DOH exec: Huge PhilHealth reimbursement to SPMC proportionate to size of hospital

The huge amount of Philippine Health Insurance Corporation (PhilHealth) COVID-19 reimbursement to Davao City-based Southern Philippines Medical Center is due to the fact that it is a big hospital, Health Undersecretary Maria Rosario Vergeire said Wednesday.

Vergeire made the response after PhilHealth's legal counsel, Roberto Labe Jr., revealed during Tuesday’s Senate inquiry on alleged corrupt practices in PhilHealth that SPMC topped the list of hospitals with the highest amount of IRM (Interim Reimbursement Mechanism) allocation at P326 million.

SPMC eclipsed UP-Philippine General Hospital in Manila—a COVID-19 referral facility—which was only allotted with P263 million worth of IRM.

“Itong IRM, how they compute it is based on historical claims, iyong claims for three months the previous year. Wala pa tayong COVID noon,” Vergeire said in an online forum.

“SPMC is a 1,200-bed hospital. Comparing it with other hospitals, ito na ang pinakamalaking hospital na meron tayo and they take a lot of cases, even specialized cases. Kaya hindi rin tama na ma-ico-compare natin ito sa mga regions with [a lot of] COVID-19 cases,” Vergeire added.

Vergeire said that SPMC is capable of treating hard specialty cases, various types of cancer, and is equipped with facilities of high technology.

“Kaya kung saka-sakaling mataas, marahil iyon ang kadahilanan, iyong kalakihan ng kanilang ospital,” Vergeire added.

During the same Senate hearing, however, Senator Joel Villanueva also called out PhilHealth for releasing 100% of the IRM allocation of dialysis clinics when only 50 to 70% of the IRM entitlement of other COVID-19 hospitals amid the COVID-19 pandemic were released.

Based on Health Department records, the most number of COVID-19 cases  is with the National Capital Region with 76,870 cases.

Region 4A or Calabarzon ranked second with 18,054.

Rounding up the top five are Region 7 or Central Visayas with 17,784, Region 3 or Central Luzon with 4,166 and Region 6 or Western Visayas or 2,317.

Davao City, hometown of President Rodrigo Duterte, is in Region 11 or Davao Region.

Also on Wednesday, Senate Majority Leader Juan Miguel Zubiri said it is unlikely that President Rodrigo Duterte had a hand on why SPMC got the lion's share of PhilHealth's releases under the IRM.

“I don't think the President had asked them to put the money in Davao, those Davao City hospitals, I don't think he’ll do that,” Zubiri said in an interview on ANC.

“Baka mayroong nagsisipsip lang kay Pangulo, maybe that’s one,” he added. 

Zubiri said the P326 million IRM fund that SPMC received is justifiable because it shouldered a lot of COVID-19 testing and treatment in the region during the onset of the pandemic when surrounding areas were not capable yet. — RSJ, GMA News