Healing ailing PhilHealth

What to do with the Philippine Health Insurance Corp. or PhilHealth has been a nagging question since the previous administration, when the state-run agency was found to be mired in corruption, with whistleblowers exposing a “mafia” composed of officials within the agency allegedly pocketing funds from various fraudulent schemes.

While whistleblowers put the anomalous deals involving ghost treatments and fraud at a mind-boggling P154 billion, the Commission on Audit meanwhile flagged the agency’s overpriced P2.1 billion information technology project. Private hospitals and the Philippine Red Cross are also hounding PhilHealth for unpaid claims during the pandemic.Following an investigation, the Senate in 2020 recommended the filing of charges against key PhilHealth officials as well as then Health Secretary Francisco Duque III over irregularities in the interim reimbursement mechanism or emergency cash advance to hospitals during the public health emergency, which involved at least P14 billion at that time.

Deeply-rooted corruption

As if corruption and mismanagement issues were not enough, PhilHealth data were also compromised by cybercriminals who demanded a $300,000 ransom late last year.

Given such mayhem in the agency, Health Secretary Teodoro Herbosa has proposed PhilHealth’s transfer from the supervision of the Department of Health (DOH) to the Office of the President to make its operations “more efficient.” While some lawmakers supported this proposal, it was not clear how it could bring about much-needed reforms in the agency, especially since there has been no indication that the deeply-rooted corruption in its ranks was being dealt with.

Despite the unpromising scenario, PhilHealth members will have to cough up a higher premium contribution for this year if President Marcos does not suspend the rate hike from four to five percent.Herbosa has opposed the premium rate hike, saying that PhilHealth has “enough money to actually continue to give benefits” to its direct contributors, or those who pay their premiums through salary or voluntary deductions, and to indirect members like senior citizens whose premiums are subsidized.

Affordable health care

The agency “will not be hurt by delaying the increase in premium [hike],” the DOH chief said. “You need to have a science-based policy. You can’t raise [premiums] on a whim,’’ he added.Clearly, PhilHealth is at a crossroads on how to fulfill its role in implementing the Universal Health Care Act, which mandates “equitable access to quality and affordable health care” for all Filipinos. No less than Mr. Marcos had promised to make health care accessible to all, as provided for in the law signed in 2019. “It is not a privilege to have health care—it is a right,” the President said.A timely move toward this end might be a review of the PhilHealth charter that Speaker Ferdinand Martin Romualdez had asked Congress to do in the wake of issues hounding the state health insurance firm. PhilHealth should function more like a health maintenance organization that focuses its resources on health services rather than in investing them, Romualdez said.

Reserve funds

“With substantial annual allocations from Congress and regular contributions from private employees, there is no excuse for PhilHealth to scrimp on coverage,” the House official said on Tuesday.

Romualdez asked the House committee on health to conduct a review and find ways on how PhilHealth can expand its services to its members, including covering half of medical costs in private hospital wards and providing free examinations for the early detection of deadly diseases.

The review, he said, “underscores the government’s dedication to strengthening the health-care system, making it more responsive to the needs of its citizens, and ensuring that every Filipino has access to the care they need, when they need it.”For PhilHealth to be able to focus on providing health services, Congress must revisit the Universal Health Care Act which allows the state insurer to set aside a portion of its revenues as reserve funds that can be invested.

Recurring malaise

Other proposals have been raised on how to make PhilHealth more efficient. Noting the massive corruption in the agency that he called the “biggest scandal in recent history,” Sen. Sherwin

Gatchalian said this warrants the privatization of the health insurer.

For sure, PhilHealth’s current benefits, including its free dialysis sessions for members, go a long way in helping majority of Filipinos who can barely afford preventive care and the hospitalization that can save many of them from dreaded diseases. Such largesse proves Herbosa and Romualdez right: PhilHealth has all the resources—from its members’ contributions and hefty allocations from the government—to actually go beyond what it currently offers.But PhilHealth is seriously ailing—which speaks to the sorry state of our public health system. A review of its functions and an honest-to-goodness reform program should certainly be prescribed to cure the agency of its recurring malaise.