PhilHealth execs became ‘lazy’ to hasten claims system for COVID cases–solon
MANILA, Philippines — For Marikina Rep. Stella Luz Quimbo, it is the “laziness” of the Philippine Health Insurance Corporation’s (PhilHealth) executive committee that led to the use of the controversial interim reimbursement system (IRM) for coronavirus cases instead of looking for ways to expedite the agency’s claims system to aid in the pandemic.
During the online joint hearing of the House committee on public accounts and the committee on good government and public accountability on Thursday, Quimbo did not mince her words as she grilled PhilHealth officers over the issue of IRM.
Citing PhilHealth Circular No. 2020-007 or the “Guidelines on the Provisions of Special Privileges to those Affected by a Fortuitous Events” which tackles the disbursement of IRM funds, Quimbo said that fortuitous events should “result in the displacement of communities.”
Quimbo said there are only two “fortuitous events” in the circular such as “act of God” which includes floods and typhoons and “act of man” which includes rebellion, insurgencies, and wars, which would result in in the “destruction” of the health sector.
“Sa aking palagay, hindi applicable ang konsepto ng IRM dito sa COVID kasi wala namang nasira na ospital,” Quimbo argued.
(I think, the concept of IRM is not applicable for COVID because no hospital was destroyed.)
‘Yun ang aking pinagtatakahan, binasa ko ng buong-buo tong circular tungkol sa pag-apply ng IRM and it’s very clear that it’s related to fortuitous events resulting in the destruction of healthcare facilities,” she added.
(That’s what I am thinking about, I read the circular regarding the application of IRM and it’s very clear that it’s related to fortuitous events resulting in the destruction of healthcare facilities.)
Quimbo argued that what PhilHealth officials should have focused on is expediting the claims processing.
The lawmaker then asked PhilHealth senior vice president for health finance policy sector Israel Francis Pargas why the executive committee decided that using the IRM system is the “appropriate response” to the pandemic, instead of expediting its claims system.
Pargas explained that the IRM not only applies to damage to healthcare facilities, but to the operation as a whole of the healthcare system.
“Because there was this proclamation of a national public health emergency and the proclamation of a national state of calamity, so in order to help these facilities, especially for those directly affected or indirectly affected ng fortuitous events, so nagbigay tayo ng IRM (we provided IRM funds),” Pargas explained.
“Ito naman is to make sure that the facilities can actually respond and provide continuous access to care and health provision to all our patients pero hindi siya limited only for COVID cases but even indirect effects na nandun din sa scope ng circular,” he added.
(This is to make sure that the facilities can actually respond and provide continuous access to care and health provision to all our patients but this is not just limited for COVID cases but even indirect effects which is within the scope of the circular.)
But Quimbo seemed unsatisfied, expressing her beliefs that PhilHealth’s executive committee became “lazy” to think of ways to hasten their claims system.
“Sa akin lang, ang sa tingin ko talagang nangyari dito ay tinamad na lang ang execom, tinamad na lang ang head office na mag-isip ng mekanismo na appropriate for the purposes of expediting reimbursements para sa ating COVID patients,” Quimbo said.
(For me, I believe what really happened is the executive committee became lazy to think of a mechanism that is appropriate for the purposes of expediting reimbursements for COVID patients.)
“Ganun lang, tinamad. Imbes na gumawa ng isang special lane or an expedited claims processing para sa COVID, in-apply na lang tong IRM,” the lawmaker added.
(That’s it, they became lazy. Instead of providing a special lane or an expedited claims processing for COVID, they just applied the IRM.)
If it were not out of laziness, Quimbo said there may be something else that is going on.
“Tinamad ang execom na mag-isip ng paraan para ma-expedite ang claims. Kung hindi katamaran ‘yan e baka may masamang balak din diyan,” the lawmaker added.
(The executive committee became lazy to think of ways to expedite claims. If it’s not laziness then maybe they are up to something bad.)
For now, Quimbo said that the committee can propose to PhilHealth to suspend liquidation for non-COVID claims and suspend the application of COVID case rates for suspected and probable cases.
The committee later approved the motion “strongly” urging PhilHealth to withdraw its policy of shouldering costs of suspected and probable cases of COVID-19.
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