SONA 2015: PhilHealth: The boon and the bane of medical insurance

The Philippine Health Insurance Corporation (PhilHealth) has a special place in State of the Nation Addresses of President Benigno Aquino III. The chief executive often trumpets how his administration has improved the health insurance system for Filipinos. 

 

In his 2014 SONA, he did not mention anything about the state-run health insurer. Instead, he signed into law Republic Act 10645 or "An Act Providing for the Mandatory PhilHealth Coverage for All Senior Citizens” in November.

 

Senator Ralph Recto, principal author of RA 10645's Senate version, said all citizens who are 60 years old and above will receive the benefits and discounts extended to ordinary PhilHealth members by presenting a valid ID that proves their real age.

 

This year, however, the health-insurer was hit by a chain of allegations of irregularities over the way management has been treating its finances, and abuse of benefits involving hospitals. 

 

The Commission on Audit questioned the state-run health insurer for giving its officers and employees P1.761 billion in bonuses despite official notices not to do so. 

 

PhilHealth claimed it has filed appeals that are now pending before the COA Commission Proper. 

 

And then there was the Senate blue ribbon committee probe into the "up scaling" of pneumonia cases in some hospitals, primarily involving fraudulent insurance claims. 

 

PhilHealth president and CEO Alexander Padilla said the P7.6 billion in reimbursements for pneumonia cases in 2014 constitutes the highest pay outs for the health insurer.

 

Before the Senate hearing, PhilHealth suspended payments to suspicious eye clinics after the total cost for cataract removal operations ballooned to P2 billion in 2014. 

 

Reforms

In his first SONA, Aquino promised the roll out reforms for PhilHealth, an affiliate of the Health Department. Social Welfare and Development Secretary Dinky Soliman was leading the changes to give the poorest of the poor the priority in health insurance coverage.

 

"Ngayon pa lang, kumikilos na si Secretary Dinky Soliman at ang DSWD (Department of Social Welfare and Development)  upang ipatupad ang National Household Targeting System, na magtutukoy sa mga pamilyang higit na nagangailangan ng tulong. Tinatayang 9 bilyon ang kailangan para mabigyan ng PhilHealth ang 5 milyong pinakamaralitang pamilyang Pilipino," the President said. 

 

In the same venue the following year, Aquino claimed that 5.2 million Filipino families have been added as PhilHealth members. 

 

"Malawakang pag-unlad at pag-asenso ng lahat: Iyan po ang panata natin. Walang maiiwan sa tuwid na landas," he said.  

 

The Department of Budget and Management released P5 billion to cover the premiums of indigents left unpaid by the previous administration. 
 

 

Widen scope of coverage

In 2012, Aquino pointed out there were more than 36 million Filipinos who were not covered by PhilHealth when he took office and that taking them into the fold of the state-run health insurance system would cost P42 billion. 

 

The President noted that 23.31 million Filipinos were already PhilHealth members. 

 

But then in his 2013 SONA, Aquino noted there was a scramble to widen the scope of PhilHealth coverage.

 

"Ang natitira nga pong wala sa talaan ay ang mga hinahanap pa, kabilang na po ang informal sector at mga katutubo. Inaasahan po natin ang pakikipagtulungan ng mga lokal na pamahalaan upang maisali na natin sa sistema ang lahat ng ating mamamayan," the President said. – VS, GMA News