PhilHealth seeks to defer UHC implementation, expansion of care benefits

MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) called for a delay in the implementation of the Universal Health Care (UHC) law and in the expansion of primary care benefits as it saw a significant drop in contribution collections amid the coronavirus pandemic.

During the joint congressional committee meeting on updates on the UHC law implementation on Tuesday, PhilHealth President and CEO Ricardo Morales said that the state health insurer projected that it could experience a fund deficit until 2024 under the COVID-19 scenario.

“We will be running a deficit by the end of 2020 and we will be maintaining that deficit up to 2024,” he told lawmakers.

Morales also noted that PhilHealth’s response to the coronavirus pandemic from February 2020 to January 2021 will cost the state health insurer P40.7 billion.

He mentioned that PhilHealth only collected a total premium income of P46.5 billion as of April 30, 2020.

This, he said, is below the benefit expense of P52.5 billion.

“We have a benefit expense of ₱52.5 billion and we have collected a total premium income of ₱46.5 billion. In other words, we are spending 13 centavos more per peso than we collect as premium collection,” the PhilHealth chief said.

Among the recommendations Morales made before the joint congressional committee are to consider a “general delay” of the UHC implementation and the postponement of the implementation of primary care benefit expansion.

However, Quezon Rep. Angelina “Helen” Tan did not agree with postponing the expansion of primary care benefits, underscoring its need amid the pandemic.

“With the realization na nangyari po na COVID-19 and the pandemic…Hindi ba mas kailangan na magbigay tayo ng attention dun sa primary care packages or services?” Tan, chair of the House health committee, asked.

(With the realization that COVID-19 is happening…Don’t you think we need to give attention to primary care packages and services?)

In response, Morales explained that PhilHealth is taking a “very prudent approach” in rolling out new packages under the UHC law.

He also disclosed that the state health insurer’s collection “dropped significantly” given the impact inflicted by the COVID-19 crisis.

“Our collection is actually, to tell you the truth, our collection is about 10 percent of last year. The collection from the direct contributions has dropped significantly kasi wala hong negosyo. Wala hong nagbabayad ng mga premiums sa mga direct contributors,” the PhilHealth chief said.

(Our collection is actually, to tell you the truth, our collection is about 10 percent of last year. The collection from the direct contributions has dropped significantly because businesses are closed. No one is paying premiums from the direct contributors).

“Yung mga indirect din ho, it also depends on business activity [which] has also suffered a downturn. So we are falling back on our reserve which we anticipate is going to take a hit,” he added.

Morales proposed that the government focus on the lighter expenditures of the primary health care like the organization, accreditation, identification of the primary health care providers, the registration of the members,

“As of this moment, we are still taking a very prudent stance as rolling our new packages, new benefits under the universal health care,” he said.

“As we get more data and as we see how this pandemic develops, maybe we can begin to plan to deliver packages under the primary health care package, depends on how things turn out with the pandemic,” he added.

Still, Tan maintained the need to improve primary care benefits amid the coronavirus pandemic.

“I understand yung concern po natin in the income or collection ng PhilHealth but for consideration, Sir, sana tignan natin na the more na dapat mag-focus tayo doon sa kalusugan ng ating mamamayan outside the hospital, which is the primary care. Which means ang magiging impact nun actually mas male-less ang expenses ninyo into hospitalization,” she said.

(I understand the concern for PhilHealth’s income and collection but for consideration, Sir, I hope we can see that amid the situation, the more we need to focus on the health of the Filipino public outside of hospital settings, which is the primary care. Which means that the impact of that in terms of expenses into hospitalization will be less).

“Ngayong may pandemic, marami tayong kababayan na hindi nakakakita ng doktor o hindi pumupunta sa health care facilities because of the fear. Ako ang paniniwala ko bilang doktor, mas kailangan natin sa panahong ito i-strengthen ‘yung primary care services,” she added.

(In this time of pandemic, a lot of Filipinos are not able to see a doctor or are not going to health care centers because of fear. My belief as a doctor is we really need to strengthen our primary care services).

Senator Risa Hontiveros, who is also part of the joint congressional committee, shared Tan’s view on primary care services.

“Alam naman siguro ni President Morales yung rule of thumb sa health insurance at health financing institutions na for every $1 na ginagastos sa primary care, nakaka-save ang isang bansa ng katumbas ng $3 to $4 sa opposite end the spectrum sa tertiary care, including hospitalization,” she said.

(I think President Morales knows the rules of thumb with health insurance at health financing institutions is that for every $1 that a government is spending, a country could save $3 to $4 on the opposite end of the spectrum in tertiary care, including hospitalization).

“I would believe na that is true even moreso sa panahon ng mga healt crisis tulad ng isang pandemic. So kung gagastos din lang naman talaga pa rin ang PhilHealth ngayong panahon ng COVID-19, I think it would still be wise and even wiser na mas gumastos sa primary care in order to preempt higher expenditure,” she added.

(I would believe that that is true even moreso in this time of COVID-19. So if PhilHealth will already spend for COVID-19 financing, I think it would still be wise and even wiser to spend on primary care in order to preempt higher expenditure).diture).