Poe urges COA to release a report on PhilHealth’s state of finances

Poe urges COA to release a report on PhilHealth’s state of finances

By Ernie

MANILA — Sen. Grace Poe urged the Commission on Audit (COA) to
release the 2020 Audit Report on the Philippine Health Insurance Corp.
(PhilHealth) to give legislators a clear picture of the state of its
finances while discussion on the 2022 national budget is ongoing.

“We need to know exactly how much PhilHealth owes hospitals and
healthcare workers. They must be paid soon and government must figure
out where to get the funds,” Poe said.

The senator pointed out that the COA report will render a credible
audit of PhilHealth’s financial condition and see to it that funds are
effectively used for the people’s health services needs.

“The operations of hospitals are at risk. We are still in a pandemic
and people are still dying. PhilHealth must not hide or sugarcoat its
numbers,” Poe added.

In COA’s 2019 Annual Audit Report on PhilHealth, benefit claims have
totaled P75.57 billion, close to double the P39.79 billion benefit
claims reported at the end of 2018.

The Private Hospitals Association of the Philippines Inc. (PHAPi) said
they are still awaiting PhilHealth’s action to pay the COVID-19 claims
from 2020 even as some hospitals said they are contemplating not
renewing their accreditation.

“This will make it difficult for PhilHealth members to reap the full
benefits of their membership as they will have to pay for their
medical expenses from their own pockets and hope that the state health
insurer will reimburse them,” Poe said.

“PhilHealth cannot resort to delaying and scare tactics to discourage
hospitals from pursuing what’s due them,” Poe added after PHAPi
reported that some hospitals have received summonses from the National
Bureau of Investigation concerning their claims.

PhilHealth received 35,147 COVID-19 claims from hospitals in 2020 but
only 10,265 of the claims were paid, amounting to P2.5 billion.

Of the 2,859 claims for critical COVID-19 cases, PhilHealth only paid
642 claims or P505.6 million. It refused to pay for 309 cases
amounting to P243 million. PhilHealth returned 1,179 claims of
hospitals for critical cases costing P927.15 million and 729 claims
for critical cases were still under process as of July 31, 2021.

For critical COVID-19 cases, PhilHealth ought to have shouldered
P786,384 of a member’s hospitalization.

The 2019 COA report had concerns about PhilHealth’s actuarial estimates
and assumptions and sought an improvement in its actuarial valuation

“We at the Senate need to examine PhilHealth’s finances and take that
into consideration in the discussions for the 2022 government budget,”
Poe said.

“Before COVID-19, COA already had concerns on PhilHealth’s actuarial
valuation process. COVID-19 would have made it more urgent for
PhilHealth to get an actuarial study of the fund to come up with a set
of recommendations that would make the fund viable and sustainable,”
Poe added. (ai/tvn)

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