HELP DESK A standee directs patients and their relatives to a Philippine Health Insurance Corp. customer assistance desk at Rizal Medical Center in Pasig City. —LYN RILLON
MANILA, Philippines — Malacañang on Monday called on the Philippine Health Insurance Corp. (PhilHealth) to pay the claims of private hospitals promptly after the latter threatened to disengage with the state health insurer over its circular suspending reimbursements to medical institutions under investigation for fraud.
Hospital groups have claimed that the circular lacked basis and saw it as a ploy to further delay payments to them.
Presidential spokesperson Harry Roque said the hospitals’ threat to cut ties with PhilHealth could derail the provision of universal health care to Filipinos.
Private hospitals provide 70 percent of health-care services in the country, he pointed out.
“I call on PhilHealth to pay what you need to pay,” Roque said at a press briefing.
Shirley Domingo, PhilHealth vice president for corporate affairs, said on Monday that the state-owned health insurance firm owed only P12.9 billion — not P86 billion — in claims from hospitals since the start of the COVID-19 pandemic.
Culprits
Roque said the intent of the universal health care law was for the government, through PhilHealth, to be the sole purchaser of medical goods and services.
“I reiterate, there should be cooperation, PhilHealth should pay faster. Lack of funds is not an excuse. I will be the first to tell you, PhilHealth funds will never run out,” he added.
He acknowledged that there were fictitious and anomalous claims filed before the state insurer, and said these should be investigated.
“But let us not use blacklisting and the threat of blacklisting because, I will repeat, universal health care cannot be implemented if it would only be government hospitals providing services, especially in this time of a pandemic,” he said.
Roque also asked PhilHealth President Dante Gierran why only one official had resigned in the wake of investigations into alleged corruption inside the agency.
“Do you mean that after all the previous anomalies, the persons responsible for these are still there, and not one person in PhilHealth should be fired? That is unbelievable,” he said.
Health Secretary Francisco Duque III has pushed for a dialogue to resolve the dispute between PhilHealth and the hospitals.
Despite the call, however, the Department of Health (DOH) has backed PhilHealth.
“The money we spend to pay these providers comes from the pockets of the people, from taxes. So we have check and balance and that is what PhilHealth is doing,” Health Undersecretary Maria Rosario Vergeire said at a press briefing on Monday.
“We appeal to medical providers and medical associations. PhilHealth is having [a] dialogue with them to explain that PhilHealth is not accusing anyone. This is just part of the process,” she added.
Appeals
Sen. Grace Poe on Monday also called on PhilHealth to reach a middle ground with hospitals to break the impasse that has delayed the payment of claims and, in turn, prevented them from paying the benefits of health-care workers.
She said PhilHealth must not resort to a sweeping mechanism that could further hold up the payment of its legitimate obligations.
“The well-being of PhilHealth members is on the line if the standoff will not be resolved,” Poe said.
House Deputy Speaker and Bagong Henerasyon Rep. Bernadette Herrera added that PhilHealth might have overstepped its powers in issuing the circular.
“PhilHealth cannot abuse its powers to the detriment of the country’s health-care system, including our medical front-liners who have been fighting against the coronavirus since the start of the health crisis last year,” she said.
Welfare of Filipinos
In a statement, the lawmaker urged the state health insurer to think about the welfare of Filipinos who would be deprived of universal health care access if hospitals cut ties with PhilHealth.
“PhilHealth should be reminded of its mandate under the Universal Health Care Act, which is to provide every Filipino the highest possible quality of health care that is accessible, efficient, equitably distributed, adequately funded, fairly financed, and appropriately used by an informed and empowered public,” Herrera added.
Meanwhile, Roque said he hoped nurses would stay in their posts and drop their plan to quit en masse if the government would not give them the benefits due them by September.
Roque said the President had already directed health and budget officials to provide their benefits in 10 days.
“I hope they won’t [resign]. The President has ordered that within 10 days from last Friday, the special risk allowance should be given,” he said.
If the nurses resign, more Filipinos would be jobless amid the pandemic and this would worsen the government’s problems, he said.
“We don’t have additional cash aid to give to them,” he added.