Senators want PhilHealth’s IRM suspended pending policy changes

Senators want PhilHealth’s IRM suspended pending policy changes

MANILA – Several senators on Wednesday called for the suspension of the Philippine Health Insurance Corporation’s (PhilHealth) interim reimbursement mechanism (IRM) until policy changes have been made for an accountable and equitable distribution of the advance payment scheme.

“We should suspend the release of the IRM until we can come out with a proper formula for the accountable release of the funds. Dapat talaga magkaroon ng formula sa pagbigay ng IRM, kasi itong IRM na ito, napaka-prone sa corruption (A formula is really needed in the disbursement of the IRM because it is very prone to corruption,” Senate Majority Leader Juan Miguel Zubiri said in an online press briefing.

He noted that the distribution of the IRM, which allows PhilHealth to make advance payments to hospitals handling coronavirus disease (Covid-19) cases, was one of the major issues tackled during Senate hearings on the alleged corruption in the agency.

It was revealed during the hearings that a large portion of IRM funds have been disbursed to dialysis centers and maternity clinics. It was also found out that disbursements in certain regions or hospitals were immediately released, while other regions or hospitals are still waiting for their respective releases.

Zubiri stressed that PhilHealth should come out with concrete plans on which health facilities should be prioritized, and the proper amount to be given.

“There should be a better formula. Just like in local government units (LGUs), you can’t release the fund without the plans,” he said. “Kulang na kulang na nga, inamin ng pangulo wala siya pondo. Kaya ang pondong naiiwan sa (The funds are already inadequate, as President Rodrigo Duterte has admitted that he has no more funds. That’s why the remaining funds of) IRM should be accurately and correctly accounted for and should be equitably distributed.”

Favoritism is also one of the strong issues that Senate Majority Leader Franklin Drilon had against the IRM.

“The dialysis centers are beneficiaries of the IRM that is supposed to benefit the pandemic. There is no way they are involved in activities related to Covid-19. Yet, there are hospitals in Covid-19 areas not given the same assistance. These facts clearly established that there is something wrong with the implementation of the program,” Drilon said in a separate online interview. “Also, the liquidation is long overdue. These are indications of the questionable nature of this IRM as a mechanism for an emergency.”

Like Zubiri, Drilon said there must be standards that must be set so that favoritism and with it, suspicions of corruption, will not take place.

“There must be strict rules on liquidation. If PhilHealth is efficient in processing claims and paying them on time, you have no reason to launch an IRM or an advanced payment system,” Drilon said.

Senator Risa Hontiveros also said PhilHealth should suspend the IRM until the issues of favoritism, inequitable distribution and liquidation have been resolved.

“Andaming tanong na kailangan pang sagutin ng PhilHealth sa prosesong ito (PhliHealth still has a lot of questions to answer about this process). Until we are confident that a system can be put in place to ensure that PhilHealth funds are not being corrupted, the IRM has to be suspended,” Hontiveros said in a statement.

Senator Francis Pangilinan said he is in favor of “suspending all releases,” and revise and redistribute the approved allocations.

“The current allocation system is a complete disaster and is a huge stumbling block for our hospitals to be able to effectively address the killer pandemic,” he said in a separate statement.

On the other hand, Senator Sonny Angara said the IRM should not be suspended for the time being.

“We don’t have to suspend it yet, but it’s worth examining if the releases have been responsive to the needs of the times, aside from other common ailments of our kababayans (countrymen),” he said.

Angara said funding for testing should be prioritized, especially since many of the lower-income sectors have expressed frustration at being unable to get tested for Covid-19.

“They need it badly given the conditions in many of our urban communities where people live in cramped quarters. Dapat ipa-ikot -ng pera (Funds should be distributed) around the whole country to make testing available and accessible,” Angara said.

Senator Joel Villanueva agreed with Angara, saying that all IRM releases should only cater to the fund requirement which is to provide cash advances for medical facilities handling Covid-19 cases especially during this health crisis.

He said other facilities handling non-coronavirus cases should continue to follow its regular processing of claims.

“PhilHealth has all the power and authority to make it easier for hospitals and other medical facilities to expedite their regular process for claims. Private hospitals are already overburdened with the nonpayment of their claims, and if they are forced to close, our healthcare system might collapse,” Villanueva said.

Meanwhile, Senate President Pro-Tempore Ralph Recto suggested that IRM releases should be posted in the PhilHealth website to make it “transparent and open to scrutiny.”

Recto said the releases should enumerate the basic data, which include the amount, date of release, recipient institutions and their facility capacity, liquidated amount, and the number of member beneficiaries.

He cited for example the Department of Budget and Management (DBM) website where tens of thousands of pages of budget documents going back more than a decade are banked.

“Bring these data out in the open because sunlight is the best disinfectant, and the antidote to the ingrained palakasan (patronage system) in the release of the IRM,” Recto said. (PNA)

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