THE Philippine Health Insurance Corp. (PhilHealth) on Tuesday said it expects the number of its claims to hit the 2-million mark with the full implementation of the Universal Health Care Law (UHCL).
In a media forum, newly appointed PhilHealth President and CEO Ricardo C. Morales disclosed this is double the 1 million claims per month which they received prior to the UHCL.
In anticipation of this challenge, the retired general said they will be “plugging the holes” in their finances, as well as enforce a “top-to-bottom” reorganization.
“This year we will be rolling out the Universal Health Care Law. This is going to change our health-care environment for the future. Hopefully for the better. And if we do it right, people in the future will thank us, if not they will curse us,” Morales said.
Morales recently took over the helm of PhilHealth after the institution drew flak, over the alleged loss of P154 billion of its funds due to overpayment and fraudulent transactions.
PhilHealth said the report is now being validated by the Commission on Audit (COA) and it already coordinated with the National Bureau of Investigation (NBI) to file cases against the people behind it.
Based on its record, it said it has only incurred P3 billion in losses from fraudulent activities in the last five years.
New tech
To minimize if not completely eliminate such irregularity, Morales said they are considering fully automating their transactions using an online system for the filing of claims.
“We notice face-to-face transactions are really prone to corruption,” Morales said.
He said they are now also considering tapping the biometric feature of the National ID system of the Philippine Statistics Authority (PSA) to get real-time personal information about their clients.
The said information, he said, can be used to check if the procedure undertaken by their client is valid or not.
Additional personnel
Yet another challenge to PhilHealth, Morales said, is having enough personnel to service additional claimants.
A review on how to reorganize their existing plantilla to allow their handling of increasing clients is ongoing.
“The purpose [for the reorganization] is to become efficient and economical in the performance [of our personnel] in the function of the office,” Morales said.
Additional personnel for some overburdened departments may be considered.
He cited the case of their legal department, which only has 12 lawyers handling at least 15,000 administrative cases.
PhilHealth Senior Vice President Rodolfo del Rosario Jr. said these cases include misrepresentation, upcasing and multiple filing of claims.
Morales said they hope to come up with successfully filed cases, wherein the people behind an illegal act are prosecuted and jailed, to deter other wrongdoers.
Fund sustainability
Morales said ensuring the sustainability of existing funds is a challenge.
The current fund is expected to increase from P160 billion to P257 billion with the reforms introduced under the UHCL.
The agency will rely on their rate hike from the “sin” tax, their membership premiums, Philippine Amusement and Gaming Corp. (Pagcor) and the Philippine Charity Sweepstakes Office to generate enough revenue for the UHC program.
Morales, however, noted this may still not be enough, especially if the population will continue to rise.
“That is why [Finance] Sec. [Carlos] Dominguez is very emphatic we should plug all leaks and to make sure we are in the blue. In other words we should not lose money by running our operations efficiently and plugging all leaks [in our finances],” Morales said.