PhilHealth probes steep rise in cataract surgeries

MANILA, Philippines—Health officials are investigating how cataract operations have become the highest paid-for service under the Philippine Health Insurance Corp. (PhilHealth), the national health insurance program.

Health Secretary Enrique Ona said he ordered the investigation after one ophthalmologist was able to obtain P28 million from PhilHealth for cataract surgeries that he performed in just one year.

“Since PhilHealth began supporting cataract operations—it gives P18,000 per eye operation—within a period of something like two years, cataract operations (have become) the highest paid-for service of PhilHealth,” he told a press briefing on Friday.

According to Ona, the ophthalmologist who became the highest paid cataract surgeon by PhilHealth last year “had very little practice two or three years before.”

He said the Department of Health was not investigating particular ophthalmologists but was looking into how these cataract surgeries had become the leading type of operation under PhilHealth.

Not a racket

“Now let us not say that it is all (a) racket. Maybe there are really that many unmet needs of our people, especially senior citizens who have cataracts … but that has to be proven,” Ona said.

He said old people usually developed cataracts “but the question is whether they should have surgery.”

“We want to determine if the patients really needed these surgeries. These operations became the no. 1 paid service by PhilHealth,” Ona said.

“I’m not saying that the doctor was guilty. We want to look into how these (surgeries) grew in number so fast,” he added.

University of the Philippines-Manila Chancellor Manuel Agulto said the eye doctors involved should have been investigated “from the start.”

“I want to tell you that those who do these are just a minority. I am the ethics committee chair of the Philippine Board of Ophthalmology and I’m very angry and very emotional about this issue,” Agulto said.

2 million with cataracts

According to Agulto, two percent of the Philippine population, or around two million Filipinos, have cataract problems but not all of them require surgery.

“Majority of ethical ophthalmologists out there in the field are not doing this. It’s the unethical ones who are trying to make money out of the misery of our countrymen,” he said.