The coronavirus pandemic has affected various countries with its sudden blow on the health care system, leaving many still grasping for the right balance between health and economic aspects.
The Philippines — a third world country — had likewise struggled for resources, jumping from varying quarantine protocols in order to assist workers battling at the frontlines to contain the virus and save more lives.
One thing that has been a topic for many months since the onset of the pandemic was the country’s capacity to assist the public’s need for health resources as mandated by the law through its agency, the Philippine Health Insurance Corp. (PhilHealth).
In last year’s State of the Nation Address (SoNA), President Rodrigo Duterte mentioned the recent uncovering of “massive fraud” committed within the public health insurance system, manned by PhilHealth.
Duterte was pertaining to the exposed practice of WellMed Dialysis Center in Quezon City, where it allegedly had “ghost” dialysis cases that were consistently covered by PhilHealth’s paid claims.
Witness and former employee Edwin Roberto said, from 2016 to 2018, payments for the dead patients were continuously made as WellMed forged the signatures of the patients to make the claims.
Roberto explained PhilHealth allowed 90 sessions per dialysis patient, which were renewed yearly.
In Duterte’s SoNA, he mentioned the money paid in the fraud could’ve been saved and used for the benefit of many Filipinos with existing illnesses.
“I am grossly disappointed. The government is conned of millions of pesos, which could be used to treat illnesses and possibly save the lives of many,” he said.
The incident led to the appointment of a new PhilHealth president, as well as an order for the National Bureau of Investigation to conduct a probe and arrest those found liable to the crime.
A few years later, the COVID-19 pandemic hit the country and PhilHealth struggled with allocating funds over months of lockdown and restricted movement to contain the virus.
Universal Health Care Law
Taking a toll on the public’s health, the state health insurer assured that all expenses spent on testing and treatment of COVID-19 will be shouldered under the implementation of the Universal Health Care Law, which automatically enrolls all Filipinos in the National Insurance Program.
“PhilHealth wishes to assure all Filipinos that even under the period of this pandemic, it intends to fulfill its mandate under the Universal Health Care Law of providing adequate health service to all Filipinos when needed,” it said in a statement last April.
However, it was later revealed that, with a limited existing fund and longer quarantine protocols implemented, PhilHealth can only cover so much.
In a House hearing last June, PhilHealth president and CEO Ricardo Morales urged lawmakers to pursue a “general delay” after he admitted to PhilHealth’s current struggle with receiving significant payments from contributors of members.
On top of this, they also acquired backlash from hospitals and other medical organizations over alleged unpaid claims that will supposedly cover for COVID-19 patients admitted.
Private Hospitals Association of the Philippines Inc. (PHAPi) president Rustico Jimenez earlier said many small hospitals have threatened to shut down due to bankruptcy caused by alleged delayed payments from PhilHealth.
It was later denied by the agency in a statement, and said the many establishments that have been affected by the pandemic, especially among hospitals with a sharp decrease in their patient admission in fear of contracting the virus.
As stated, PhilHealth said they have already released around P43 billion worth of claims to hospitals, where around 56.8 percent were paid to private hospitals.
With these paid claims, the state health insurer announced case rates that served as compensation depending on the severity of the disease per individual.
The rates for COVID-19 patients are P43,997 for mild pneumonia, P143,267 for moderate pneumonia, P333,519 for severe, and P786,384 for critical pneumonia.
It likewise included a range of testing packages from P2,710 to P8,150, depending on how the test kits were used and procured.
However, due to recent anomalies, the testing packages set by PhilHealth were doubted by lawmakers and stated that it might be overpriced.
In a Senate hearing, Minority Leader Franklin Drilon questioned Morales on why the test kits in the package cost over P8,000, despite existing test kits that cost only from P800 to P900.
After it was asked to be reviewed, PhilHealth announced a new set of rates where testing included in the package now only costs from P901 to P3,409.
Working on the frontlines against the pandemic, the country’s health system capacity has also struggled to cope with the sudden change of situation brought by the unexpected coronavirus disease.
In the earlier onset of the outbreak, the Department of Health (DoH) assured the public that hospitals in the country have been tasked to allocate COVID and non-COVID pathways and facilities to avoid possible transmission of the virus while continuing to provide both services.
Although hospitals at first were able to handle the situation, the sudden rise of cases brought by community transmission in areas with more eased restrictions has overwhelmed their capacities.
Only this month, a number of hospitals reported they are already operating at maximum capacity of their allocated beds for COVID-19.
All separate statements urged patients to be referred to other hospitals with available capacities as they are unable to admit them.
Health Undersecretary Maria Rosario Vergeire said one of the reasons why most hospitals are already at their full capacity was that not all are able to comply with the mandated 30 percent of beds for COVID-19 cases.
Left with no choice, the DoH revised the protocol for public hospitals to further increase their capacity by 50 up to 70 percent, while private hospitals by 10 percent should there be a surge in cases.
In response, hospitals and medical organizations lamented that their facilities can only be increased by as much as their available space and staff permit.
They also added that with health care workers also testing positive for the virus, a decrease in the number of operating staff is inevitable.
Philippine General Hospital spokesman Dr. Jonas del Rosario, in an interview, pointed out that capacities in hospitals don’t only pertain to beds and rooms, but also in the capability of health workers to monitor and care for the patients.
At present, the Philippines’ tally for COVID-19 cases rose to 72,000 as experts from the University of the Philippines fear the cases may rise further to 100,000 by August with no finalized vaccine yet in sight.
With more eased restrictions to assist in the economic recovery of the country, UP experts said cases due to increased mobility are expected to increase more.
UP senior lecturer Paul Quintos pointed out that the current condition of the country in this pandemic is not solely due to the lack of experience, but more on the Philippines’ existing “sorry state of the public health system.”
He urged the government that in moving to a “new normal,” gaps in the system should be addressed to be prepared in dealing with future emergency situations.
“We need an inclusive, just and equitable health system that will help us look forward to a ‘new and better normal’ for all,” he said.
On Monday, 27 July, President Duterte is expected to deliver his SoNA as DoH Undersecretary Vergeire vaguely mentioned that it may include topics concerning COVID-19 related issues and the forward implementation of the Universal Health Care Law.