Senate President Chiz Escudero called on the Philippine Health Insurance Corporation (PhilHealth) to rethink what it means to be indigent when it comes to the health requirements of Filipinos.
Insofar as the health of people is concerned, Escudero said being indigent takes on a whole different meaning.
“Any person who is sick or who has a family member or loved one suffering from cancer, heart, kidney or lung disease is considered an indigent,” Escudero explained.
“Even if that individual is earning P28,000, P68,000, or even P100,000 per month, given the daily expenses for food, housing, medicines, and other bills, that person is cancer indigent, heart disease indigent, lung disease indigent or kidney failure indigent. This should be the new outlook of the government toward healthcare,” he pointed out.
In its current effort to adjust the case rates for inpatient members, Escudero said PhilHealth should take into account the amount of contributions members are making on a regular basis.
Similar to how it works with various insurance products, the Senate President said the level of benefits received would vary based on how much premium is being paid by the clients.
During a hearing of the Committee on Health, Escudero asked PhilHealth officials if they did the math in determining how much benefits a member should receive.
“Bakit hindi tumugma ‘yung actuarial study ng kontribusyon doon sa benepisyo na binibigay? After several questions, bakit ganoon kadali magsabing 30 percent? Bakit hindi 50 percent? Bakit hindi 100 percent? Is there an actuarial study that is based on?” Escudero asked.
If the level of contributions to PhilHealth by employees is based on the amount of compensation they receive, Escudero asked why the state health insurance firm has only a single case rate that applies to all members.
“Bakit ‘yung case rate iisa, magkano man ang kontribusyon mo? Parang ‘yun pa lang may mali na. Hindi ba ang tipikal na insurance, sa pribado bibili ka ng package at depende sa premium na binayaran mo, ‘yun ang makukuha mong benepisyo. Bakit sa PhilHealth ‘yung case rate ay aplikable sa lahat kahit magkano ‘yung kontribusyon mo? Baka ‘yan ang rason kung bakit nakaipon ng ganyan kalaking reserves din ang PhilHealth,” Escudero said.
PhilHealth started implementing the All Case Rates policy in 2013 in lieu of the fee-for-service provider mechanism.
Since 2013, most case rates have not been adjusted and so the PhilHealth Board, through PBR No. 2871 s. 2024 (Resolution Adopting a 30 percent Inflation Adjustment Factor for Select Case Rates) approved an inflation adjustment factor of 30 percent for existing case rates to account for price changes over the past decade.
“For most employees of government for instance, they are not considered indigent. Whatever amount they earn, it’s never going to be enough to pay the medical expenses if you’re a cancer patient or if you need a heart operation,” Escudero said.
“Kaya ‘yung lumang concept natin na indigent lang tutulungan, sa totoo lang kahit sino na may kamag-anak na magkakasakit na seryoso tulad ng cancer o sakit sa puso, hindi po sapat ‘yung suweldo kahit isandaang libo pa ‘yan kada buwan dahil ginagastos mo rin ‘yun,” the Senate President added.
Escudero argued that PhilHealth has the funds to cover for the adjustments in its case rates as seen in the ballooning of its reserve fund over the years.
PhilHealth’s reserve fund has reached close to P500 billion, an amount which Escudero noted is so huge that if left unutilized, is losing value due to inflation.
Based on a four-percent inflation rate, Escudero said “you are losing, in terms of value, P20 billion.”
“Dalawampung bilyong piso ang halaga ng serbisyong nabibigay mo sana sa Pilipinong nangangailangan ng medical services na hindi niyo naibigay dahil hindi mo ginastos ang pera, and we simply lost that amount to inflation,” Escudero said.
“That’s why the Department of Finance considered getting the money kasi sayang. Nagde-depreciate lang ang pera, hindi napapakinabangan and yet in the middle of all of this, lives are being lost. You should’ve acted yesterday, you should’ve acted last week, last month, even last year so kindly act with a sense of urgency because tomorrow is already late,” he added.