PhilHealth to hospitals: Give patients the benefits they deserve

PhilHealth. Photo courtesy of doh.gov.ph

MANILA — The Philippine Health Insurance Corp. (PhilHealth) on Monday warned hospitals to give the benefits that every patient deserves or face government sanctions.

In a press briefing in Malacanang, PhilHealth president and CEO Alex Padilla said they have received information that Private Hospitals Association of the Philippines Inc. (PHAP) president Dr. Rustico Jimenez came out with a threat that some hospitals would not clear PhilHealth members due to delayed reimbursements from the insurance corporation.

Padilla warned hospitals not to carry out such action because it is against the law and violators will face fines or sanctions.

“This is against the law. This is against their commitment to PhilHealth. All PhilHealth members must be given the full benefits that they are entitled to. No more, no less, basta full benefits ho ‘yon, hindi ho puwedeng paglaruan ‘yan ng mga ospital,” he said.

Once a hospital is proven to have violated the law, Padilla said PhilHealth will suspend or revoke its accreditation.

Violators may not get any reimbursement from PhilHealth and can be blacklisted for not following the insurance corporation’s guidelines, Padilla said.

PhilHealth could also call for a boycott by encouraging the public not to patronize certain hospitals, he said.

“Mayroon tayong ganoon in place but we wish to avoid such situation. Kaya sana lang ibigay sa ating mga miyembro ang lahat ng mga benepisyo nila,” he said.

The PHAP has complained that some member hospitals are not receiving their reimbursements from PhilHealth on time.

Padilla has denied this but attributed some delays in reimbursement to PhilHealth’s shift from the fee-for-service system to the case rates system, which was introduced last January 1.

Under the fee-for-service system, PhilHealth paid for every input, with different rates and prices for different hospitals.

In the case rates system, however, PhilHealth makes lump sum payments for the treatment of certain diseases, regardless of the type of hospital or whether it is public or private, Padilla said.

PhilHealth coverage is part of the government’s universal healthcare program, or Kalusugan Pangkalahatan.

In the President’s fourth State of the Nation Address last year, he reported that PhilHealth has so far been able to cover 81 percent of the country’s population.