A lawmaker at the House of Representatives on Monday said the PHP26.8-billion allocation for Philippine Health Insurance Corp.’s (PhilHealth) Interim Reimbursement Mechanism (IRM) fund has far exceeded the estimated cost of coronavirus disease 2019 (COVID-19) hospitalizations.

During the joint House hearing into the alleged corruption in the state-run insurance firm, Marikina Rep. Stella Luz Quimbo said the total estimated cost for COVID-19 this year only amounts to PHP3.3 billion based on her computations.

She explained that while PhilHealth has estimated 209,000 COVID-19 cases this 2020, only 20 percent of this number would require hospitalization.

“[Of these estimated cases] about 20 percent of COVID cases develop difficulty in breathing and require hospital care according to WHO [World Health Organization],” she said.

Quimbo noted that 90.3 percent of COVID-19 patients in the country are mild cases, 0.9 percent are severe cases, and 0.6 percent are critical cases.

Basing her computations on PhilHealth’s case rate for COVID-19, Quimbo noted that the estimated cost would only reach PHP3.3 billion with an estimated total of 41,800 hospital admissions.

“From a PHP26.8 billion IRM total fund, the estimated losses due to fraud is PHP2 billion,” she said, citing the study conducted by PhilHealth showing fraud index in the country was at 7.5 percent.

Quimbo highlighted that there would also be around PHP541 million of foregone revenues per year due to excess IRM.

“In total, [we have] PHP2.5 billion lost due to wrong policy on IRM and design,” Quimbo said.

On Thursday, PhilHealth announced the suspension of IRM to pave way for a review after the release of payments to hospitals for COVID-19 services had been marred by supposed irregularities.

PhilHealth pledged to look for ways to make IRM “more responsive to the needs of healthcare facilities affected by the current pandemic to assure patients of continuous access to needed health services.”

The state insurer, nevertheless, ensured that its members can still avail of COVID-19 packages and other benefits. (PNA)


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