PhilHealth's Mismanagement: Billions in Reserve While Hospitals Struggle

PhilHealth's Mismanagement: Billions in Reserve While Hospitals Struggle | Daily Tribune

The Philippine Health Insurance Corp. (PhilHealth) has built up a huge surplus fund as most hospitals, including those owned by the government, have limited benefits to mostly the poor because of payment backlogs in the agency.

Government hospitals, Health Secretary Teodoro Herbosa revealed, have claims of about P15 billion dating back to the pandemic.

Some 45 percent, or P6.7 billion, of that has been overdue for at least two years. During the recovery period, PhilHealth accumulated P600 billion, more or less, in reserve funds due to its failure to render adequate health services.

For a hospital bill of about P100,000, PhilHealth assumes only P15,000 which Senator JV Ejercito, the proponent of the Universal Health Care (UHC) Act, called an appalling situation since the law provides that all Filipinos are entitled to free medicine and hospitalization.

The failure of PhilHealth to settle its obligations also has serious implications for hospital operations.

Legislators during the recent inquiry into the budget of the Department of Health raised concerns about the lack of medical supplies and equipment in government hospitals.

Patients are forced to pay for supplies which should not be the case had PhilHealth been prompt in paying its debts.

The last time PhilHealth remitted payments to hospitals was in March when it distributed P3.5 billion, with the agency using the excuse that it was still helping hospitals design their systems to avoid erroneous claims.

PhilHealth also claims to have settled P26 billion in debts from January to February.

While it runs up a long list of debts to hospitals, PhilHealth launched the Konsulta program which is receiving a tepid response from health professionals.

Under the program, the state agency provides P500 per patient in public hospitals and P750 in private hospitals but this has been getting a lukewarm response.

The recent controversy on the siphoning of P89.9 billion in excess funds of PhilHealth made hospitals skeptical about its ability to cover its arrears.

Yet, PhilHealth practically has a fountain of funds.

Since the enactment of the Sin Tax Law in 2012, PhilHealth has amassed an incredible amount in excess funds. Every year, it generates an estimated P50 billion to P80 billion in savings.

Instead of meeting its mandate of free health care for all, the agency chooses to invest the huge surplus in government securities and other high-yielding financial instruments and investments.

Health experts indicated that even without a national government subsidy, PhilHealth continues to generate sufficient resources from sin taxes, from the Philippine Amusement and Gaming Corporation, the Philippine Charity Sweepstakes Office, the Department of Health, and from member contributions.

Thus, with ample sources of funds, the main problem of the agency is the incompetence, twisted logic and extremely flawed mindset of its current management, an expert on healthcare said.

By prioritizing financial investments over expanding health benefit packages for its members, PhilHealth has recklessly abandoned its mandate of providing optimum health coverage and benefits for the Filipino people.

Currently, the benefit packages are so inadequate and so outmoded that they offer little comfort and value to members who get sick and are hospitalized.

The support value of PhilHealth’s hospitalization coverage is estimated to be only about 40 percent of the total costs. This means members have to shoulder out-of-pocket 60 percent of their hospital bills.

This situation is totally unacceptable, highly anomalous and borders on the criminal.

PhilHealth is not a financial institution and has no business investing its funds to generate profits. Its mandate is to cover the population with social health insurance and to spend all its resources to safeguard the health of the Filipino people.

It has the money yet Filipinos continue to suffer the loss of their life savings whenever disease strikes. If that is not disgraceful, nothing is.