Hospitals' associations on Tuesday, August 17, complained of the Philippine Health Insurance Corporation's (PhilHealth) supposed "arbitrary denial" of over P13.8 billion in benefits claims.
At the hearing of the House Committee on Health, Philippine Hospitals Association (PHA) president Dr. Jaime Almora said the "arbitrary denial of payment, resulting in losses to hospitals, is not only unlawful but morally wrong".
"Constant and escalating loss to hospitals will ultimately lead to collapse and failure of healthcare delivery system...to the detriment of the whole country.The ultimate loser are the people of the Philippines" he warned.
Almora, citing PhilHealth figures, noted that 619,956 claims amounting to P13,800,958,485.04 have been denied from January, 2020 to June, 2021.
"This would result to an average P22,261 per claim, and if we are to look in hospitals engaged in accommodating COVID-19 cases, the P13,800,958,485 would translate to something like P13,800,958 per hospital that was denied to the hospital," he pointed out.
Aside from the denied reimbursements, Almora also lamented the delay in pending claims and those that were returned to hospitals (RTH) for compliance with certain deficiencies.
Some P25.6 billion worth of claims are still being processed by the PhilHealth, while over P46.6 billion were RTH.
The amounts, he said, could have been used by hospitals to improve their capacity and services.
"If we are to look at the impact of this amount of P86 billion and look at how it would be translated to the operations of the hospitals, it would have been a big factor in helping the hospitals cope up with the past situation, especially during the second wave, and especially now, that we are in the midst of the third wave and expecting it to grow even higher," Almora said, citing the need for ventilators, oxygen generators and other equipment, as well as facilities.
"And of course the much-needed increase in the salary of nurses, especially, and other personnel. If we are to give them P30,000 per month from the current P15,000 to P25,000 that they are receiving, this will be a big boost so they will not be transferring to other sectors of our economy offer better returns or salary, or even migrating abroad. So we can solve the shortage that we are having now," he also pointed out.
Private Hospitals Association of the Philippines Inc. (PHAPi) board member Dr. Jerry Gonzales echoed the PHA, saying hospitals are now having a hard time recovering their expenses.
"Talagang pahirapan po (It's really difficult these days). It is basically, right now, a hand-to-mouth existence. Weekly, we even look at our expenses, and our income, if we can pay the salaries of our health care workers," Gonzales lamented.
Earlier, Almora said the hospitals were forced to use their savings or loan from banks to due to the "severe financial distress" caused by the unpaid claims.
President Duterte last week pressed the PhilHealth to settle its outstanding obligations to COVID-19 hospitals. The PhilHealth, for its part, assured to address the complaints on the delayed claims.