Defensor urges gov’t to abolish PhilHealth’s case rate system

Anakalusugan Partylist Rep. and House committee on public accounts chair Mike Defensor urged the Duterte administration to abolish the case rate system in the Philippine Health Insurance Corporation (PhilHealth) which allegedly started the culture of corruption in the state insurer.

At the House of Representatives’ hearing, Defensor bared that PhilHealth has accumulated almost ₱154 billion losses since 2013 due to its case rate system, mostly due to overpayment to private hospitals. The case rate system started in 2011, with a separate circular released in 2013, allowing the agency to implement a uniform rate for the provision of health care to certain diseases, whether admitted to public or private hospitals.

“Kapag ikaw nagkasakit, gumastos ka ng ₱5,000, ipagpalagay natin na pneumonia, ang ginastos mo ay ₱5,000 lamang. Pero dahil ang case rate ay ₱15,000, babayaran pa rin ang hospital ng ₱15,000,” Defensor explained. Meanwhile, Marikina Rep. Stella Quimbo said the problem lies not in the program, but the way it was implemented.

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