HEALTH experts called on the government on Thursday to invest more in kidney transplantation to help address the issue on the alleged misspending of public funds for dialysis treatments of indigent patients.
This was their common response to the alleged processing of dead patients’ claims to the Philippine Health Insurance Corp. (PhilHealth) by WellMed Dialysis and Laboratory Center.
Based on reports, two former employees accused the health provider for its illegal collection of deceased patients’ benefits. They asserted that its owners and officers allegedly participated in the illegal scheme.
Earlier, PhilHealth confirmed that it had monitored fraudulent acts of such health-care provider. As per its findings, 28 medical cases that have been filed involved deceased patients, while 12 others are under investigation. Given this, it recently filed 28 administrative cases against WellMed.
Meanwhile, the Department of Justice has recommended the filing of charges of the complex crime of estate via falsification of official documents against WellMed owner Bryan Sy and two others regarding the alleged moneymaking scheme from nonexistent kidney treatments.
“It was a clear violation of existing rules. You cannot be charging for dialysis of a dead patient. So this is blatantly a fraud,” Dr. Susan P. Mercado told the BusinessMirror after the media launch of the documentary film contest by Renal Gift Allowing Life for Others (Regalo) held at the National Kidney and Transplant Institute (NKTI) in Quezon City.
While the issue is alarming, she said, it also opens up the questions on why there are so many people on dialysis and what should be done to address it.
This also raises concerns on the gap of public spending on kidney- failure treatments, added former Health Secretary Dr. Enrique Ona.
Out of the P110 billion that PhilHealth pays for renal-care coverage of its members, he added, about P11 billion goes to dialysis.
Mercado even noted that it sponsors up to 90 sessions of dialysis with such amount, but only pays about P115 million on kidney transplantation.
“So we really have to do something about the cost of care,” said Ona, who is the president and chairman of Maria Corazon Torres Y. Javier Foundation and Kidney Foundation of the Philippines.
“Instead of paying for so much dialysis, shouldn’t PhilHealth be sponsoring more transplants because the patients become productive, they live longer, and they don’t suffer,” Mercado said. “This is a policy issue that needs to be addressed. Why are we spending so much on dialysis and not on transplantation?”
Based on 2016 data, there are about 37,000 prevalent patients on dialysis in the Philippines. Every year, about 20,000 new patients start undergoing dialysis. The two leading causes of kidney failure are diabetes and high blood pressure, respectively.
“The DOH has just concluded a study looking at the cost benefit of dialysis and transplantation. It found out that the highest quality of life and best cost benefit was achieved from kidney transplantation,” said Dr. Romina A. Dañguilan, organizing committee lead for Regalo Organ Donation Advocacy.
To do three times a week of hemodialysis, it costs around P400,000 a year, whereas in kidney transplant, the huge payout is only to the operation itself, but after two years, the expenses go down since it just only needs medication, if needed.
“It’s really sad that the alleged misuse of
PhilHealth funds happened. Again, there’s always abuse of the system. We really
need to be very vigilant to be sure that this does not happen again. So for the
doctors, they have to be more active, maybe in the centers where they practice
to be sure that this abuse does not occur,” Dañguilan stressed.