Lawmakers question PhilHealth’s claim that fund may not be enough for next year
Marje Pelayo • August 6, 2020 • 259
MANILA, Philippines — The Philippine Health Insurance Corporation (PhilHealth) claims that the agency’s actuarial life or fund will last only until next year due to the coronavirus disease (COVID-19) pandemic.
PhilHealth’s senior vice president for actuary, Nerissa Santiago said the pandemic has delayed members from remitting their contributions. The agency has also been shelling out more funds due to the increase in the number of COVID-19 patients.
PhilHealth estimates that around 209,000 patients will be needing financial support from the agency this year.
This could lead to further depletion of PhilHealth funds by the start of next year.
But Marikina Representative Stella Quimbo questioned this saying PhilHealth should still have P112-billion and that support for COVID-19 patients shouldn’t reach that much amount.
Quimbo noted that based on global measures, only about 20 percent of COVID-19 patients are expected to be admitted to hospitals and this will not cost PhilHealth an amount of P45 billion.
“I use the global distribution for mild, severe and moderate, and computation ko lang po dyan maximum na is maximum P3.2 billion only. Hindi po talaga aabot iyan ng P45 billion,” Quimbo said.
“Ang worry ko po is, sa kaka-project ninyo ng napakalaki ay nagkakaroon ng mas malaki leeway sa fraud,” she added noting that there is a problem with the implementation of the agency’s case rate program.
She added that PhilHealth’s actuarial life should still be enough for up to 10 years according to the Department of Health (DOH) projection in August last year.
“If your case rate is properly computed, wala po tayong problema ng overpayment nor underpayment,” Quimbo said.
PhilHealth President R/Gen. Ricardo Morales claims that PhilHealth’s fraud rate is at 7.5 percent and to address this he said upgrading the agency’s IT system would be key to reducing it.
Other lawmakers also questioned alleged irregularities in the agency’s case rate system.
PhilHealth started its case rate system in 2011 which provides health care institutions a corresponding amount for every illness like pneumonia, gastroenteritis, urinary tract infection (UTI), and now COVID-19.
Since the start of COVID-19, PhilHealth has allocated a 30 billion-peso-fund for the interim reimbursement mechanism.
Out of the said amount, the agency has already released about P14-B but only about P1-B has been liquidated.
The agency has since been working on case rates like P15,000 for pneumonia; P6,600 for gastroenteritis; P7,000 for urinary tract infection (UTI).
For COVID-19 cases, PhilHealth has set P44,000 insurance for mild cases and up to P788,000 for critical cases.
Lawmakers asked PhilHealth officials why they have to pay for cases worth less than the amount of a particular case rate.
“Ano po ibig sabihin nito? Nagpunta ka ng ospital at ikaw po ay binigyan ng kaukulang atensyong medikal. Ang ginastos mo ay P20,000, ang babayaran pa rin ng PhilHealth sa ospital ay P43,000 under the case rate system?” asked the House Committee on Public Affairs Chair Mike Defensor.
“So tinuturing niyo na kita na ito ng ospital, kumbaga ay reward, dahil mas mura ang ginastos nila kesa doon sa case rate na ini-assign ng PhilHealth? Ganoon po ba iyon?” asked Bagong Henerasyon Partylist Rep. Bernadette Herrera-Dy.
Morales explained that what hospitals get from the agency is an incentive to make their services more efficient.
“Magiging incentive na doon sa mga ospital nang maging efficient sila,” he said.
Morales added that the case rate will be transitioned to a global budget wherein funds will be entrusted to local government units as part of the Universal Health Care Law.
The Lower House will continue the hearing on the alleged irregularities in PhilHealth next week. MNP (with details from Rey Pelayo)
MANILA, Philippines – The Department of the Interior and Local Government (DILG) on Monday urged local government units (LGU) in Metro Manila to endorse to Oplan Kalinga quarantine facilities mild and asymptomatic novel coronavirus disease (COVID-19) patients that could no longer be accommodated in local isolation centers.
In a statement, DILG Secretary Eduardo Año said there now 4,000 beds available in Oplan Kalinga facilities due to the increase in discharges or recoveries in the previous weeks.
“We urge all Metro Manila LGUs to endorse patients which they can no longer accommodate in their local isolation facilities to endorse them to the Mega TTMFs and Oplan Kalinga Hotels which now has some 4,000 beds available because many have already been discharged,” he said.
Año said this is in compliance with Inter-Agency Task Force (IATF) Resolution No. 74 which states that all confirmed mild and asymptomatic COVID-19 patients are required to isolate in government-approved facilities, except those who are vulnerable or have comorbidities as certified by a local health officer.
Also exempted in this rule are confirmed mild and asymptomatic COVID-19 patients in areas where the government-recognized isolation centers are in full capacity.
“Meron tayong mga Mega Quarantine Facilities and 31 COVID hotels na kung saan puwede sila mag-isolate. Importante kasi talaga na mailabas sila sa bahay kasi nakahahawa sa pamilya,” the DILG chief said.
According to DILG spokesperson, Undersecretary Jonathan Malaya, LGUs can coordinate directly with the One Hospital Command Center (OHCC) located at the Metropolitan Manila Development Authority (MMDA) which was created to facilitate a comprehensive and coordinated response to the pandemic by ensuring an efficient health facility referral in Metro Manila.
Malaya said that with the establishment of the OHCC, LGUs and individuals can now easily locate hospitals or isolation facilities near them.
The DILG said the command center is open 24/7 and individuals needing treatment may call the OHCC hotlines at 0927-728-0750, 0927-728-0753, 0927-728-0755, and 0927-728-0798.
Individuals needing assistance from the OHCC may also download the PureForce Citizens App via Google Play Store or App Store, it added.
MANILA, Philippines — The Inter-Agency Task Force (IATF) is now requiring facility-based isolation for confirmed asymptomatic and mild coronavirus disease (COVID-19) cases through IATF Resolution 74.
The new policy however, exempts patients who are considered vulnerable or having comorbidities and their home meets the conditions specified in the Department of Health (DOH) and the Department of the Interior and Local Government (DILG) Joint Administrative Order 2020-0001.
Likewise, another exception is when the Ligtas COVID-19 Centers within the region are fully occupied and the local government unit does not have sufficient isolation facilities.
MANILA, Philippines — Iloilo City has been placed under modified enhanced community quarantine (MECQ) effective September 25 until October 9 due to the increasing number of coronavirus disease (COVID-19) cases in the city.
According to Presidential Spokesperson Harry Roque the new measure is based on the issued Inter-Agency Task Force (IATF) Resolution 74 which also requires facility-based isolation for confirmed asymptomatic and mild COVID-19 cases.
However, the resolution exempts patients who are considered vulnerable or having comorbidities as confirmed by the local health officer.
Another exception would be when the Ligtas COVID-19 Centers within the region are fully occupied and the local government unit does not have sufficient isolation facilities.
On Tuesday (September 22), 33 employees of the Iloilo City Hall tested positive for COVID-19 prompting the three-day temporary closure of the establishment beginning Wednesday (September 23) as declared by Mayor Jerry Treñas in Executive Order No. 215-A.
Prior to that, 13 barangays in the city were placed under total lockdown due to the increase in community transmission of COVID-19.
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