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What’s the problem?

by Dr. Ramon Ricardo A. Roque, CESOI, Diplomate

Philhealth – the government corporation mandated to administer the National Health Insurance Program of the Philippines – has serious management problems.

The reported P9-billion loss of the corporation is a clear indication of its management problems. As a government corporation, it is expected to earn (or at the very least break even) and continue to provide the health insurance benefits for its members.

The billions of pesos in unpaid claims from private hospitals is another clear indication of Philhealth’s management problems. The assertion of Philhealth officials that the reported operating losses are not related to its capacity to settle its obligations reinforces that the quality or performance of its management is its core problem.

Given the issue on unpaid claims from private hospitals, the pronouncement of Philhealth Interim President, Dr. Celestina Ma. Jude P. de la Serna, that the problem is simply a matter of reconciling the records of Philhealth and those of private hospitals does not reflect recognition of the corporation’s core problem but it does mirror the extent of the problem.

If the solution to the problem is indeed a simple reconciliation of records, why does the matter need to reach the extent that the members of the Private Hospitals Association of the Philippines (PHAP) are now threatening to file a case against Philhealth and its officials in the Office of the Ombudsman? If the solution is that simple, why are PHAP members considering the loss of their Philhealth accreditation as a better option for their survival even if it will mean lesser patients for them?

From the management point of view, the unreconciled records of Philhealth and private hospitals are mere symptoms of the problem. The failure of the management team in Philhealth to regard it as such is a sign that the corporation is in for even bigger problems in the future.

The assertion of the current Philhealth Interim President that the issue on unpaid claims from private hospitals is a responsibility of the corporation’s Regional Vice Presidents further reinforces the corporation’s management problems. Again, even if, for argument’s sake, such assertion is correct, the unsatisfactory performance of Philhealth’s Regional Vice Presidents is a mere symptom of the problem.

Such assertion in itself is another symptom of serious management problems in Philhealth.

The issue is simple – Philhealth cannot provide a solution unless it knows what the problem is.