DOH sees need to regulate medical missions

MANILA, Philippines - Health Secretary Enrique Ona has underscored the need to reform and regulate medical missions to prevent them from being abused by “fly-by-night” individuals.

Ona said the Department of Health (DOH) has issued an administrative order requiring medical missions organizers to report to the agency but this is not being followed.

“There are at least 200 medical missions in the Philippines that are being reported to the DOH and we all know there are more,” he said.

Speaking at a press briefing of Zuellig Family Foundation for its Community Health Partnerships program, Ona noted that reforms and “some sort of regulation” must be put in place to protect the public against unscrupulous medical missions.

“I’m not saying they are useless. But certainly, we can reform it so that it can have a bigger impact on the improvement of medical mission. We have to make sure that these missions are not by fly-by-night (organizers) and that it will help strengthen local health systems,” he added.

In 2007, the Senate investigated the Philippine Health Insurance Corp. (PhilHealth) after it had been defrauded of P4 billion in overpriced and unnecessary medical procedures since 1995.

It turned out that some of the fraudulent claims involved procedures done during medical and dental missions.

Circumcision and cataract surgeries accounted for a big bulk of reimbursements with PhilHealth involving medical missions.

PhilHealth has issued a circular early this year that it will not reimburse surgical procedures performed during medical missions that are not sponsored by government funds.

In Circular 001-2012, PhilHealth president and chief executive officer Eduardo Banzon defines medical or surgical missions as outreach programs for “humanitarian non-profit purposes” for the benefit of “people who have limited or no means to pay.”

Claims involving surgical procedures done during medical missions sponsored by the national or local governments and conducted in PhilHealth-accredited government facilities shall be compensated “provided that the professional fees are pooled for distribution to all facility personnel.”

The circular states that such claims shall also be approved “subject to provisions” in Republic Act 7875 or the National Health Insurance Act of 1995 on the enrollment of beneficiaries.

“All doctors of foreign nationalities who participated and/or performed surgeries in a surgical medical mission should not file, by themselves or through other doctors, claims for reimbursement of benefits for PhilHealth members or dependents, otherwise they shall be reported to the DOH and the Professional Regulatory Commission for appropriate action,” the circular said.