Press Release
November 8, 2021

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

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 totalled 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 on PhilHealth's actuarial estimates and assumptions and sought an improvement in its actuarial valuation process.

"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.

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[FILIPINO TRANSLATION]

Poe, hinimok ang COA na ilabas ang report sa PhilHealth

Hinimok ni Sen. Grace Poe ang Commission on Audit (COA) na isapubliko ang 2020 Audit Report ng Philippine Health Insurance Corp. (PhilHealth) upang mabigyan ang mga mambabatas ng malinaw na impormasyon sa estadong pampinansyal ng ahensya habang tinatalakay ang 2022 national budget.

"Kailangan naming malaman kung magkano talaga ang utang ng PhilHealth sa mga ospital at healthcare workers. Dapat itong mabayaran agad at matukoy ng gobyerno kung saan kukunin ang pondo," pahayag ni Poe.

Binigyang diin ng senadora na ang COA report ay magbibigay ng credible audit sa financial condition ng PhilHealth at malalaman kung epektibong nagagamit ang pondo para sa pangangailangan ng publiko sa kalusugan.

"Nanganganib ang operasyon ng mga ospital. Nasa pandemya pa rin tayo at marami ang namamatay. Hindi dapat itago ng PhilHealth ang mga numero," diin ni Poe.

Batay sa 2019 Annual Audit Report ng COA sa PhilHealth, umabot sa P75.57 bilyon ang mga benefit claim na halos doble ng P39.79 bilyon na naiulat sa pagtatapos ng 2018.

Ayon sa Private Hospitals Association of the Philippines Inc. (PHAPi), hinihintay pa rin nila ang aksyon ng PhilHealth sa mga COVID-19 claim mula 2020 sa gitna ng plano ng ilang pagamutan na hindi na ire-renew ang kanilang akreditasyon.

"Lalong mahihirapan ang mga miyembro ng PhilHealth na makuha ng buo ang kanilang benepisyo dahil kinakailangan na nilang bayaran mula sa sariling bulsa ang gastusin sa kanilang pagpapagamot at umasang mare-reimburse sila," paliwanag ni Poe.

"Hindi maaaring gumamit ang PhilHealth ng delaying at scare tactics para panghinaan ng loob ang mga ospital na singilin ang utang sa kanila," diin ni Poe matapos ihayag ng PHAPi na ilang pagamutan ang pinadalhan pa ng summons ng National Bureau of Investigation.

Nakatanggap ang PhilHealth ng 35,147 COVID-19 claims sa mga ospital noong 2020 ngunit 10,265 lamang ang nabayaran na nagkakahalaga ng P2.5 bilyon.

Sa 2,859 claims para sa mga critical na COVID-19 cases, 642 lamang ang nabayaran ng PhilHealth o P505.6 milyon. Tumanggi itong bayaran ang 309 cases na umaabot sa P243 milyon. Ibinalik naman ng PhilHealth ang 1,179 claims para sa critical cases sa mga pagamutan na umaabot sa P927.15 milyon at ang 729 claims naman ay pinoproseso pa hanggang noong July 31, 2021.

Para sa critical COVID-19 cases, dapat P786,384 ng hospitalization ng miyembro ang binayaran ng PhilHealth.

Sa 2019 COA report, pinuna ang mga actuarial estimate at assumption ng PhilHealth at kanilang inirekomenda ang pagpapatibay sa actuarial valuation process.

"Kailangan naming mabusisi sa Senado ang estadong pampinansyal ng PhilHealth para magamit itong batayan sa pagtalakay ng 2022 government budget," dagdag ni Poe.

"Bago pa ang COVID-19, pinuna na ng COA ang actuarial valuation process ng PhilHealth. Sa gitna ng pandemya, nakita na dapat nang magkaroon ng actuarial study ang PhilHealth sa kanilang pondo at bumalangkas ng mga rekomendasyon para maging viable at sustainable ang pondo," giit pa ni Poe.

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