PhilHealth’s P45-B projection for COVID-19 claims questioned

MANILA, Philippines — The Philippine Health Insurance Corporation’s (PhilHealth) P45-billion projection for claims related to the coronavirus pandemic (COVID-19) was questioned Tuesday over possible overestimation.

During the hearing of the House committee on public accounts, PhilHealth acting Senior Vice President Nerissa Santiago said based on their estimation of 209,000 COVID-19 cases in the country by the end of the year, payouts could reach P45 billion.

But Marikina Representative Stella Luz Quimbo, an economist, pointed out that her estimates only reached P3.2 billion—P41 billion less than PhilHealth’s estimates.

Quimbo explained that based on global measures, only 20 percent of COVID-19 cases are hospitalized, noting that even presidential spokesperson Harry Roque said that more than 90 percent of the cases are considered mild.

“Hindi po talaga aabot ‘yan ng [P45 billion]. Ang worry ko is sa kaka-project ng napakalaki, nagkakaroon ng mas malaking leeway sa fraud na hindi naman maganda kasi sa ngayon ay talagang binabantayan natin ‘yan,” Quimbo said.

(It will not reach P45 billion. My worry is that by projecting huge amounts, there becomes a leeway for fraud which is not good and we are monitoring that.)

PhilHealth is facing a probe before the lower chamber over alleged anomalies within the agency.

In the same hearing,  Anakalusugan Partylist Rep. Mike Defensor, who chairs the House panel, said that computed conservatively at 20 percent as set by the Commission on Audit (COA), PhilHealth has lost P102 billion due to overpayment from 2013 to 2018.

Aside from this, Defensor added that computed at 10 percent, PhilHealth has likewise lost P51.2 billion due to fraud in the same timeframe.

“Tinataya na P153 billion magmula 2013 na nagsimula and case rate to 2018 and nawalang pondo sa PhilHealth,” Defensor said.

(PhilHealth has lost an estimated P153 billion from 2013 when the case rate started to 2018.)

/MUF