The ghosts of PhilHealth

Until very recently, things were somewhat looking good for the health care sector. The fallout from the Dengvaxia scandal still lingers, but its effect on vaccination confidence seem to have been neutralized — ironically — by the measles outbreak.

Capping off a series of health-related legislation passed over the past two years, the universal health care (UHC) law was also approved in February, and the much-needed revision of the sin tax law, though delayed, seems to have made it — by a hair — before the end of the 17th Congress.

This euphoria, however, was dampened when news broke of a private clinic in Novaliches that was said to have made dialysis claims for patients who were already dead. Drawing on the testimony of two whistleblowers who worked at WellMed Dialysis Center, a three-part exposé in this broadsheet went on to document other kinds of insurance fraud (e.g. “upcasing”), their financial toll (P154 billion no less), and the complicity of a Philippine Health Insurance Corp. (PhilHealth) “mafia” in perpetuating corruption in the state insurance company.

“It’s very disappointing, knowing that so many of us are doing our best to follow the strict requirements of PhilHealth [to make claims], and we have so many patients who are trying to make do with their maximum of 90 dialysis sessions a year,” a nephrologist who requested anonymity told me in response to the news.

President Duterte was quick to express fury over the situation, ordering the arrest of the clinic owners and a purge of the PhilHealth leadership. Back from political hibernation, Harry Roque has surfaced as the lawyer for the whistleblowers, and is calling for the suspension of the UHC law until the issue is resolved, citing the “corrupt pigs” in PhilHealth.

I do not think the UHC law should be suspended; we cannot allow a corruption scandal to deprive legitimate patients of health care. But Roque has a point: How can we expect the people and the government to go along with our call to invest more on health if the funds end up being stolen? The PhilHealth scandal raises the question of trust, which is why it must be taken very seriously.

How can we move forward from this fiasco?

The first is by exacting justice — one that is not abusive, selective or reactionary. The swift arrest of Dr. Brian Sy, WellMed owner, may be cheered by many, but its warrantless nature raises the question of adherence to the rule of law, which cannot be sacrificed in the name of “justice.” Moreover, if there is indeed a mafia in PhilHealth, the alleged malpractice in WellMed is just the tip of the iceberg.

Of the hospitals and officials involved in insurance fraud, which ones get to be investigated and who gets a free pass? How many will actually have their licenses revoked? As with the administration’s campaigns against drugs and corruption, vigorously pursuing cases against some while turning a blind eye to others will undermine the credibility of the entire campaign and will not solve the problem of mistrust.

The second is by ensuring competent leadership in PhilHealth. With so much money in the agency’s hands, we need people with integrity and innovation at its helm. I urge President Duterte to think carefully, and be as consultative as possible, in deciding who to appoint (or retain) in the PhilHealth board. Health is too important to be handed over to an unqualified presidential friend—or an owner of a hospital group. Conflicts of interest should be avoided at all costs.

The third is by improving PhilHealth’s patient database. “This scandal has exposed their loophole — they actually have no means to check if the patient is dead or alive!” exclaimed the nephrologist I spoke to, underscoring the need for a more effective and responsive health information system.

If there’s any silver lining in this situation, it is the opportunity to make meaningful, structural and sustainable reforms in PhilHealth — which, in the wake of this scandal, can have the popular support and political backing required to exorcise its ghosts and banish the spirit of greed. Given what’s at stake — public trust in our health care system—this is an opportunity that we must take at all costs. The legitimacy of PhilHealth and the viability of the UHC depend on it.

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