Pay up, PhilHealth

There is no excuse for the Philippine Health Insurance Corp.’s continuing failure to reimburse hospitals for health claims a year after the pandemic struck, and especially when hospitals are overwhelmed with patients due to the recent surge of COVID-19 infections.

PhilHealth owes an astounding P28 billion in health claims to 700 private hospitals belonging to the Private Hospitals Association of the Philippines Inc., according to its president Dr. Jose de Grano.

Even more deplorable is that these were debts owed for March to December 2020, when the pandemic started, and not counting the unpaid claims for the first months of this year when record number of infections again overwhelmed an already ailing health system.

If public hospitals and other private health facilities were included, PhilHealth’s debts for 2020 alone would amount to P50 billion, according to De Grano.

Considering the unbearable situation of recent weeks, when people were dying in their homes or outside hospitals without getting treatment, PhilHealth’s failure to pay the claims is untenable for the overburdened hospitals.

In recent weeks when the country recorded its highest numbers of positive cases and deaths, people desperately went hospital-hopping even outside of Metro Manila to find a bed for their sick loved ones. Hospitals in the National Capital Region went beyond their capacity, in terms of beds and health personnel, to accommodate critically ill COVID-19 patients. A few hospitals had to close down some units as many of their nurses, doctors, and health care workers also came down with the virus.

The dire situation in public hospitals was seen at the Philippine General Hospital, one of the three COVID-19 referral hospitals, which had 220 of its 250 beds occupied by COVID-19 patients. The PGH also reported a high mortality rate of five patients dying per day in the past three weeks, showing the severe situation a year after the pandemic began.

Last week, patients at the National Kidney and Transplant Institute were seen sleeping on the hallways and on hospital grounds as the facility ran out of beds to accommodate both COVID-19 and kidney patients.

Amid the upsurge of COVID-19 cases, which prompted the reimposition of strict lockdowns in Metro Manila and neighboring provinces, the government had been pressing private hospitals to increase their bed capacity for COVID-19 patients.

Private hospitals were already running at full or critical capacity and were short of health care workers due to infections within their ranks, De Grano pointed out. And yet while fending for themselves, these hospitals have had to contend with the financial constraints brought about by PhilHealth’s failure to settle those account payables—for a year and counting.

What’s PhilHealth’s excuse? Officials of the graft-ridden agency invoked the need to observe processes to make sure that health claims were valid. But should this take a year, and in the time of a raging pandemic when hospitals are the critical battlegrounds for saving people’s lives?

PhilHealth president and CEO Dante Gierran issued a Debit-Credit Payment Method (DCPM) last April 8 supposedly to fast-track the payment of claims to hospitals. But as it turned out, this program is not fast or efficient enough.

Per De Grano, the DCPM was only made available to hospitals in the NCR Plus, or Metro Manila and the nearby provinces placed under a modified enhanced community quarantine this month. Apparently in response to the complaints of hospitals, Malacañang on Thursday announced the DCPM would now be applied to all high-risk and critical areas in the country.

Still, hospitals are to be paid only 60 percent initially, the rest upon completion of the liquidation requirements. “That’s our money (but) it’s as if our hands are tied,’’ De Grano lamented. He said some hospitals have refused to participate in the program because of the uncertainty as to when the 40 percent would be settled by PhilHealth. Also, only P10 billion was allocated to the DCPM, which is manifestly not enough given the high number of COVID-19 claims.

PhilHealth’s inaction and apathy have also caused mounting debts to the Philippine Red Cross, with its chair Sen. Richard Gordon complaining many times that this has hampered the Red Cross’ COVID-19 testing operations. As of April 6, PhilHealth owes the Red Cross P876 million.

In October last year, PhilHealth’s outstanding balance reached P1 billion, prompting the Red Cross to halt its COVID-19 tests. PhilHealth then settled half of the amount.

Is PhilHealth waiting for hospitals to close or turn away more COVID-19 patients before it sees the urgency of settling the claims?

“This situation weighs heavily on our medical frontliners, patients, and the most vulnerable among our people,” said Sen. Grace Poe in calling on the state health insurer to pay up. “Huwag na natin silang pahirapan pa, antagal na nilang nagsasakripisyo at nagtitiis.’’