he added.
Dy said the passage of the UHC law, which required a budget of P257 billion for the first year of its implementation, warranted the removal of “organizational bureaucracy” in PhilHealth to ensure the timely payment of hospital dues.
He said PhilHealth’s critical role in attaining the law’s goals “will never be realized unless industry-wide collection is improved dramatically.”
“The confidence of the various sectors in PhilHealth’s credibility to successfully implement the provisions of this new law rests on your capability to finally clear away PhilHealth’s transactional backlog,” Dy reminded Almanon. —With a report from Jovic Yee
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