PhilHealth branch facade
MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) cannot invest in the proposed Maharlika Investment Fund (MIF) because its charter prohibits such a move, the head of the state-run agency said on Wednesday.
“For now, it’s very clear in the [PhilHealth] charter [that] it’s not allowed, so we’re not considering it,” PhilHealth president and CEO Emmanuel Ledesma Jr. told reporters.
But in the event Congress decides to amend PhilHealth’s charter to allow investments in the proposed wealth fund, he said: “If it will help the country, we’re open. But we will [have to] study [it] thoroughly.”
He made this position as PhilHealth executives told a press briefing that the agency maintains a good fiscal position despite the “opportunity loss” of about P17 billion due to the delayed increase in premium payments.
Ledesma expressed confidence that his agency could cover the planned rollout of new benefit packages for 2023, given its nearly P400 billion in assets and a projected annual income this year of about P50 billion.
Emmanuel Ledesma, PhilHealth president and CEO (Photo from LinkedIn)
While PhilHealth is yet to release its full earnings for 2022, it already recorded a net income of P46 billion from January to September last year.
“PhilHealth continues to do very well with regards to its financial position,” said Ledesma, who also served as president of the state-owned Power Sector Assets and Liabilities Management Corp. during the Benigno Aquino III administration.
Although there were concerns that the suspension of the premium rate hike would affect the rollout of benefits, “we can assure you that not only will the benefits continue, but [they] will even improve this year,” he pointed out.
Other fund sources
PhilHealth will be tapping other funding streams such as contributions from the Philippine Amusement and Gaming Corp. (Pagcor) and the Philippine Charity Sweepstakes Office (PCSO), both of which are mandated under the Universal Health Care Act to remit a portion of their revenues to finance the enhancement of health benefit programs.
An estimated P21 billion from Pagcor and PCSO are expected to come in this year, according to Israel Pargas, PhilHealth senior vice president for health finance policy.
Former officer in charge Eli Santos, Ledesma’s predecessor, also dismissed concerns over PhilHealth’s actuarial life, saying that its “life span has no limit and that [it] is here to stay.”
“It can pay its obligations within 12 months. The fund life is dependent on how we manage income. And because of that, PhilHealth will last,” Santos said.
Increased benefits
During the deliberations on PhilHealth’s budget for 2023 in Congress last September, Santos had told lawmakers that PhilHealth’s funds would “only last until 2027” if it would not receive additional funding from the national government.
Among the benefits set for rollout this year are the expansion of coverage of outpatient hemodialysis to 156 from the current 90, as well as the introduction of new packages for mental health and malnutrition in children below 5 years old.
The state insurer is also shifting toward “full digitalization” to improve its claims collection, but this “might take some time,” according to Ledesma, as talks with various third-party providers are still ongoing.
This is one of the measures PhilHealth is looking to implement to address system loopholes that enabled corrupt practices within the agency.
An earlier Inquirer report on how a dialysis center in Quezon City had been paying claims for dead patients, as well as other cases of fraudulent claims and ghost patients, had led to a Senate investigation in 2019.
The Commission on Audit had also found that PhilHealth paid P20.3 million in hospital expenditures for 961 dead patients.
Based on PhilHealth data, there were a total of 38.27 million claims amounting to P368.66 billion during the pandemic years 2020 to 2022. Of this number, P17.95 billion worth of claims were denied, while P11.95 billion are still pending.
The current national average for turnaround time to process claims is 29 days, according to PhilHealth.