THE chairman of the House committee on health yesterday said Dante Gierran might not be the right man for the job of president of the Philippine Health Insurance Corp (PhilHealth) as he seems clueless on the many problems besetting the state health insurer.
“If you’re going to ask me, straightforward, I think hindi,” Quezon Rep. Angelina Tan said in an interview with ANC.
PhilHealth spokeswoman Shirley Domingo, sought for a reaction, said, “We can’t comment on something that we can’t confirm.”
Gierran is a CPA-lawyer who served as NBI director from 2016 until last year. He was appointed to PhilHealth by President Duterte a year ago to replace Ricardo Morales who stepped down for medical reasons amid allegations of graft and corruption against the agency.
Tan, a medical doctor, said Gierran apparently does not even know about the retroactive clause under PhilHealth Circular No. 2021-008, which she said provides that the coverage of COVID-19 in-patient packages are only for confirmed cases.
Tan was referring to the health panel’s hearing last week during which lawmakers prodded Gierran to raise the issue before the PhilHealth board since the retroactive clause, which was released only last June, covers hospital admissions from Nov. 26, 2020.
Under it, probable COVID cases can only avail themselves of an intermediate package, a policy perceived to be unfair for hospitals that granted PhilHealth coverage to suspected COVID-19 patients from November 2020 to June 2021.
The circular stopped COVID-19 probable cases from availing themselves of the in-patient package because it is allegedly being abused by some who have not acquired the virus.
Gierran initially urged affected healthcare institutions to just seek arbitration to contest their denied claims, frustrating lawmakers led by Tan, who want the circular amended.
Tan said she was disappointed because it appeared to her that Gierran did not know what was happening “when we asked on the issue on inconsistencies of the circular on the benefit package on COVID.”
“It seems na parang medyo hindi niya alam (he does not know) what’s happening and they cannot defend the circular, and the events of the issuance of the circular,” she said.
Tan said Health Undersecretary Leopoldo Vega would seem fit for the job, “having that experience for a very long time” on the operations of hospitals.
“Alam din niya ang usapin (he knows what it’s like) on the ground and I think being a doctor, alam din niya (he also knows) supposed to be how to reconcile disagreements between the medical auditors and the clinicians, him being a clinician himself,” she said.
Tan said the Universal Health Care Act clearly provides for the primary qualifications for a PhilHealth chief: that he or she should be knowledgeable on health insurance, health economy, and public health.
CLAIMS SUSPENSION
During the resumption of the panel’s hearing yesterday, officials of PhilHealth and the Department of Health briefed lawmakers on the implementation of Republic Act No. 11223, otherwise known as the Universal Health Care (UHC) Act” and another controversial PhilHealth circular on the temporary suspension of payment of claims (TSPC) to hospitals that are under suspicion of fraud.
In a joint statement last week, the Private Hospitals Association of the Philippines, the Philippine Medical Association, and the Philippine Hospital Association said the bridge between healthcare providers and PhilHealth now has “serious cracks” and is “bound to collapse.”
The Tan panel carried a motion urging PhilHealth “to review and possibly suspend the circular without prejudice to any legislative remedy or measure that may be filed in the future.”
The DOH clarified that while PhilHealth Circular No. 2021-0013 is new, the policy has been in place since 2016.
PhilHealth acting senior manager Dr. Lambert David said the temporary suspension of payment of claims was merely updated and the recent circular was “issued in the spirit of proper fund management and fraud control.”
Gierran, for his part, assured all healthcare providers that the policy will be enforced with respect to due process and rules and regulations.
In a statement, PHA president Dr. Jaime Almora said the circular will not only affect healthcare providers but patients as well, adding that healthcare providers are questioning its timing, which comes amid the health crisis brought about by the COVID-19 pandemic.
He read a public statement of healthcare providers urging a review of their engagement with the PhilHealth and continue negotiations.
As a compromise and to improve their relations with PhilHealth, the healthcare provider groups called on PhilHealth to avoid “biased and unfair” evaluation of reimbursement claims by using qualified and knowledgeable claim evaluators.
They also asked PhilHealth to refrain from oppressive or abusive use of quasi-judicial power; to exercise restraint on unfounded accusation of fraud and unethical practice; to remove policies that create too much financial risk for hospitals; to install a representative of healthcare providers in the governing board of PhilHealth; to increase case rates; and to immediately pay COVID-19 reimbursement claims.
Health Secretary Francisco Duque III said in the same hearing that only 87 percent of the country’s population are registered with PhilHealth now even if the Universal Health Care Act requires the entire population to be covered.
The 87 percent only covers individuals registered with PhilHealth and not the ones who memberships are subsidized by the government, the DOH told the panel.
PhilHealth acting vice president Lemuel Untalan said around 22 million members are subsidized, which translates to some 50 million people, which includes the members’ dependents.
ALLOWANCES
Duque said the Department of Budget and Management (DBM) has found a funding source for the special risk allowances (SRAs) of more than 20,000 healthcare workers who have been protesting against the unpaid allowances and other benefits under the Bayanihan 2 law.
Duque said Budget officer-in-charge Undersecretary Tina Rose Marie Canda has assured him that as of now, a total of P311 million can be sourced from the Miscellaneous Personnel Benefit Fund (MPBF) to pay the frontliners, who are entitled to P25,000 each, starting today.
It was not clear yet why the SRA will be now be sourced from the MPBF, the fund used to pay retirement benefits of state workers, because the DOH earlier said it was tapping its savings to come up with about P311 million.
President Duterte on Saturday gave the DOH and the Department of Budget and Management 10 days to pay the health workers with “whatever money there is” following complaints from the medical frontliners about unpaid allowances and other benefits due them under the Bayanihan 2 Act.
The law, which lapsed last June, mandates the provision of special risk allowance (SRA), life insurance, free meals and transportation, among others, to public and private healthcare workers.
Duque said the Department of Health is working with the DBM, Center for Health Development, local authorities, and hospitals to expedite the release of the SRAs.
