Hospital group urges next administration to fix PhilHealth’s reimbursement system

Job Manahan, ABS-CBN News

Posted at May 28 2022 02:57 PM | Updated as of May 28 2022 08:27 PM

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MANILA — The Private Hospitals Association of the Philippines Inc. (PHAPI) on Saturday urged the incoming administration to fix the reimbursement system at state insurer PhilHealth.

PHAPI president Dr. Jose De Grano said private hospitals have been relying primarily on PhilHealth's reimbursement mechanism, but some hospitals' claims were delayed or have yet to be released. 

"Doon sa naging karanasan namin noong nakaraang taon, ilang taon sa PhilHealth, ’yun ang palagay kong kailangang pagtuunan ng pansin ng susunod na administrasyon na sana ay hindi magkaroon tayo ng problema sa ating claims sa PhilHealth," De Grano said in a televised briefing. 

"Kung maayos po natin ang organisasyon ng PhilHealth nang sa ganoon ay makaayon dito sa mga hinihiling ng ating mga pribadong ospital, [pati] siguro government hospitals, palagay ko maganda ’yun na maisakatuparan at sa gayon po ang ating healthcare system ay magiging maganda para sa susunod na 6 na taon."

In late December last year, some hospitals threatened to cut ties with the insurer, citing millions of pesos in unpaid claims that accumulated in the past few years.

PhilHealth CEO and president Dante Gierran in January said the insurer owed hospitals more than P25 billion and it plans to settle the payment by June. 

But De Grano said PhilHealth has already communicated to them and the state-run firm was still paying dues. He described their relationship with PhilHealth as "fair" because of this. 

"Siyempre ang ine-expect namin na pagbabayad ng claims, hindi pa nabibigay lahat lalo na ’yung mga hospitals na sinasabing malalayo," he said. 

"Hindi pa po kumpleto ’yung kanilang kine-claim pero doon sa nakaraang buwan nakapagbigay naman ang PhilHealth ng at least ibang kabayaran para maipagpatuloy ng mga ospital yung kanilang operasyon." 

Gierran had attributed the slow payment of claims to the lack of manpower and information technology caused by the pandemic.

As of January 7, the agency has already released P12.05 billion to 444 hospitals via the Debit-Credit Payment Method (DCPM), he added.

PhilHealth had faced corruption issues, with allegations about officials supposedly pocketing P15 billion in public funds, approving overpriced projects, and releasing funds to favored hospitals.

Gierran had said the P15 billion "missing" funds have already been accounted for.