Quimbo likens PhilHealth's IRM funds to 'blank checks' freely used by hospitals

Marikina City Representative Stella Quimbo has likened the Philippine Health Insurance Corporations' (PhilHealth) interim reimbursement mechanism (IRM) funds to "blank checks" after she found out that healthcare institutions could freely use them for any purpose.

Quimbo coined the term in her interpellation during the continuation of the House joint panel inquiry into the alleged irregularities at PhilHealth on Monday.

The PhilHealth defines the IRM as "a special privilege for the provision of substantial aid to an eligible Health Care Institution (HCI) directly hit by fortuitous event with clear and apparent intent to continuously operate and/or rebuild the HCI in order to provide continuous health care services to adversely affected Filipinos."

But during Quimbo's interpellation, PhilHealth senior vice president Renato Limsiaco Jr. agreed that hospitals can use IRM funds for other purposes, including the purchase of testing kits and medical supplies, as well as for the salary of their personnel.

"Ang pera po ay nag-transfer natin sa healthcare facilities para sa kanilang operation din po and then based sa claims na nasa atin at isa-submit po nila," PhilHealth senior vice president Dr. Israel Pargas added.

Quimbo was surprised to find out that accredited hospitals could just freely use the IRM funds given to them.

"Klarong-klaro naman na ang IRM ay tila nagiging blank check na binigay sa mga ospital na puwede nilang gamitin sa kahit ano, pambili ng floor wax, pambili ng kotse, at saka na lang ili-liquidate," she said.

This explains why, she said, there was a delay in the liquidation of the funds from hospitals.

"Out of the P14.9 billion, ang nali-liquidate ay P2.7 billion pa lang. Siyempre naman, because hospitals can freely dispose of the funds for the time being, habang hindi pa liquidated," Quimbo said.

"Ang IRM ay tila nagiging blank check para sa isang free-loan na binibigay sa mga hospitals na yan naman ay talagang wala sa mandato ng PhilHealth, dahil ito ay hindi isang insurance company, hindi yan pautang na interest-free," she added.

Continuing with her interpellation, Quimbo claimed that the IRM funds given to hospitals could have been much lower than what PhilHealth released. She estimated that the IRM funds could have been only at P3.3 billion, way lower than the P26.8 billion that PhilHealth released.

In coming up with her calculations, Quimbo used PhilHealth's estimate of 209,000 cases of COVID-19 for 2020, but applied the World Health Organization's figure that only 20% of these cases would develop difficulty in breathing and require hospital care.

Quimbo estimated that there would only be 41,800 hospital admissions and, applying PhilHealth's case rates, would yield an amount of only P3.3 billion that is needed for the medication of these COVID-19 cases.

"Bakit ang laki naman ng inyong itinalaga para sa allocation ng IRM? P26.8 billion kumpara sa P3.3 billion. Hindi ba OA masyado itong P26.8 billion na inestima niyo?" she asked PhilHealth.

In response, PhilHealth acting senior vice president Nerissa Santiago said: "Kasi magkakaiba ang ating assumptions. So hindi natin ma-concretize ng data sa ngayon kasi hindi pa pumapasok na claims para sa COVID."

But Quimbo could not accept Santiago's explanation since IRM funds were released as early as June 9 when cases of COVID-19 in the country have already reached 50,000.

"Sa akin, hindi katanggap-tanggap yung sinasabi ni Madame Actuary na kulang pa sila sa datos, dahil ang petsa ng pag-release ng IRM, kung ako ay hindi nagkakamali, ay June 9," she said.

"By June 9, alam na natin ang patterns ng ating COVID cases. More than 50,000 na ang cases natin by then. So dapat sapat na ang datos by then to make a good enough or reasonable estimate," she added.

During Quimbo's explanation, the House joint panels also moved to call for the withdrawal of funds provided to healthcare institutions through the IRM.

The call, they pointed out, was for hospitals to liquidate the P14 billion fund previously advanced by PhilHealth and to put on hold the unreleased P15 billion until such time the funds have been liquidated.

PhilHealth last week already announced that it has suspended the IRM system "to review its overall implementation and resolve issues arising from Congressional inquiries." —KBK, GMA News