As contributions drop as a result of the Covid-19 pandemic and benefit payouts continue to increase, state-run medical insurer Philippine Health Insurance Corporation (PhilHealth) could reach the end of its actuarial life next year and totally collapse in 2022.

During the Senate investigations into the agency’s alleged corruption, PhilHealth Senior Vice President Nerissa Santiago said the agency would suffer from P90 billion and P147 billion operating losses in 2020 and 2021 due to the “double impact” of the Covid-19 pandemic.

Senate Minority Leader Franklin Drilon, however, placed the blame on the agency’s failure to comply with the Commission on Audit’s (COA) auditing rules.

“We are in this mess because of PhilHealth’s non-compliance with rules, including a simple COA rule. That is why we have all these problems because you disregard all the rules designed to protect the public funds,” Drilon said during the Senate’s Committee of the Whole inquiry on August 4.

Drilon questioned the P15 billion funds released to hospitals through the Interim Reimbursement Mechanism (IRM), while PhilHealth only liquidated one billion stressing that COA does not allow additional cash disbursements without liquidation.

According to Drilon, the corruption in PhilHealth could be more “fatal” than the pandemic that country is facing now. 

“It is absolutely outrageous and offensive that in the midst of our fight against a dreaded disease that has so far infected over 100,000 of our people, killed over 2,000 people, claimed over five million jobs, and brought hunger to over five million families, the agency mandated to provide health insurance coverage and ensure accessible healthcare services for Filipinos continues to be haunted by controversies,” Drilon said.

Cash Advance

Former anti-fraud legal officer Thorrsson Keith, who resigned from his post last July 23 due to PhilHealth’s “widespread corruption” scheme, alleged that “mafia members” were in charge of the agency’s anomalous transactions.

Keith revealed during the same Senate hearing that officials have “stolen” some P15 billion from PhilHealth using different fraudulent schemes. 

Senator Joel Villanueva expressed disappointment over the failure of PhilHealth officials to provide answers on the allegations of corruption surrounding the agency during the Senate hearing.

“Hindi po nila nasagot yung mga tanong natin kanina, kahit po ang average hospital bill ng mga kumpirmado at posibleng pasyente na may COVID-19 na hinihingi natin, para makita natin kung sapat ba ang PhilHealth case rates para sa mga COVID-19 patients. Naglalaro po tuloy sa isipan natin na parang ayaw nila sagutin ang tanong para hindi masabi na maliit ang benefit value ng PhilHealth,” Villanueva said.

Citing PhilHealth data, Villanueva pointed out that even prior to the Covid-19 pandemic, the support value, or the portion of the hospitalization costs that the agency covers, has been persistently low despite the increased funds from payments of contributors and annual appropriations in the national budget. 

According to data from the health insurance agency, from a 59 percent support value in 2014, the rate decreased steadily every year, reporting only a mere 41 percent value in the first six months of 2019. 

PhilHealth also allegedly favors certain hospitals, who have fewer Covid-19 cases, to receive a cash advance, according to Villanueva.

“[M]ay mga pinaboran rin na mga ospital na nabigyan ng cash advance sa mga lugar na wala o may mababang bilang ng kaso ng COVID-19. Sa estado ng mga nalaman natin sa PhilHealth, mas lalo pa nitong pinagtibay ang hinala natin na may mafia sa loob ng ahensya,” he added.

Courtesy Resignation

Meanwhile, Senator Francis Tolentino questioned the promotion of four PhilHealth officials involved in an earlier dialysis scam that was also investigated by the upper chamber.

“Walang tinanggal, walang na-suspend, na-promote pa,” Tolentino said over the promotion of Cheryl Peña, Dr. Rizza Majella Herrera, Dr. Bernadette Lico and lawyer Recto Panti to department manager III on May 18.

Tolentino also said that the PhilHealth vice presidents failed to comply with President Duterte’s call to tender their resignation amidst the corruption. 

The resignation of the key officials, said Tolentino, could have paved the way to enact reforms within the corporation. 

“Paano mangyayari ang hinihinging paglilinis at reporma sa PhilHealth kung hindi sinunod ang utos ni Pangulong Duterte na mag-resign sila,” Tolentino said.

However, PhilHealth president Ricardo Morales said the presidential directive only covered the board members of the corporation and was not relayed to the vice presidents.

Morales also added that the board members of PhilHealth made a resolution, to heed President Duterte’s directive, to request officials who have salary grade 26 to make a courtesy resignation.

“My reason for asking that is that I wanted to continue cooperating or running the corporation and a resignation of SG-26 executives…in my opinion, would be too disruptive to the corporation,” he said. Jayziel Khim E. Budino and Veracel A. Martinez