UNDER THE MICROSCOPE
Hardly had I sent my column to press two weeks ago (Hemodialysis and PhilHealth July 9, 2024) when news broke out on the transfer of a whopping ₱90 billion of “surplus funds” from PhilHealth to the National Treasury. This was purportedly to finance the additional ₱450 billion increase in unprogrammed appropriations (the modern reincarnation of pork barrel funds) that our lawmakers inserted into the 2024 General Appropriation Bill.
Huh?! Here I was pleading for proper reimbursement for the hemodialysis package so that hemodialysis centers could make ends meet and continue serving kidney patients, only to find out PhilHealth has surplus funds?
How did it happen that PhilHealth has surplus funds? Based on the enabling laws, PhilHealth is supposed to plow any excess funds into either reducing member contributions or increasing members’ benefits. Neither of these happened. Quite the reverse in fact! Effective this year, member contributions increased from four percent to five percent of their monthly salaries.
Neither has PhilHealth increased the benefits for its members. Its No Balance Billing (NBB) policy has very limited coverage for many catastrophic diseases, including cancer. Only in-patient benefits are recognized. You have to be seriously sick enough to be admitted to a hospital for the NBB policy to take effect. In the meantime, patients are reduced to begging from family members, friends, charitable organizations, politicos disbursing our hard-earned tax money and PCSO to cover outpatient treatment costs, which can be considerable over extended periods of time.
Why does PhilHealth have surplus funds when they haven’t been settling the claims of hospitals, both government and private? Dr. Jose Rene de Grano, president of the Private Hospitals Association of the Philippines Inc. (PHAPI), stated that unpaid claims for private hospitals alone amounted to ₱8–₱10 billion as of mid-2023. Of that, PhilHealth settled around ₱3–₱5 billion. That left ₱4–₱6 billion unpaid and since then, it has been accumulating. He said one hospital alone has ₱100 million in unpaid claims, and his own hospital has ₱50 million unpaid claims. That’s just two hospitals.
Then, there is the matter of unpaid Covid-19 testing, dating all the way back to three years ago when then Senator Richard Gordon decried the non-payment of the Philippine National Red Cross claims for its Covid-19 testing operations, which amounted to ₱380 million in May 2023. This was after PhilHealth settled a portion of the ₱1 billion it owed PNRC in 2020.
There are many other Covid-19 laboratories still waiting to receive compensation for their efforts, after large-scale testing was performed on orders of the national government. For the Philippine Childrens Medical Center alone, the unpaid claims for Covid-19 testing of returning Overseas Filipino Workers have amounted to over ₱250 million as of 2023. The payments have been coming in piecemeal.
PhilHealth seems to be either inefficient or delinquent in its payments of claims from hospitals and Covid-19 testing laboratories. If so, has it figured out how much it still owes these claimants before declaring it has surplus funds?
Has PhilHealth really investigated the true costs of the hemodialysis package it implemented and pegged at ₱4,000 with NBB? Or is it bent on squeezing its providers dry just to have “surplus” funds?
What about the other Z-packages for catastrophic diseases? Can’t it increase the benefits of patients with breast, prostate, colon, lung and other cancers instead of declaring the funds as surplus?
There is a continuing outcry about this attempt to move the ₱90 billion “surplus” fund to the National Treasury. Or is it a done deal? It is the hot topic for many columnists and bloggers on social media.
There is a lot that can be done if the decision is reversed. Retract the one percent increase in member contributions and increase members’ benefits, especially for outpatient treatment of chronic diseases not needing hospitalization. Implement the Universal Health Care Program in earnest using this “surplus” fund. Review the hemodialysis packages and other NBB programs if they are realistic or not, and increase funding for these if necessary.
There are so many ways the money can be spent for the benefit of PhilHealth members, paying and non-paying. It is doubtful that after all these are implemented, there will still be surplus funds.
Hopefully, the PhilHealth Board of Directors, under its president-CEO Emmanuel Ledesma Jr. and ex-officio members – Health Secretary Teodoro Herbosa J. Herbosa, DSWD Secretary Rexlon T. Gatchalian, DOLE Secretary Bienvenido E. Laguesma, DOF Secretary Ralph G. Recto, and DBM Secretary Amenah F. Pangandaman, will reconsider this decision.
Finance Secretary Ralph Recto has opined that based on the opinions of the Governance Commission for GOCCs, Office of the Government Corporate Counsel (OGCC) and the Commission on audit (COA), the move was legal. It may be legal, and that’s debatable and subject to legal challenge.
But is it moral?
Please do the right thing.