Congressional hearing: Corruption allegations against PhilHealth

Congressional Hearing 5 August 2020
 
1) I do not agree with Cong. Defensor when he said that investing in an IT system while still using the All Case Rate (ACR) system will “computerize” corruption in PhilHealth. Regardless of the provider payment system, an IT system will actually help the Corporation and health care providers in 1) filing of claims, 2) reimbursement, 3) collection of data on health outcomes, and 4) analysis of data to inform policy.
 
The ACR system replaced the Fee-for-Service payment mechanism to simplify reimbursement processes and to promote efficiency in the delivery of quality care. The issue is not the ACR but how it was implemented. I believe a good IT system would have given us real-time data on the costs associated with specific bundles of care, utilization, and outcomes of care by collecting them in a systematic, secured way.
 
There is no perfect provider payment mechanism. Other countries utilize a mix of different PPMs. FYI the Philippines is now transitioning to global budget payments based on diagnosis-related groups. This policy was created by the same congressmen who approved the UHC bill.
 
2) COA suggests that PHIC will pay whichever is lower: case rate or actual hospital bill. The policy decision for this will serve as a precedent for prospective global budget payments. Quite dangerous, I must say.
 
In GBP, hospitals are provided a fixed reimbursement amount for a specific period rather fixed rates for individual services or bundles of services. This type of PPM provides hospitals the flexibility to allocate limited resources. In essence, it will help control costs.
 
There is a tendency for hospitals to under provide services. Hence, performance incentives should be linked to global budget payments. If PhilHealth will only be allowed to pay for actual charges, then it is precluded from providing prospective payments (GBP) which are allowed by the UHC law.
 
Finally, the Interim Reimbursement Fund (IRM) is also a form of prospective payment that is now being questioned by lawmakers. I do not understand their “anger” for “advance payment” when they were the same people who approved “prospective payment” under UHC?

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