Dr. Jose de Grano, PHAPI president, the plan to stage “PhilHealth holiday” was his group’s way of showing support for hospitals that earlier announced their disengagement from the health insurer due to mounting unpaid claims. —CONTRIBUTED PHOTO
MANILA, Philippines — The state-run Philippine Health Insurance Corp. (PhilHealth) on Monday said it hoped private hospitals would reconsider their plan to hold a so-called “PhilHealth holiday” since ordinary Filipinos would be greatly affected.
The Private Hospitals Association of the Philippines Inc. (PHAPI) is urging its members not to accept claims for PhilHealth deductions for health services from Jan. 1 to 5, according to Dr. Jose de Grano, PHAPI president.
He said this “PhilHealth holiday” was their way of showing support for hospitals that earlier announced their disengagement from the health insurer due to mounting unpaid claims.
The latest was Far Eastern University-Dr. Nicanor Reyes Medical Foundation (FEU-NRMF), which said it would no longer renew its accreditation with PhilHealth because of some P200 million in unpaid claims.
Earlier, seven major private hospitals in Iloilo City announced plans to sever ties with PhilHealth starting next year due to unpaid claims amounting to more than P545 million.
These are the Iloilo Doctors’ Hospital, Iloilo Mission Hospital, Medicus Medical Center, Metro Iloilo Hospital and Medical Center Inc., St. Paul’s Hospital of Iloilo, The Medical City-Iloilo and Qualimed Hospital-Iloilo.
“We will show that we support these hospitals as we encourage our members to observe a PhilHealth holiday,” De Grano told the Inquirer over the phone.
While he admitted that other hospitals might find it difficult to join the “holiday” since there were services that were dependent on the agency, De Grano appealed for the public’s understanding should it push through.
PhilHealth spokesperson Shirley Domingo said in a Viber message to the Inquirer that they were hoping that PHAPI would rethink the planned action.
“Eventually it will be the Filipino people who will suffer the consequences of such a call,” she said.
Claims payment
As of Dec 24, Domingo said PhilHealth had fast-tracked the release of P11.64 billion for the payment of claims through the Debit Credit Payment Method (DCPM) to hospital partners nationwide.
“Under the third wave (of its implementation), all hospitals treating COVID-19 patients and those offering the PhilHealth testing package can now avail themselves of DCPM,” Domingo said.
DCPM3 provides the fast release of funds to qualified hospitals even while their reimbursement claims are still being processed. Under this scheme, 60 percent will be paid initially to hospitals, and the remaining 40 percent settled upon completion of the processing requirements.
Domingo added that to date, 182 hospitals have submitted their letter of intent to participate in DCPM3.
Funding support
“With the welfare of patients in mind, PhilHealth is constantly conducting reconciliation meetings on claims reimbursement issues with all its hospital partners nationwide to ensure continuing availment of members’ benefits,” she said.
Sen. Panfilo Lacson on Monday urged the government to act now to stop the departure of private hospitals from PhilHealth coverage by providing the state-run company with an additional P84 billion in funding.
In a press conference in Pangasinan province, Lacson lamented how more private hospitals were reported to be cutting ties with PhilHealth over unpaid hospitalization claims that reached about P20 billion as of November.
Lacson said the full implementation of the Universal Health Care (UHC) Act was crucial for the country to address the pandemic.
As one of the senators who passed the UHC Act, Lacson also wondered why the law could not be funded correctly, as a fully-funded health care act meant that all barangays in the country would be covered and that there would be one hospital bed for every 800 population.
He cited 2020 statistics showing that in the country’s poorest regions such as Mimaropa (Mindoro, Marinduque, Romblon, and Palawan), the prevailing hospital bed-to-patient ratio was one hospital bed per 10,000 people.
Mandate
This data, Lacson said, was way below the proportion of one bed for every 1,000 prescribed by the World Health Organization.
Senatorial aspirant Francis Escudero on Monday also said that PhilHealth must find a way to pay the legitimate claims of accredited health facilities.
“We want to know what is happening inside PhilHealth so we can all address the problem and prevent a mass disengagement of private hospitals that have the capacity to provide quality health care where our government facilities cannot,” the incumbent Sorsogon governor and former senator said.
“It is given the budget to perform its mandate—to ensure affordable, acceptable, available, and accessible health care services through health insurance coverage for all. This is at the center of health reforms in the [UHC law],” Escudero said.
“How can you provide universal health care when you have more and more hospitals giving up their PhilHealth accreditation?” he said.
“This is going to hurt our implementation of the [UHC law] because private hospitals are integral to a functional health service provider network, especially in municipalities and cities where there are no public tertiary hospitals,” he added.