Spotlight on PhilHealth

A Filipina domestic worker has a worn out purse where she keeps items that are of great value to her – a child’s photograph, some emergency cash and her laminated PhilHealth card.

Every quarter without fail, she religiously reminds her employer not to forget her PhilHealth contributions.

That piece of paper may come in handy one day, says the helper who keeps her PhilHealth card like a precious stone.

I’m not sure if our policymakers know just how much the ordinary Filipino worker values his or her Philippine Health Insurance Corp. membership.

Never mind the rich and famous, at least in this regard. They have no trouble paying for their medical bills; some even own the hospitals but for the most ordinary of ordinary Filipinos who have no medical insurance from a private health maintenance organization, a PhilHealth benefit is as precious as health itself.

The PhilHealth discount they get when they are hospitalized is a big deal. It can spell the difference between being able to pay their bills and getting themselves or their relatives discharged after confinement, and knocking on the doors of lawmakers for a GL.

GL, in case our policymakers also don’t know, means guarantee letter and it’s been a go-to option, too, for the underprivileged and the desperate.

In times of health emergencies, they ask people in their communities of any link to a congressman or a senator’s office to ask for a guarantee letter – from the barangay health worker who might know a friend of a friend or a relative of a neighbor, etc. – until they find that one contact to the lawmaker’s office. Any contact and any lawmaker will do as long as he or she manages to get the hapless individual that much needed guarantee letter which is given to hospitals to settle bills.

This is not in my imaginings; this is really how it goes for the desperate and the downtrodden, especially those who are not PhilHealth members.

Against this backdrop, it is especially important that our government keeps PhilHealth running – and efficiently.

Arrears

And yet, why do I still hear of reports of PhilHealth arrears to hospitals?

One hospital alone has recorded unpaid PhilHealth bills of P400 million. Wow. That is by no means insignificant and it has affected the operations of this private hospital. The amount increased by 100 percent during the COVID-19 pandemic.

I’m sure this is not an isolated case. Perhaps if I dig deeper, I will find more hospitals in similar situations.

PhilHealth also has unpaid obligations to the Philippine Red Cross of approximately P320 million, as revealed by the chairman himself, former senator Richard Gordon.

Gordon, as quoted by Insurance Business, said despite promises of payment, PhilHealth has not paid what it owed the organization for services rendered during the COVID-19 pandemic.

“(That’s supposedly) payment for our resource recovery and services rendered during COVID-19. They keep promising they will complete their payment but (it’s still delayed),” the Red Cross chief told me yesterday when I asked about the status of their PhilHealth problems.

As I said, it’s very likely that there are other similar PhilHealth-related horror stories going around hospitals.

Given this, the Marcos administration must ensure that PhilHealth fulfills its obligations so that hospitals and organizations like the Red Cross can continue to function efficiently.

Excess health funds

There’s also the issue of the use of excess PhilHealth funds.

Antonio Leachon, a former health special adviser, urged legislators to investigate the state-owned health insurer for allegedly failing to use excess funds to boost the benefits of its members and reduce their annual contributions.

The Department of Finance has issued a circular allowing the unused funds of PhilHealth worth P89.9 billion to be classified as unprogrammed appropriations.

He believes that PhilHealth funds can’t be reallocated just like that, even as PhilHealth officials said the matter went through due process.

“No portion of the reserve fund or income thereof shall accrue to the general fund of the National Government or to any of its agencies or instrumentalities, including government-owned or -controlled corporations,” Dr. Leachon said, referring to a provision of the Universal Health Care Act.

The excess funds, he said on social media, may instead be used to improve PhilHealth benefits, provide outpatient health packages to members, expand benefits for catastrophic illnesses, buy better tech equipment to avoid being hacked again, reduce out of pocket expenses during hospitalizations and yes, pay arrears or hospitals.

Clearly, our state health insurer needs fixing.

Our government must know that PhilHealth members regard their membership with utmost importance, setting aside part of their hard-earned money every month just to be able to pay their premiums.

This is no joke. To many Filipinos, that PhilHealth card is a ticket that can help them get through a medical emergency, spelling the difference between life and death.

It is therefore imperative that our government regard this social service with as much importance as its members do.

Messing with PhilHealth funds is an incompetence we cannot afford and more than that, it is a great disservice to our nation and our people.

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Email: [email protected]. Follow her on Twitter @eyesgonzales. Column archives at EyesWideOpen on FB.