Senators split on proposal to suspend PhilHealth’s internal reimbursement mechanism

Published August 12, 2020, 4:20 PM

by Hannah Torregoza 

Senators on Wednesday remain split on whether there is a need to suspend the Philippine Health Insurance Corp.’s (PhilHealth) Internal Reimbursement Mechanism (IRM), which has been slammed for being an inequitable “advance payment scheme” among hospitals and health care facilities.

Senate President Vicente Sotto III and Senate Majority Leader Juan Miguel “Migz” Zubiri both said they believe IRM should be suspended.

“It would be better if we replace the entire leadership with reliable and incumbent employees whose records are clean so that the programs will not be hampered. But, yes, IRM should be suspended,” Sotto said in a text message to reporters.

Zubiri pointed out even the Commission on Audit (COA) noticed how PhilHealth was showing “favoritism” through its IRM policy.

“With the way we see it, yes, I support that we suspend the release of the IRM funds until we come out with a formula,” Zubiri said in an online interview.

Sen. Francis “Kiko” Pangilinan also said he sees the need to suspend all releases, revise and redistribute the approved allocations.

“The current allocation system is a complete disaster and is a huge stumbling block for our hospitals to be able to effectively address the killer pandemic,” Pangilinan said in a statement.

Sen. Juan Edgardo “Sonny” Angara, however, said he sees no need to suspend it immediately.

“We don’t have to suspend it yet, but it’s worth examining if the releases have been responsive to the needs of the times, aside from other common ailments of our kababayans,” Angara said in a separate text message.

“Dapat i-prioritise yung  (We need to prioritize the) funding for testing especially since many of the lower income sectors have expressed frustration at being unable to get tested for COVID-19. They need it badly given the conditions in many of our urban communities where people live in cramped quarters,” he pointed out.

“Dapat ipa-ikot ang pera (the money should revolve to other health care institutions)  around the whole country to make testing available and accessible,” he said.

Sen. Joel Villanueva, on the other hand, noted that since the IRM is designed to provide cash advances for medical facilities handling COVID-19 cases, all releases of IRM should only cater to this requirement especially at this point in time.

“Other facilities handling non-COVID cases should continue to follow its regular processing of claims,” Villanueva suggested.

Villanueva said PhilHealth has all the power and authority to make it easier for hospitals and other medical facilities to expedite their regular process for claims.

“Private hospitals are already overburdened with the nonpayment of their claims, and if they are forced to close, our healthcare system might collapse,” the senator warned.

Senators scrutinizing the IRM policy said they have found it a tool for politics and corruption within the state health insurance agency.

Senate minority leader Franklin Drilon said he found the IRM a “misnomer” since it is, in fact, a system of cash advances and not reimbursements.

Senators slammed the fact that under the IRM, PhilHealth is quick to provide cash advances to some dialysis centers and maternity clinics while there are many hospitals reeling from COVID-19 patients are still waiting for their share of payouts.