Ex-Health chief Dayrit: PhilHealth not shouldering enough of COVID patients’ hospital costs

State insurer Philippine Health Insurance Corporation (PhilHealth) is not shouldering enough of the cost of COVID-19 treatment in hospitals, former Health Secretary Manuel Dayrit said Wednesday.

Dayrit, in a webinar between officials from the Department of Health and the private sector, presented data that PhilHealth was only able to shoulder P786,000 of the P1 million to P2.5 million cost of critical hospital care for each COVID-19 patient, whether the patient is confined in a private or public hospital.

As for non-critical cases, Dayrit said that PhilHealth only shoulders P44,000 to P334,000 of the hospital care cost, which ranges from P65,000 to P948,000.

“Among top NCR hospitals alone, PhilHealth receivables have reached P200 million since March. Someone’s gotta give,” Dayrit said.

“PhilHealth has to find a way to address this,” he added.

Having said that, Dayrit suggested that PhilHealth can revise its policies to cover an increased amount of hospital care cost for those in need.

“PhilHealth could revise its reimbursement policy on no balance billing so private hospitals can charge balance for patients that can afford [to pay],” Dayrit said.

“It could also adjust its case rate to reflect the true cost of hospital care [for a COVID-19 patient],” he added.

During the Senate inquiry on Tuesday, PhilHealth's acting Senior Vice President Nerissa Santiago claimed that the insurer's actuarial life is down to one year due to decreased collections and expected increase in benefit payouts amid the COVID-19 pandemic.

In the same hearing, however, former PhilHealth anti-fraud legal officer Thorsson Montes Keith also claimed that the PhilHealth "mafia" has deep roots in the agency, including top officials in the executive committee, and that racketeering has resulted in P15 billion worth of losses for PhilHealth.

Keith accused his former colleagues of being behind fraudulent schemes via cash advances, the use of the interim reimbursement mechanism, and the continuous procurement of IT equipment the agency already has.

A day later in a House inquiry, Commissioner Greco Belgica of the Presidential Anti-Corruption Commission (PACC) linked at least 36 officials of PhilHealth to overpayments allegedly made to hospitals. — BM, GMA News