AN economist-lawmaker said on Monday the Philippine Health Insurance Corp.’s (PhilHealth) P26.8-billion allocation for its Interim Reimbursement Mechanism (IRM) has far exceeded the estimated cost of Covid-19 hospitalizations.
Her estimates come as the Philippine Red Cross repeated its accusation that PhilHealth has failed to reimburse it in timely fashion for hundreds of millions in costs for doing Covid-19 RT-PCR tests for priority sectors, such as returning OFWs and locally stranded individuals.
At the continuation of the joint hearing of the House Committee on Public Accounts and Committee on Good Government, Marikina Rep. Stella Luz Quimbo said her computation showed the total estimated cost for Covid-19 this year is only P3.3 billion.
According to her, the PhilHealth has estimated 209,000 Covid-19 cases this 2020.
“[But of these estimated cases] about 20 percent of Covid cases develop difficulty breathing and require hospital care according to WHO [World Health Organization],” she said.
Also, citing the Department of Health, Quimbo said 90.3 percent of Covid-19 patients in the country are mild cases, 0.9 percent are severe cases, and 0.6 percent critical cases.
With this, Quimbo, quoting the PhilHealth case rate for Covid, said the cost for mild, severe and critical cases, which are estimated to represent 41,800 hospital admissions, will only reach P3.3 billion.
“From a P26.8-billion IRM total fund, the estimated loss due to fraud is P2 billion,” she said, citing the study conducted by PhilHealth showing the fraud index in the country was at 7.5 percent.
On top of that, Quimbo added there is also P541 billion missing in PhilHealth’s forgone opportunities due to excess IRM.
“In total, [we have] P2.5 billion—P2 billion from fraud and P541 million from forgone investment income for one year—lost due to wrong policy on IRM and design,” Quimbo added.