MANILA, Philippines — A House panel on Wednesday called for the abolition of the case rate policy in the Philippine Health Insurance Corp. (PhilHealth), citing it as the “root of corruption” in the agency.
During the hearing of the House public accounts committee, panel chair Anakalusufgan Partylist Rep. Mike Defensor said the case rate set-up has resulted in the loss of billions of PhilHealth funds due to overpayment.
The case rate is the fixed amount that PhilHealth will reimburse for a specific illness, which will cover for the fees of health care professionals and the use of hospital facilities.
“Yan ulit ang magiging ugat ng problema ng PhilHealth at diyan magkakaroon ulit ng butas ng issue ng corruption ang PhilHealth,” Defensor said.
“We would request na magkaroon na ng malinaw na polisiya. Na sa ilalim ng adminsitrasyon ni Pangulong Duterte, ay itigil na ang all case rate policy na nagiging ugat ng korapsyon sa PhilHealth,” he added.
The case rate for pneumonia amounts to P15,000; P6,000 for food poisoning or acute gastroenteritis; and P7,000 for urinary tract infection (UTI), Defensor noted.
He said PhilHealth pays an average of P700,000 annually in claims for the past five years for pneumonia cases; P350,000 yearly for cases of acute gastroenteritis; and P300,000 for UTI cases.
Defensor said this is prone to corruption.
“Yun pong all case rate policy na binabanggit ko sa inyo kahit na anong gawin niyong computerization, nako-computerize na ho ang corruption diyan sa loob ng PhilHealth,” the lawmaker told PhilHealth president and CEO Ricardo Morales, who attended the hearing through video conferencing
“Dahil binabayaran ng buo, base on a case rate, imbes na dun sa actual na ginastos dun sa isang pasyente,” Defensor added.
He then cautioned Morales that the latter would not be able to rid the agency of corruption if a case rate set-up continues to be a policy of the agency.
“Hindi niyo maayos an PhilHealth pagka po hindi niyo to ibago. Yung sinasabi niyo pong reporma, wag po kayong makinig sa mga tao niyo diyan na nagsasabi ng case rates. Mali po yan” he told the PhilHealth president.
“Kahit sinong insurance company ang kausapin niyo, pag ikaw nabangga, kung magkano ang bangga, yun lang ang babayaran. Kung ikaw ay nagkasakit, kung ano ang gamot, kung ano ginawa sayo, yun lang ang babayaran. It cannot be a package,” he added.
Recent allegations of corruption hounding PhilHealth regarding its “overpriced” IT project has put the agency on the scrutiny of lawmakers yet again.
Last year, the Senate blue ribbon committee, led by Senator Richard Gordon, investigated alleged “ghost” dialysis treatments and other irregularities which defrauded the agency of billions of pesos in the past few years.