The government has the funds to settle unpaid claims with the Philippine Health Insurance Corp. (PhilHealth), the Palace said Tuesday, even as more private hospitals considered cutting ties with the state medical insurer.
This developed as senators renewed their call to PhilHealth to immediately settle the unpaid claims of many private hospitals amounting to at least P20 billion, due since August this year.
Palace spokesman Harry Roque noted PhilHealth sources funds from premiums, taxes, the Budget department's appropriation, and the revenues of the Philippine Charity Sweepstakes Office (PCSO) and the Philippine Amusement and Gaming Corp. (PAGCOR).
“I am telling you, government funds for this are not lacking," Roque said in a press briefing.
“I am calling on PhilHealth President Dante Gierran. I will repeat the request of President (Rodrigo) Duterte to president Gierran, ‘Keep paying that,’” the spokesman added.
The healthcare system will suffer a capacity shortage without private hospitals, which account for about 70 percent of medical services, Roque said.
The Private Hospitals Association of the Philippines Inc. (PHAPI) said last week some of its 700-plus members might not renew their accreditation with PhilHealth because most claims for the treatment of COVID-19 patients last year remain unpaid.
Out of the 1,071 licensed private hospitals at the Department of Health, 50% are recognized members of the association “who actively participate and support all PHAPI activities since its inception,” the group’s website said.
PhilHealth and PHAPI, in a meeting with Executive Secretary Salvador Medialdea on Tuesday, "committed to work together" over the issue, said Duterte's longtime aide Sen. Christopher Go.
Some private hospitals, including in Metro Manila, will release in November a position paper on whether they would cut ties with PhilHealth, said PHAPI president Dr. Jose Rene De Grano.
"Many of them may not renew with PhilHealth next year because of what they have experienced. There is no concrete solution from PhilHealth for the last 2 or 3 months,” he told TeleRadyo.
“When we talk about renewal, it means January 2022, but there are hospital administrators who think no concrete solution has been offered to address their situation. They are considering announcing in a week or two that they will not be renewing with PhilHealth,” the PHAPI leader added in an interview over radio dzBB.
“Some hospitals in General Santos City, Iloilo City, Cagayan Valley, and then now the hospitals in Laguna, Quezon, and Cavite and also a big hospital in NCR, are saying nothing seems to be happening with their discussions with PhilHealth,” De Grano said.
De Grano also noted PhilHealth beneficiaries would also be affected, as some hospitals have yet to receive payment for some COVID-19 claims in 2020.
“That is what will actually happen to our beneficiaries or PhilHealth members. They will be provided with the service but then the PhilHealth members need to provide advance payment, they will be given a statement of account and then they will be the one to bring it to and communicate with PhilHealth for whatever benefits they should get,” he said.
In October, De Grano said, an estimated 5 percent to 10 percent of nurses in private hospitals in the country left their jobs.
He said they are currently urging nurses and health care workers to stay in the country.
Last month, De Grano said PhilHealth still owed at least P834 million to some private hospitals in General Santos, Iloilo, and Northern Luzon.
At a Senate hearing, PhilHealth admitted to delays in processing of claims for COVID-19 cases.
“We are so swarmed with an increase of claims. Can you just imagine, in 2020, we have the average of daily claims of 31,000, and the average number of claims now is 39,000. Which means that is job increase of 26 percent," Gierran said.
PhilHealth also faced a manpower shortage, he added.
Senator Imee Marcos said Philhealth should pay billions of pesos in debts to private hospitals and file charges against those involved in fraud if it has the evidence.
She added that the Universal Health Care Act and PhilHealth would be useless if hospitals would boycott the state insurer and no longer see accreditation in the coming years.
“Now that people have no job and money, who will pay their medical expenses if hospitals are not registered with PhilHealth?” Marcos asked
There are about 95 million direct and indirect contributors of PhilHealth who could lose their benefits.
Senator Grace Poe said PhilHealth must pick up the slack in settling its mounting obligations to hospitals, saying the situation compromises the health care system.
She branded as "unjust" that frontline institutions must wait for years and not know when they can be reimbursed.
"We expect the state health insurer to come up with an aggressive catch-up plan for the due reimbursement of claims," she said.
The delay in payment, she said, could force hospitals to downsize or worse, halt operations, to the detriment of their workers who willlose jobs, and the people who cannot anymore take a heavy beating from the pandemic.
"As this unfortunate situation persists, our health system becomes more vulnerable to being overwhelmed, especially in a pandemic,” Poe said.
Senator Risa Hontiveros also appealed to private hospitals to remain committed to ensuring access to affordable health care.
"The government, given its limited capacity to provide hospital care, should explore options to provide crucial financial aid to hospitals at risk," she said.
She said the pandemic isn’t over yet and the health system must be able to serve the needy, and not just those who are able to pay.
Meanwhile, Senator Joel Villanueva said PhilHealth delays in reimbursing private hospitals for treating members of the state health insurer will make it harder for hospitals to retain critical manpower.
“This is also a jobs issue. When reimbursement is slow the flight of talent accelerates,” Villanueva, chairman of the Senate labor committee, said.
PhilHealth, he added, should be the reason for retaining private hospitals' staff, not the cause of their departure, “especially at a time when the pull of foreign recruiters is strong.”
When private hospitals suffer from workforce reduction, it is the public that suffers, he added.
“You can have hospital beds but without medical staff, those beds are reduced to pieces of furniture,” he said.
“During an epidemic, when the call is ‘all hands on deck,’ the role of a state corporation is to ensure that frontline units operate at optimum capacity,” he said.
“PhilHealth reimbursement is a critical part of the supply chain.
That’s what the government needs to understand,” Villanueva added.
Villanueva said PhilHealth should aim for a “zero backlog” in settling reimbursement claims by the end of the year.
By failing to solve the long festering problem of slow reimbursement, PhilHealth is unwittingly aiding headhunters in recruiting nurses to work abroad, he said.