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ROUGH CUTS |     Bludgeoning government to submission




HERE they are again. We mean this time, the associations of owners and managements of some private hospitals in the Philippines.

     Seemingly, the recent move of health workers who are in the forefront of the fight against the deadly virus that has resulted in a pandemic has, somehow rubbed in on the people who are on top of hospital and related establishments’ operations.  While the medical and other health workers focus the intention of their threat to go on mass leave or just simply quit working, to get their additional incentives, the hospital owners and managements have centered their intention to force the PhilHealth to pay what they claim as payables to them from the government health insurance agency in the amount over P80 billion. Of course PhilHealth did not deny that it has some payables to the hospitals. But it said the agency has already paid a substantial portion of the amount claimed. The same agency says that it is not the lack of money that has delayed payment of the amount due to the hospitals but it is the need to validate their claims.

     Perhaps the hospital owners group and the association of its managements may have taken clue from the apparent positive result of the health workers’ threat of mass action so the former groups join the fray and this time train their eyes specifically on PhilHealth. 

     But how reasonable is their threat? According to the hospital owners and management associations they will cut ties with PhilHealth and stop giving their services to patients who have only PhilHealth’s membership as guarantee for payment of their hospital bills. Easily, this warning can be taken to mean that the hospital owners and management are willing to see the poor patients deprived of health services and other medical care if they cannot produce the money to pay whatever charges made by the hospitals. In effect, it is something like, “To hell with you poor people. You can die, for all we care, if you do not have money.”

     Of course we can understand the groups’ actuation. The hospitals have to pay their employees. They have to spend on medicines and other supplies needed in treating patients. They have monthly bills from utility companies; they have to pay taxes and other maintenance expenses. They have to contend with threats from their creditors of the possibility of denying them their needed supplies. So, if indeed it is true that all their payables have also accumulated because of non-payment by PhilHealth of whatever amount due them, it is only right that they have to be brash in their demand for immediate payment.

     On the other hand, PhilHealth also has to be extra cautious in disbursing the money which comes from the contributions of its members other than what is given as subsidy by the government.  Therefore, it is also incumbent on its part to validate the veracity of each claim submitted by the hospitals to the agency for reimbursement. After all, hospitals are no ex-cathedra if the issue is the honesty of its claim.

     We are no stranger to some connivance between some corrupt PhilHealth employees and scheming and greedy officials of certain hospitals. We were hospitalized as well as some of our loved ones and close friends several times in our lifetime.  And we know how they craft a rather fool-proof methodology in “scamming” the agency to pay large amounts of money to services either not rendered or availed of for a much shorter period of time.

     One example was a close family friend who had his/her cyst protruding on a portion of the skin covering one of his/her feet removed. The process was really done inside the hospital facility but the infirmed was discharged less than an hour after the extraction of the cyst. When the relatives of the patient asked for the bill so this could be settled, he was told that the standard charge of the hospital for such a procedure is P3,500. And there will be proper documentation to be done so whatever is chargeable to PhilHealth will be properly supported with documentary evidence. The patient’s relative however, was told that he can have an option if the patient wants to be discharged immediately and go home. This can be done, according to the doctor, if the patient pays the amount of P500 and signs documents intended to support the hospital claim for reimbursement. And voila!  P500 versus P3,500? The patient quickly forked out a P500 bill and paid it. Thereafter the patient was off for his/her residence. How many days are required for a patient’s confinement bill to be reimbursed by the government’s health insurance agency? Three, four, five or more…? And how many times this thing happens and how many hospitals are doing this in the past and even until these days?

     And how many times did we hear cases of padded claims by certain hospitals submitted to PhilHealth? This kind of report may be far from comforting among hospital owners but there is no amount of denial that can disprove these allegations.

     Now can the hospital owners and those running the institutions and PhilHealth officials stand opposite each other and see eye-to-eye without their conscience bothered by even an iota of guilt from some untruths or half-truths on their charges and counter claims? If in all honesty they can withstand such a kind of test, then let them go ahead with whatever action they think is appropriate. The hospital owners pushed through with cutting ties with PhilHealth and PhilHealth further delaying payments to make sure it has a well-done validation. Let them carry on their shoulders the burden of whatever will be the consequences of their actions.



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