THE issue on ghost kidney treatments charged to and paid for by Philhealth raises serious concern about the fate of Republic Act No. 11223 or the Universal Health Care Law.
The said law is a historic policy as it is one that truly responds to the need of all Filipinos for access to health care regardless of their economic status. It is also a law that provides for how government programs should be – inclusive and equitable.
Like for any other laws, the real value of the Universal Health Care Law is measured not on what provisions are included in it but on how well its provisions are implemented.
The specific issue of ghost dialysis treatment points to some weaknesses of the operating system of Philhealth which, if not addressed, will certainly compromise the intended public service of the Universal Health Care Law.
While the whistleblowers claim that Philhealth did not act on the information they provided regarding the illegal reimbursements of a health facility in Quezon City, Philhealth asserts otherwise.
Even if Philhealth indeed filed cases against the concerned health facility and has, since early this year, stopped paying claims of said facility, it is clear that the agency’s system is still weak because it appears that without the whistleblowers’ information, the anomaly would not have been discovered.
While we understand that the current Philhealth management has been instituting reforms in its operations, including those that are directed towards internal cleansing in the agency, the occurrence of bogus claims from medical facilities and practitioners reflect the insufficiency of institutional mechanisms to prevent the same.
The appeal of Philhealth for the public to report any anomaly on Philhealth reimbursements is reasonable because we, the people, also have responsibility for good governance. However, given the current system of Philhealth only those who have access to information on the actual claims filed by doctors and medical facilities can respond to Philhealth’s appeal.
On the part of the members of Philhealth, there appears no mechanism for them to verify the accuracy and truthfulness of the claims made by doctors and medical facilities.
Given the current information and communications technologies, there are many ways for Philhealth to engage the public in safeguarding public funds against illegal claims. The agency should also design mechanisms that will encourage Philhealth members to ensure that claims in their behalf are accurate and truthful and prevent them from conniving with unscrupulous medical facilities and practitioners.
Recognizing and acknowledging the weaknesses in its operating system is the first step to Philhealth’s effectiveness in performing its role in the provision of a truly universal health care for all Filipinos.
