Principle behind IRM is good

During the Committee Hearing on August 17, Marikina Rep. Quimbo was surprised to know that hospitals are allowed to use funds from the Interim Reimbursement Mechanism (IRM) for other operational expenses (e.g. salary). Let me reiterate that the same mechanism is expected when “prospective payments” (in the form of global budgets) will be provided to hospitals in 2021/2022. This is legal under the Universal Health Care (UHC) law. Is she saying that we will not be able to frontload funds to hospitals when we roll UHC in the coming years?

Congressmen insist that PhilHealth should not release cash advances (e.g. IRM) because the Corporation should only reimburse after healthcare provision. The way I see it, PhilHealth did a proactive measure to help finance healthcare at a systemic level during a “fortuitous” event (i.e. pandemic). We are not saying that we will allow hospitals or PhilHealth to commit fraud. We’re saying that the principle behind IRM is good.

Rep. Quimbo also said that only 3.3B pesos are expected to be incurred given the number of cases expected to be admitted to hospitals. What they do not understand, I guess, is that operating expenses for all levels of healthcare providers increased due to the pandemic (i.e. PPE use, disinfectants, etc.). According to PhilHealth, these additional expenses were included in the assumptions of the IRM. More importantly, even health services for NON-COVID cases were included.

Clearly, our honorable congressmen do not understand the law they’ve written years ago. Now, these same congressmen are saying that PhilHealth should NOT fund hospitals through IRM. That would be tantamount to government neglect (of patients suffering from non-COVID-related conditions).


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