Poor likely to fall behind in hiked PhilHealth premium

Jan. 24, 2014

Davao Today

DAVAO CITY – Low-income earners and health activists expressed anxiety over the increased premiums imposed by the Philippine Health Insurance Corp (PhilHealth) and how it would further heighten debate as to its capability to widen its coverage into the poorer sectors.

Starting January this year, the medical insurance company would collect a monthly premium of P200, up from P150, for self-employed or low-income members and overseas workers, and charge corresponding higher rates at 100% for employed members.

PhilHealth Social Insurance Officer Johanna Blason explained that Philhealth members should pay at least a period of a quarter of the year, or three months, to have their accounts active, lest the account would be suspended.

The increase came at an unlikely timie when the Social Security System also increased its collection, which generated a string of protests and petitions at the Supreme Court to stop the increased collection, citing hard times for the poor.

Such problems were raised during an orientation by Philhealth regional staff with barangay officials.

Alice Solante, barangay kagawad from Barangay 44, cited an old complaint when the rates were still not increased, that a pregnant woman was denied access to Philhealth benefits even if she had paid the minimum of one quarter to avail of her benefits.

Another kagawad who requested anonymity said he stopped paying his Philhealth premium due to hard times and to finance his schooling. He asked PhilHealth if it would still honor delinquent accounts such as his.

New scheme

Presidential Communications Secretary Sonny Coloma said such increase aims to provide the poor access to public health services, including some four million families considered “sponsored members” that will receive access to 85 public hospitals nationwide.

Germaine Tan, head of PhilHealth’s Informal Economy Management Section, explained that the increase was necessary due to increased PhilHealth payments to accredited hospitals and other medical facilities.

The Davao regional office, for instance, spent beyond the level of its collection in the past four years. Last year, they churned up P3.4 billion in medical expenses to members while collecting only P1.4 billion.

PhilHealth in the region covers 3.9 million members and dependents, with around 60% of paying members coming from the employed sector.

Nationwide, PhilHealth has covered 80% of the population.

Tan said PhilHealth assessment indicated that it had only covered 8% of total health expenditures in 2013 or around P 20 billion.

This year PhilHealth will implement a new scheme of case-based payments based on the admission of patients in hospitals, eliminating the fee-for-service which the agency said has been wasting resources.  The coverage is posted in its website and in pamphlets distributed during orientation

PhilHealth will also cover the Point-of-Care program of Davao Region’s government-ran Southern Philippines Medical Center (SPMC) that will provide free hospitalization and medicines to indigent patients.

SPMC Finance Head Barbara Cezar told Davao Today that the Point-of-Care program has served around 3,000 patients since its implementation late November 2013.  Cezar also said that half of the average 180 patients admitted in a day are covered by PhilHealth.

b>Hardships of low-income workers

But other sectors doubted if they can fully avail of the health care, citing hard times to pay regular contributions.

Alma Magallanes, an urban poor resident in Agdao, told Davao Today that her husband’s PhilHealth coverage did not cover her mother’s hospitalization at SPMC because the agency only covers direct family members.

“My husband is a Philhealth member since he paid regularly from his salaries working at a hardware store. But since my mother was not directly related to him, she was not covered as a dependent. We had to find money to pay for her hospitalization,” Magallanes said.

Magallanes said she did not apply for PhilHealth as she had been unemployed. She only once availed of sponsored PhilHealth cards during the term of President Gloria Arroyo which later was not funded after her term and could not be used anymore to claim free medical attention.

Benjie Badal, deputy secretary of the urban poor group Kadamay, said informal settlers in Davao City are constantly hard-pressed for money, saying that, for instance, a store clerk in retail stores receive below minimum wages at around P100 to P200.  The minimum daily wage is set at P301

With meager wages and widespread practice of contractual work that pays generally below the mandated wage, paying health insurance thus, takes a backseat as many would strive to meet daily food requirement of the household.

Private hospitals benefiting more

The independent health organization Council for Health and Development also doubted if PhilHealth had really benefited the poor.

“PhilHealth covers a mere 30% of a patient’s hospital bill, members churn out more from their pockets,” said Grace Cuasay, CHD director for health education training and services .

Even as the government is pushing for accessibility of universal health care, Cuasay said high medical costs defeat such purpose.

“Accessibility to health are two things, its availability and affordability. Definitely, there is a lack of public hospitals in the country. There are those that do not even function or have broken equipment and structures. Even prices of government specialized hospitals like Philippine Heart Center and National Kidney Institute have comparable rates to private and posh hospitals here in Metro Manila.

Cuasay also said there’s an issue of double taxation on the people in this case.

“People are paying taxes, including the value-added tax, yet the money doesn’t go to public services such as health, and so why are we still paying P200 monthly for our health care?”

The group Kilos Bayan Para sa Kalusugan (KBK or People Act for Health) said that PhilHealth is more maximized for private hospitals rather than government-run health facilities where majority of the poor people go.

Citing PhilHealth’s financial statement on September 2013, the company reported a benefit payment of P10.871 billion to the private sector and P5.564 to the government sector.

KBK spokesperson Alberto Pascual said such data shows “PhilHealth is useless, and the government should just channel these funds to public hospitals and other state-run health facilities in the country.”

Pascual also berated PhilHealth for hiking its rates after granting P1.65 billion worth of bonuses to its board members, executives and contractors in 2012.  The Commission on Audit demanded the bonuses to be returned, but the agency filed an appeal.

“PhilHealth’s argument that their bonuses are legal is unacceptable in the eyes of a hungry family or a sick person who cannot afford to betreated in a hospital because he does not have the money to do so,” Pascual lamented. (Tyrone A. Velez, davaotoday.com)

, ,
comments powered by Disqus