Hospital owners appeal to President Duterte to commence reforms at PhilHealth

Published May 13, 2021, 8:59 AM

by Mario Casayuran

The Private Hospitals Association of the Philippines Inc. has appealed to President Duterte to commence reforms at the Philippine Health Insurance Corporation (PhilHealth) by appointing a President and Chief Executive Officer (CEO) with the appropriate qualification and experience to effectively lead a multi-billion-peso State health insurance agency.

In a position paper submitted to Senator Imee R. Marcos as chairwoman of the Senate economic affairs committee, Jose Rene D. De Grano, PHAPI president, said corruption (at PhilHealth) is primarily a failure of governance.

De Grano said special attention has to be given to the qualification and experience of the PhilHealth President and CEO based on the Implementing Rules and Regulation (IRR) of the Universal Health Care Act (RA 112233) which states that ‘’the Board cannot recommend a President and CEO of PhilHealth unless the member is a Filipino citizen and must have at least seven years of experience in the field of public health, management, finance and health economics or a combination of any of these expertise.’’

The Association then aimed its guns at former PhilHealth President and CEO Ricardo Morales for finger pointing at hospitals and other professionals as the source of corruption, ‘’accordingly since hospitals are the ones receiving money.’’

‘’This puts healthcare providers in a bad light which is totally unacceptable, having seen how our member hospitals have sacrificed beyond words in our daily fight against COVID-19, and who regardless of situations have served well the Filipino people.’’

‘’Before we point that finger of blame, have we asked if it is fair to generalize all? This appears to be his last desperate act of redeeming himself after having been forced to leave the agency embroiled in another corruption controversy under his leadership.

A Senate Committee of the Whole public hearing focused on some corruption issues and the controversial Interim Reimbursement Mechanism (IRM).

President Duterte accepted on August 27 the resignation of Morales, a retired Army general.

In his resignation letter, Morales thanked the President for allowing him to rest and would now focus on his health and his family. He is a cancer patient.

Morales was replaced by Dante Gierran, a former National Bureau of Investigation (NBI), director.

PHAPI, with 745 hospitals as members, maintained that the PhilHealth Board recognized the necessity to institute temporary remedial measure which was in the form of IRM as additional aid to healthcare institutions (HCIs) to remain financially viable and continuously serve the health care needs of patients.

‘’We reiterate that all hospital claims are transmitted to PhilHealth. After transmittal, PhilHealth gains the ultimate control and unlimited power to check the veracity of claims, then determine whether these are for reimbursement, for Return-to-Hospital, or for Denial; with the power to prosecute and suspend accreditation, leaving the fate of hospitals and doctors to its absolute judgment. Given the omnipotent powers of PhilHealth from evaluation to payment or even ending in denials of claims, how can one logical mind say that fraud is committed by hospitals and doctors? ’’it asked.

Curbing corruption makes more political sense than ever before so we could progressively realize universal healthcare in the country. That ultimately is the long-term interest of all layers of society. And PHAPI is the first in the line to protect that interest and shield social policy so as to eliminate the marginalization of the disadvantaged,’’ it pointed out.

The PHAPI submitted a list of recommendations including the the representation of hospitals in the PhilHealth Board and reinstate the PHAPI Accreditation as one of the requirements for renewal of hospital license.