Finance Secretary Carlos Dominguez III said the Philippine Health Insurance Corp. (PhilHealth) remains “very viable on the cash flow basis” but warned that continuous massive spending could change some of its coverage in the years to come.
In an online briefing, Dominguez said PhilHealth was amply covered by the subsidy provided by the national government as of June 2021. He said tentative figures indicated that PhilHealth had a deficit of P25.5 billion as of June.
“And the national government subsidy for the same period was P44.6 billion and PhilHealth has a reserve fund of around P164.1 billion as of June 2021. So PhilHealth is still very viable on the cash flow basis,” Dominguez said.
But he said PhilHealth had incurred a drop in contributions because of the problems with the COVID-19 pandemic and the agency also experienced an increase in expenditures.
When asked about the viability of PhilHealth, Dominguez said it could sustain massive spending for a couple of years.
“PhilHealth will not disappear. What will happen is some of the coverage might change. It’s hard to tell exactly. Life changed in January or February 2020. We better get used to it. Moaning and groaning for 2019 is not going to help, you just have to change,” Dominguez said, adding people have to change their lifestyles.
Dominguez said the Insurance Commission has already conducted an actuarial audit of PhilHealth and the regulator is currently in discussion with the PhilHealth board and management on its findings.
Dominguez said it was the first time ever that IC has examined a government institution.
Dominguez said he will let the Insurance Commission release its findings and it should not be published until all the board members of PhilHealth are aware of those findings.
Senator Imee Marcos recently warned in a press statement that PhilHealth’s delayed reimbursements to government and private hospitals will weaken their capacity to deal with the mutating COVID-19 virus, if not risk their outright closure.
“Complaints reaching our office show that at least P26 billion remains unpaid to private hospitals alone, while government hospitals are still owed hundreds of millions. Let’s not wait for them to shut down nor leave them ill-prepared to deal with the possible spread of the dreaded Delta variant,” Marcos said.
PhilHealth recently announced that it had released some P6.3 billion through a new system of settling hospital claims, known as the Debit Credit Payment Method (DCPM) put in place in April.
However, Marcos said hospitals were being shortchanged because the DCPM did not cover still unpaid hospital claims for COVID-19 treatment last year.
Marcos cited the case of one private hospital that was reimbursed only P430 million out of the P1.2 billion it is claiming, “which is 60 percent of 60 percent – in effect, only 36 percent – of what PhilHealth said it would pay through the DCPM.”
Marcos said even government hospitals have not received the full 60-percent reimbursement that PhilHealth should have released.
Data showed that as of May 31, the Philippine General Hospital has only received a reimbursement of 0.0042 percent or only P2.56 million of its claims for COVID-19 cases totaling P615.7 million.
The Lung Center of the Philippines said it has only been paid 40 percent of its receivables from PhilHealth, with P304 million still due.
The Philippine Heart Center said only 49 percent or P99.47 million has been reimbursed by PhilHealth, leaving a balance of more than P100 million for claims up to March 31.
The Private Hospitals Association of the Philippines (PHAPi) confirmed that partial reimbursements to its members via DCPM were concentrated in the National Capital Region (NCR) Plus bubble of Metro Manila and its neighboring provinces.
So far, only about 210 hospitals have agreed to participate in the DCPM, out of the 350 hospitals in the NCR Plus bubble and 1,270 health care facilities all over the country.
