Garcia: ‘False COVID patients covered under PhilHealth packages’

Cebu Governor Gwendolyn Garcia | Contributed

CEBU CITY, Philippines — Is there a hocus-pocus going on in the tagging of COVID-19 ‘probable’ cases for the sake of PhilHealth package coverage?

Governor Gwendolyn Garcia raised the concern as she said that the Philippine Health Insurance Corp.’s (PhilHealth) expenses in paying for “false” COVID-19 claims might result to shortage in funds and might lead to stalling of the implementation of projects under the Universal Health Care (UHC) law.

Garcia said that she received reports of families agreeing to tag their family members as coronavirus disease 2019 (COVID-19) cases, even if they were not, in order to avail of the PhilHealth packages.

“There have been some questions that need to be asked because I believe naa may mga COVID packages gud. Ang Philhealth mo-cover man. Kaniadto nahadlok ta kay hala kung moadto mog hospital dako kaayo mog mabayran. Pero kung PhilHealth mo, wa moy mabayran uy,” Garcia said.

(There have been some questions that need to be asked because I believe there packages for COVID. The PhilHealth will cover these packages. Before patients are wary to go to the hospital because of the expected large hospital expenses they would have to pay, but if you have PhilHealth, you don’t have to pay anything.)

Read more: PhilHealth eyes ‘full coverage’ for COVID-19 poor patients

Garcia said one of the consultants in the Capitol, who was hospitalized because of fever and cough was tagged as COVID-19 probable.

When the consultant was discharged from the hospital after 10 days of confinement, Garcia said the person only paid P1,800 because his bill was offset by the P140,000-package of PhilHealth that a patient could avail of when he would be tagged as a probable case.

The consultant’s swab test result, which came out after days after his discharge, revealed that he was not infected with COVID-19.

Read: Philhealth Circular 2020-009 

PhilHealth Circular 2020-009 dated April 8, 2020 set the guidelines for the benefit packages for the inpatient care of probable and confirmed cases.

Under the circular, the package amounts for probable and confirmed cases vary according to severity of the cases.

For mild pneumonia in the elderly and for those with co-morbidities, the package amount is P43,997; P143,267 for moderate pneumonia; P335,519 for severe pneumonia; and P786,384 for critical pneumonia.

In the circular, the PhilHealth said: “Under the Universal Health Care Act (RA 11223), PhilHealth shall ensure equitable access to quality, affordable, and accessible health care services by all Filipinos. By providing coverage for inpatient care of probable and confirmed COVID-19 developing severe illness/outcomes, PhilHealth, through PhilHealth Board Resolution No. 2516 s, 2020, shall cover the comprehensive case management for COVID-19.”

“There are reports, mosulti nako, nga mosugot na lang ang pamilya nga maski dili COVID, i-[tag as] COVID na lang kay covered man, walay bayad,’ the governor said.

(There are reports that reached me saying that some families agree that the case be tagged as COVID, even if it is really not, just so the expense will be covered.)

“At the rate that PhilHealth will be paying all of these claims nga maski og dili tinuoray nga COVID, I wonder if ma-implement pa ba nato ang Universal Health Care Law nga mas kinahanglan sa mga tawo. Mas kinahanglan nato ang pundo ana. Dagko man kaayo ang Philhealth packages,” Garcia added.

(At the rate that PhilHealth will be paying all of these claims that are not true COVID cases, I wonder if we can still implement the Universal Health Care Law to those people who need it the most. We need the funds more. The PhilHealth packages are quite huge.)

Cebu province has been identified as one of the pilot sites for the implementation of the UHC. Under the UHC implementation, the PhilHealth is expected to download funds to the province for the infrastructure improvements in the Capitol-run hospitals.

READ: DOH to launch Universal Health Care implementation in Cebu on January 9

The Cebu provincial government runs 12 district hospitals and 4 provincial hospitals.

In 2019, Garcia announced the plan to upgrade the capacity of the district hospitals, particularly those on Bantayan Island and Camotes Island, which means that additional manpower, equipment and structures will be needed.

For the province’s 2020 budget amounting to P12 billion, some P4.2 billion was expected to be sourced from extraordinary receipts tagged under “grants and donations” for the hospitals.

In earlier interviews, Governor Gwendolyn Garcia said PhilHealth would be downloading to the province initial funding for the implementation of UHC within the first quarter of the year.

As of July, Garcia said the amount earlier committed by PhilHealth has not been downloaded yet.

Garcia said she was hopeful that the UHC will be implemented soon as it is “more needed” by the Cebuanos./dbs