rrror
Thursdav,,lugust 1, 2019
@
t--.-
House minority seeks
PhilHealth rness probe
AWMAKERS belonging to the
minority bloc in the House of
Representatives said they filed a
resolution callingforan inquiryinto the
irregul3rities in the Philippine Health
Insurance Corp. (PhilHealth).
With the implementing rules and
regulations (IRR) of Universal Health
Care (UHC) nowbeingdrafted, Minority
Leader Bienvenido Abante Jr. said in i
news briefingthat Congress should f ind
out how much of PhilHealth's financial
resources are lost to ftaud.
Abante saidthelowerchambershould
also lookinto the extent ofthe fraud and
how it is being committed.
"Our objective should be to plug the
leaks so that the resources for UHC are
properlymaximized once itis rolled out.
Let's clean house before moving forward;
let's fixthe systembefore we implement
jt," he said.
In the samenews conference, Mariki-
na Rep. StellaQuimbo saidif theseprob-
lemsinthe PhilHealth are not adequately
addressed, the goals ofthe UHClawwill
not be attained.
"Universal Healthcare is one of the
landmark pieces of,legislation of the
Duterte administration and, if properly
implemented, could benefit the lives of
over 100 million Filipinos, especially
those who cannot afford proper health
care. However, this is contingent on
the implementation of much-needed
reforms in PhilHealth, as there are cur-
rently many obstacles in the effective
delivery by PhilHealth of financial risk
protection," she said.
Accordingto Quimbo, one majorissue
_,";;;;-4;,
is the low effective protection rate each
Filipinogets from PhilHealth, which to-
'day stands at 15 percent.
"This means that for every 100 pesos
ofhospital spending, only15 pesos is fi-
nancedby PhilHealth, while the remain-
ing 85 pesos is paid fdr by the patient,"
she said.
"There are three mainreasons for this
lowprotection rate. First, not everyone is
currently coveredby PhilHeath. Second,
there is little to lowawareness regarding
the PhilHealth program. Third; there
are the complexities involved in claims.
Some members who are automatically
covered, such as 4Ps families, do not
-even know that they have PhilHealth
coverage," she added.
As a result, the lawmaker said the
PhilHealth availment rate is only 66 per-
cent "so of 10 PhilHealth members who
are ill and are hosp)talized, only six are
able to successfully claim benefits from
PhilHealth."
"These figures assume that all
claims are legitimate. Howeve{, recent
reports suggest that there could be
rampant fraud in PhilHealth claims.
This means that the effective protec-
tion rate is less than 15 percent. If,
for example, 20 percent of PhilHealth
claims are fraudulent, then the effec-
tive protection rate is only 12 percent.
This means that for every P100 spent
on hospitalbills, PhilHealth shoulders
only P1 2," she added.
Quimbo also urged the Department
ofHealth to take the taskoflRRcrafting
seriousln and called on them to consult
experts, and to work with Congress to
pass supplemental legislation if this is
necessary to make UHC work.