Amid PhilHealth mess, study cites surging cost of PH health care

Coming on the heels of huge losses incurred by Philippine Health Insurance Corp. (PhilHealth) from overpayments and fraudulent claims are results of a study that found that the cost of health care in the country is surging.

An international employee benefits consultancy firm said medical inflation in the Philippines would rise 13.7 percent this year from 13 percent last year, making it the second highest increase in the Asia-Pacific region.

The rise in health care cost in the Philippines is much higher than the 5.2 percent increase in the prices of  goods and services for the whole of 2018.

Vietnam has the highest medical inflation rate in the region, at 14.2 percent. Malaysia is third with 13.6 percent.

Rising medical inflation is a global trend, according to the “2019 Medical Trends Around The World” by Mercer Marsh Benefits, which surveyed 204 insurers across 59 countries, assessing how health conditions, supplier factors and consumer habits are driving cost.

The global average is 9.7 percent, the report said. It excluded the United States because of its unique health care system.

Expensive medicines

The survey found that on the supplier side, the primary drivers of high medical inflation around the globe are the high cost of pharmaceuticals, new diagnostics and procedures, and overprescribing of low-value health tests and procedures.

Globally, the top three health risk factors influencing medical cost are metabolic and cardiovascular risk, dietary risk and emotional/mental risk.

In the Philippines, the National Bureau of Investigation  is probing hospitals and clinics that have been defrauding PhilHealth through bogus claims.

The involvement of WellMed Dialysis Center in ghost dialysis is just the tip of the iceberg, according to the NBI.

WellMed allegedly filed benefit claims for patients who had already died. The company, owned by Bryan Christopher Sy, allegedly earned more than P800,000 through this scheme.

Others doing it

But other medical facilities were doing a similar scheme and were earning more, the NBI said.

“As of now, in order not to compromise the operations being conducted by our agents we beg not to disclose yet the institutions as well as personalities,” NBI spokesperson Ferdinand Lavin said on Thursday.

After filing a case against Sy, the NBI’s next step is to identify people in PhilHealth who made the scam possible, said Deputy Director for Investigation Jun de Guzman.

Sy is still detained at the bureau after a Manila court denied his petition questioning his detention. He is facing estafa through falsification of documents after the NBI found probable cause that WellMed filed claims for dead PhilHealth members.

The state health insurer has come under fire after WellMed employee Edwin Roberto blew the whistle on the scheme, which saw the dialysis center seek payments from PhilHealth by allegedly collecting payments for the remaining treatments of patients who had died.

Sen. Panfilo Lacson on Thursday wondered why there were different standards imposed on PhilHealth officials, who were told to resign, and Health Secretary Francisco Duque III, who was not made accountable for the “ghost dialysis scam.”

In a tweet, Lacson reminded President Duterte that Duque had figured in a PhilHealth controversy when he was its president in 2004.

The senator was referring to the diversion of P530 million in Overseas Workers Welfare Administration funds to pay for PhilHealth cards linked to President Gloria Macapagal-Arroyo’s 2004 reelection campaign.

Duque served as PhilHealth chief executive officer from 2001 to 2005. As health secretary, he is ex-officio chair of the PhilHealth board.

The controversy led to the filing of plunder and malversation cases against Arroyo, Duque and several others. In 2012, the Office of the Ombudsman dismissed the malversation charges, citing lack of evidence.

Resignations

Even as top officials of PhilHealth have resigned, Duque said they were still expected to render service until Mr. Duterte will have appointed their replacements.

Duque said that of PhilHealth’s top officials, it was only acting president and chief executive officer Roy Ferrer who was told by Mr. Duterte to leave and hand in the reins of the firm to chief operating officer John Basa.

But since Basa will not return to the country till Monday, Duque said PhilHealth was being overseen by Dennis Mas, senior vice president for the management services sector.

As for the six board members, Duque said they would have to wait for Mr. Duterte’s acceptance of their courtesy resignations before they can leave. —WITH REPORTS FROM JULIE M. AURELIO AND JOVIC YEE