Only P3.3B should have been allocated for IRM, instead of P26.8B–solon

Image from PhilHealth Facebook.

MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) should have only allocated P3.3 billion to its Interim Reimbursement Mechanism (IRM), not P26.8 billion, a lawmaker said Monday.

Based on her computations, Marikina Rep. Stella Quimbo said PhilHealth would only need P3.3 billion for COVID-19 cases in the country, which was estimated at 209,000 for 2020.

Quimbo noted that not all of the estimated 209,000 cases will be hospitalized, as 20% of cases will only require hospital care, according to the World Health Organization.

The current case rate for COVID-19 cases is 786,000, which will be provided for critical cases; 333,000 for severe cases; and 43,000 for mild cases.

“Kung i-apply ko ito, kunin ko yung 20% ng 209,000 cases at i-apply ko itong breakdown of COVID patients by severity of illness, P3.3 billion ang ating expected na hospitalization claims dapat para sa 209,000 cases,” she said during a House hearing tackling the alleged corruption issues plaguing the state health insurer.

(If I would apply this, I would get the 20 percent of 209,000 and apply this in a breakdown of COVID patients by severity of illness, P3.3 billion is the expected hospitalization claims for 209,000 cases.)

“Bakit ang laki ng inyong itinalaga para sa allocations sa IRM, P26.8 billion pesos kumpara sa P3.3 billion? Hindi ba OA masyado itong P26.8 billion na inestima niyo?” Quimbo added.

(Why have you designated a huge amount of allocation for IRM, P26.8 billion compared to P3.3 billion? Isn’t this an exaggeration, this P26.8 billion that you estimated?)

In response, PhilHealth Vice President Nerissa Santiago said they have a different basis for their estimate and they do not have yet a “concretized data” since the claims are not yet completed.

“Iba iba kasi tayo ng assumption, hindi namin maiconcretize ang data sa ngayon kasi hindi pa po sapat  yung pumapasok na claims,” Santiago said during the hearing.

(There are varying assumptions, we can’t concretize the data as for now because claims that are coming in are not yet enough.)

“Iba lang yung basis ng calculation, may mga scenarios na tinitingnan kami pagdating sa pagcalculate ng COVID cases,” she added.

(Basis of calculation is different, there are different scenarios we are looking at when it comes to calculating the COVID cases.)

Quimbo asked PhilHealth to let lawmakers know the basis of their computations.

PhilHealth is currently under fire following claims of massive corruption amounting to billions of pesos within the agency.

Among allegations of corruption raised involve the procurement of alleged overpriced IT equipment; a supposedly questionable release of funds under the corporation’s IRM; and the alleged manipulation of the corporation’s financial status.

JPV