PhilHealth reimbursement to hospitals based on past figures, not COVID-19 cases - officials

Kristine Sabillo and RG Cruz, ABS-CBN News

Posted at Aug 12 2020 07:19 PM

MANILA — Officials of the Philippine Health Insurance Corporation (PhilHealth) and the Department of Health (DOH) said on Wednesday that the interim reimbursement mechanism (IRM) for hospitals is based on past figures, instead of the current need of hospitals.

The explanation was provided after PhilHealth’s decision to allocate the biggest share for the Southern Philippines Medical Center (SPMC) in Davao City was questioned amid allegations of corruption in the state insurance firm.

At a joint committee hearing in the House of Representatives, PhilHeallth SVP for Finance Israel Pargas said the IRM of SPMC is based on historical claims from 2019.

The same statement was given by Health Undersecretary Maria Rosario Vergeire when asked by reporters why hospitals in Metro Manila and other regions with high cases of COVID-19 did not receive a bigger share.

“This interim reimbursement mechanism, how they compute it, is they base it on historical figures. It’s the historical claim from 3 months from the previous year,” she said.

Pargas told lawmakers that the amount released to Metro Manila hospitals is more than 20% of the IRM released nationwide.

The SPMC topped the list of hospitals that received IRM funds with P326 million, followed by the Philippine General Hospital with P263.3 million.

The Davao Regional Medical Center received P209 million, while the Vicente Sotto Memorial Medical Center in Cebu City got P204 million.

The Jose B. Lingad Memorial Regional Hospital in San Fernando, Pampanga received P201 million.

“Ang SPMC is a 1,200 bed hospital. So, comparing it with the other hospital, ito na ang pinakamalaking hospital na meron tayo,” Vergeire said.

(SPMC is a 1,200-bed hospital. So, comparing it with the other hospitals, this is the biggest hospital that we have.)

But DOH later told reporters that while SPMC has 1,200 beds, PGH has 1,334 beds.

Vergeire also pointed out that SPMC “cater to a lot of cases, even specialized cases.”

“And they have high technology there. Kasi nga we are trying to prime this hospital to be one of the leaders in Asia,” she said.

(And they have high technology there because we are priming this hospital to be one of the leaders in Asia.)

Besides being located in President Rodrigo Duterte’s hometown, SPMC used to be headed by Health Undersecretary Leopold Vega. 

Vega was only recently appointed by Duterte to the DOH as an Undersecretary, and was assigned as “treatment czar” for the government’s COVID-19 response. He is the only undersecretary among the other anti-COVID czars.

Vega's appointment to the health department was in the midst of criticisms against Health Secretary Francisco Duque III over the government's response to the pandemic.