Sorsogon Governor Chiz Escudero has expressed alarm at the increasing number of private and tertiary hospitals disengaging from the Philippine Health Insurance Corp. (PhilHealth) due to hundreds of millions in unpaid claims.
Escudero urged PhilHealth, which oversees the country’s National Health Insurance Program, to immediately resolve unpaid claims to prevent the disengagement of hospitals and build confidence in its ability to run the insurance program, which is essential to affordable health care.
“How can you provide universal health care when you have more and more hospitals giving up their PhilHealth accreditation? This is going to hurt our implementation of the Universal Health Care Act because private hospitals are integral to a functional health service provider network, especially in municipalities and cities where there are no public tertiary hospitals,” he said.
Seven major hospitals in Iloilo have announced that they are cutting ties with PhilHealth because of unpaid claims amounting to Php545 million collectively. These are the Iloilo Directors’ Hospital, Iloilo Mission Hospital, Medicus Medical Center, Metro Iloilo Hospital and Medical Center Inc., St. Paul’s Hospital of Iloilo, The Medical City-Iloilo and Qualimed Hospital-Iloilo.
In Metro Manila, the Far Eastern University-Dr. Nicanor Reyes Medical Foundation (FEU-NRMF) became the first private hospital to declare that it will no longer renew its accreditation with PhilHealth beginning 2022 because of over Php200 million in unpaid claims.
Even if non-accredited hospitals provide documentation so patients can seek reimbursement from PhilHealth for their medical expenses, this would not work for indigents who need PhilHealth deduction at the point of payment, Escudero said.
“Kung ang mga malalaking ospital mismo ay pipiliing kumalas sa PhilHealth dahil hindi sila makasingil, paano pa ang mga mahihirap na walang konesksyon o panahon para mag-follow up ng mga claims nila? Kaya nga tayo may PhilHealth para mabawasan ang babayaran natin at hangga’t maaari ay walang out-of-pocket expenses ang mga pasyente,” the governor and senatorial candidate said.
The Private Hospitals Association of the Philippines Inc. warned that more hospitals in Quezon, Isabela and General Santos are planning to disengage from PhilHealth for unpaid claims as well, which means more patients across the country are expected to pay their bills in full and just seek reimbursement.
“PhilHealth must find a way to pay the legitimate claims of accredited health facilities. It is given the budget to perform its mandate—to ensure affordable, acceptable, available and accessible health care services through health insurance coverage for all. This is at the center of health reforms in the UHC Act,” Escudero said.
The hospitals noted that under the National Health Insurance Act, PhilHealth is mandated to process, review and pay the claims of providers within 60 days.
PhilHealth was given P71 billion this year from the General Appropriations Act, on top of some Php100 billion in contributions expected from paying members. The 2022 Budget increased PhilHealth’s allocation to P80 billion, lower than the requested Php110 billion.
“We want to know what is happening inside PhilHealth so we can all address the problem and prevent a mass disengagement of private hospitals that have the capacity to provide quality health care where our government facilities cannot. We need to make sure that our National Health Insurance Program works, or else universal health care is impossible,” Escudero said.