Philhealth militarization, ‘ghost’ claims reflect problems in health services

Despite these scandals, Philhealth will still lead and manage the implementation of the UHC, and be entrusted to manage “humongous huge amount of money” from member premiums, public funding through the General Appropriations Act (GAA) and shares from PAGCOR and sin taxes.

By JANESS ANN J. ELLAO
Bulatlat.com

MANILA – “Ghost claims” at the government’s health insurance system and the latter’s “militarization” show the inherently flawed public health system in the country, a group of health advocates said.

The Health Alliance for Democracy (HEAD) said that these should be analyzed in the context of President Rodrigo Duterte’s approval of a pre-dominantly commercial insurance-based Universal Health Care Law as it raises doubts on how it can promote people’s health care given the corruption-laden Philippine Health Insurance Corporation (Philhealth) at the helm.

Philhealth has been plagued by scandals, reducing it to a milking cow of the powers-that-be and further exposing the fundamental problem of failure to provide much-needed direct health services to its people. (See Table 1)



Despite these scandals, Philhealth will still lead and manage the implementation of the UHC, and be entrusted to manage “humongous huge amount of money” from member premiums, public funding through the General Appropriations Act (GAA) and shares from PAGCOR and sin taxes.

HEAD said that from 2013 to 2018, the Commission on Audit (COA) estimated that Philhealth lost about P154 billion due to overpayments and other fraudulent schemes. Apart from the reported ghost dialysis scam, there have been earlier reports on fraudulent claims on cataract operations and pneumonia, according to HEAD.

In addition, HEAD said that Philhealth has even served as “milking cows” as ranking officials get about 22 kinds of allowances and benefits.

The “performance” of Philhealth should also be analyzed in the context of how the country’s budget allocation that goes to direct health services has not improved in the past years. (See Table 2)

Even the Philippine General Hospital (PGH) was not spared from poor funding. This is the case even if budget allocation seems to have increased from 2017 to the present due to its inherent advantage of being part of the country’s national university, the University of the Philippines, according to Jossel Ebesate, long-time employee of the state hospital and officer of its workers union. (See Table 3)

As “apex and base of the Philippine health” system, Ebesate stressed that the seeming consistent increase of PGH’s budget can hardly cope with the influx of patients and the medical services they need. The government, he added, has yet to create a system of specialized hospitals in all regions so that Filipinos need not to flock the Manila-based PGH.

From 2015 to 2017, COA has also repeatedly called the Department of Health’s (DOH) attention for its failure to provide services due to poor planning and implementation of its projects. This has resulted in underspending, delayed construction of much-needed facilities and millions worth of expired medicines and supplies. (See Table 4)

In 2017, COA reported non-attainment of target treatment success rates for its various programs tuberculosis and for people living with HIV.

Claims from Philhealth that were disallowed or denied due to non-compliance or partial compliance of the implementing rules and regulations have also “depleted the hospital’s income that could have been used to finance hospital operations in order to provide better health care services to the public,” said COA in its annual reports. (See Table 5)

No less than the COA noted that delays in project implementation deprive the public of “intended social and economic benefits that these projects could have provided had these projects been timely completed.”

In light of the current Philhealth mess, Duterte decided to put it under the control of a retired military officer – Ricardo Morales – adding to an already overly-militarized civilian bureaucracy under this administration.

“These fraudulent schemes cannot prosper without the connivance of Philhealth insiders. This lends credence to the conclusion that a mafia runs critical systems of Philhealth and cannot be remedied by mere changes in personalities,” HEAD secretary general Joseph Carabeo said.

His appointment raised questions, as the Universal Health Law requires the head of the state health insurance system to have at least seven years of experience in the field of health and finance. But more than that, health advocate Dr. Gene Nisperos noted in a Facebook post that while militarizing the bureaucracy is bad enough, “the system that is supposed to ensure services and care is being given to one who comes from an institution that does not recognize human rights or the sanctity of life.”

For health care to be truly universal, HEAD said that the government must go “beyond a health insurance program” and “strive to achieve the people’s aspiration for a free, comprehensive and progressive health care system.” ()

Graphics by Alyssa Mae Clarin

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