MANILA, Philippines — The Department of Health (DOH) on Wednesday pointed out that it was wrong to equate the funds released to hospitals by Philippine Health Insurance Corp. (PhilHealth) with the number of COVID-19 cases recorded in their communities since the amount they received was based on the claims they made last year.
Health Undersecretary Maria Rosario Vergeire explained that the way PhilHealth’s interim reimbursement mechanism (IRM) worked was that it was computed based on the historical claims made by a hospital in the first three months of last year.
Biggest chunk
“The data you are seeing now is based on last year’s claims. There was no COVID-19 then so it’s not right to compare it with the region’s number of COVID-19 cases,” Vergeire said.
At the resumption on Tuesday of the Senate’s hearing on alleged corruption and irregularities in the state-run health insurance firm, PhilHealth said Southern Philippines Medical Center (SPMC) in President Rodrigo Duterte’s hometown of Davao City got the biggest chunk of the IRM as it received P326 million.
PhilHealth released P263.3 million to the Philippine General Hospital (PGH) while it gave Davao Regional Medical Center in Tagum City P209 million.
PhilHealth made these disbursements known as early as April 7.
Data from the World Health Organization showed that on April 6, the Philippines had 3,660 confirmed cases, of which 54 percent were in Metro Manila, 7 percent in Calabarzon, and 3.3 percent in Central Luzon.
The DOH’s Davao regional office reported 80 confirmed cases at the time.
SPMC then was among the five initial subnational hospitals assisting the Research Institute for Tropical Medicine in testing, treating and managing COVID-19 cases since the onset of the outbreak.
The four other hospitals were Baguio General Hospital and Medical Center, San Lazaro Hospital, Lung Center of the Philippines and Vicente Sotto Memorial Medical Center.
PGH, Lung Center and Jose N. Rodriguez Memorial Hospital and Sanitarium were only designated as COVID-19 referral facilities in early April.
‘Largest hospital’ in the countryVergeire said that one of the reasons why SPMC topped the list was because it is the “largest hospital” in the country, which means that it is catering to a lot of patients. She noted that SPMC has 1,200 beds.
Republic Act No. 11326 signed by President Duterte in April last year, however, increased SPMC’s capacity to 1,500 beds.
“It caters to a lot of cases, even specialized cases. It has heart and cancer specialty and other specialized services. [SPMC also has] high-technology [equipment] because we are trying to prime this hospital to be one of the leaders in Asia,” she said.
In mid-March, PhilHealth chief Ricardo Morales said the company came up with the IRM to “provide health-care providers with the much-needed liquidity to adequately respond to the pandemic.”
“These are extraordinary times that require extraordinary measures, and this arrangement will surely be of help in President Duterte’s resolve to avert the spread of the virus,” Morales said.
The PhilHealth chief earlier told critics of the IRM that it was “premature” for them to conclude that hospitals in areas with low COVID-19 cases should not have had access to IRM funds as he reminded them that transmission of the virus remained a threat.
“Remember that we have yet to contain the transmission. With [stranded people] returning home en masse, a spike in cases is still a very real possibility,” he said.
Nothing wrong
Malacañang on Wednesday said it found nothing irregular in SPMC receiving the highest amount in reimbursements from PhilHealth.
Presidential spokesperson Harry Roque said the reimbursements given to hospitals were based on their claims from PhilHealth and that SPMC had the highest PhilHealth income, reaching over P1 billion.
“Its average income for 2018 to 2019 is P1.2 billion and IRM is based on the monthly average or the track record of reimbursement for 2018 to 2019,” Roque said.
“Historically, SPMC has had the biggest amount of claims due to its regular provision of health-care services to patients all over Mindanao,” he added.
In a telephone interview with Inquirer Mindanao on Wednesday, Dr. Leopoldo Vega, who served as SPMC chief for 12 years before his appointment as undersecretary of health earlier this year, said the hospital still had P300 million in unpaid claims from PhilHealth for 2019.
Vega said the P326-million cash advance from PhilHealth was crucial to the preparation of the hospital for COVID-19 in southern Mindanao.
“It really [covers] part of the COVID-19 response,” Vega said. “It [was part of the hospital’s] financial support and SPMC is the only COVID-19 referral institute in the region. The rest of the hospitals are non-COVID, [although] we also have non-COVID patients.”
Aside from the main hospital, SPMC also has stand-alone specialty buildings, including the heart institute, cancer institute, and intensive-care complex.
The hospital has 3,600 employees.
It admitted 76,586 patients and served 586,278 outpatients in 2019.
—With reports from Leila B. Salaverria and Germelina Lacorte