The Secretary of the Department of Health Franciso Duque III appealed to private hospitals on Tuesday to renew their Philippine Health Insurance Corp. (PhilHealth) accreditation.
The Private Hospitals Association of the Philippines (PHAPi), stated their sentiment of withdrawal from PhilHealth in an open letter published last Monday with the reason of delayed reimbursements from the state health insurer.
Duque said the unilateral withdrawal would only lead to a “lose-lose situation.”
PHAPi’s decision was led by the complaints from other hospitals in Mindanao that were stripped of their accreditation.
However, Duque fought the PhilHealth coverage, saying this has been a huge help to almost all Filipinos. He said giving up accreditation would allow companies to not pay the hospital bills of their employees.
“PhilHealth cannot pay them. Only patients who can pay will pay them. But why will the patient pay them knowing that he has his benefits right under the PhilHealth law? That’s why it’s a lose-lose situation. It’s not a solution,” Duque told reporters.
Duque also pointed out that dropping the accreditation would be a refusal to serve the Filipinos, people’s detriment.
“So the service to poor Filipinos who need it, especially the sick, will be gone. You will turn your back on the sick? I think that is not right,” Duque said.
“They should not give up their accreditation because that will certainly compromise our capacity to provide much needed health-care services to members of PhilHealth,” he added.
Universal Health Care Act
Duque also said that what PHAPi wants could compromise the implementation of the Universal Health Care Act in the country.
“The capacity to provide tertiary care to patients, even secondary care to patients who are sick would be compromised.”
According to him, the estimated 600 government hospitals would not be able to accomodate all patients if private hospitals would withdraw.
Duque said several of the 1,000 private hospitals in the country whose PhilHealth accreditation had been withdrawn due to some irregularities like fraudulent claims and upcasing of illnesses.
According to Ricardo Morales, president of the PhilHealth, they would just deal individually with the private hospitals that have pending claims.
Morales said the letter signed by the president of PHAPi, Rustico Jimenez, has different reasons from other hospitals.
“Individual hospitals … are saying a different thing. It’s only Dr. Jimenez, not those hospitals. [It’s] his personal opinion.”
In the letter, Jimenez said that “many hospitals” had received return notices for “noncompliance (with) standard of care.”
“Writing the PhilHealth back will receive no reply at all or the PhilHealth response is so delayed, leaving the hospital no more time to refile their denied claims,” Jimenez said.
However, Morales explained that the sending of return notices happened because their paperwork was incomplete, saying the claims were questionable.
Moreover, Kalusugan Rep. Michael Defensor said the unfiling of PhilHealth accreditation would be a “sabotage” to the government’s health programs.
“It would be a crime for them not to be part of the universal health care program. The President had wanted to empower the hospitals in order for our citizens to have alternatives due to the high cost of confinement, and now that we are starting to see this become a reality, they take that position. I think that’s bad.”
Nonetheless, even though PhilHealth does monthly checking of payments, it admitted that it has failed to pay P14-billion worth of claims as of December 2018 due to losing of billions in net operating expenses from paying fraud dialysis treatments.