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Wednesday, April 18, 2007
Doctors hit delays in Philhealth claims
By Stella A. Estremera
DAVAO CITY –- Medical practitioners are raising a howl over the delays in the release of their claims from the Philippine Health Insurance Corporation (Philhealth) and urged the agency to resolve the problem soon.
"Sanay na kami na (we are already used to the) delayed release of claims between two to three months, okay na yun, pero sobra na ito meron din naman kaming bills na binabayaran (but this is already too much because we also have bills to pay)," Dr. Malou Monteverde speaking on behalf of the Davao Medical Society told Sun.Star Davao.
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Monteverde and three other doctors who requested not to be named said they have in fact already met with Philhealth officials in Southern Mindanao last March, but the promised release of the claims remains a promise.
Below minimum
Philhealth finance chief Filbert Sollesta admitted there was a delay in the release of the claims but insisted that this has already been settled.
He said, a total of P1.9 million was released on March 15, another P3.5 million was released on March 30, and just last April, P1.4 million.
"These claims are debited to their accounts so when we credit the accounts, most of them don't know it," Sollesta told Sun.Star Davao in a telephone interview Monday afternoon. "Maybe they just haven't checked."
The doctors, however, belittled the amount saying there are over 800 doctors in the region and an amount of P1.9 million simply means each doctor received some P2,000 for the 15-day period of March 1-15, at least P4,000 each for March 16-30, and at least P1,750 for April 10-15.
The minimum wage at around P230 a day averages a wage earner some P5,980 a month or P2,990 per 15 days.
Also, the doctors said, this amount is not even distributed equally and thus while some may have already received a big amount, others have not been paid for eight months already.
A much sought-after obstetrician-gynecologist got a claim for only one patient last month for P500-plus, not including the past eight months that remains to be unpaid.
"They have been paying us around 10 percent of what we should be getting," Dr. Monteverde said.
Hardest hit, the doctors said, are the ones who deliver "Philhealth packages" like ophthalmologists and obstetrician-gynecologists.
This is because, they explained, these doctors deliver the needed services without charging a single cent from the patients for as long as the patient has a Philhealth card. These doctors' earnings come from Philhealth.
It's like working for eight months without getting a salary, they said. The bulk of patients of ophthalmologists are those seeking cataract removal -- mostly old people. Ob-Gyne doctors are those who attend to pregnant women.
No incentive
They are still hesitant about complaining though because people might think they are only for the money. But, they added, going for eight months without their regular source of income is just too much.
"To think, these are the doctors who have opted to stay in the country and deliver health services samantalang ang dami-dami nang umaalis (when there are already many who left). Pinapahirapan pa nila (yet they let us suffer)," Dr. Monteverde said.
Sollesta explained that they have in fact hired some 40 additional personnel to cope with the backlog and there should no longer be any reason for complain since they have already ironed out the kinks.
The doctors insist there is still a lot of reason to urge for immediate action. In their meeting with Philhealth in March, they said, Philhealth explained that the delay is because the company is setting up a new system wherein all regional offices will already be online and doctors will be receiving their claims through ATMs and the Taiwan earthquake in December 2006 affected their online transactions.
The doctors said they were promised that the claims will be paid by March 15. That didn't happen. Again they were promised that the backlog will be settled by March 30. Again it did not happen.
They said the amount released is not even a trickle since doctors in the region only earned the stated amount for the periods where the claims were released, there is still the September 2006 to February 2007 period.
"Even if they already did the processing, backlog pa rin sila," Dr. Monteverde said.
To this, Sollesta said, "Actually wala kaming hino-hold (we're not holding anything). Nagkaroon lang ng delay sa aming (there was just a delay in our) system. We are trying as much as possible to get the support from the Central Office and nagbigay naman kaya nga nag-hire na kami ng mga tao (we were given support that made us hire additional staff)," Sollesta said.
Hospitals too
The doctors insist that the delay is threatening the whole health care system considering that even hospitals have not received their claims for months already, the delayed claims running up to tens of millions of pesos -- badly needed funds to run a hospital.
"It's not just the doctors who are affected, even the hospitals, and when the operation cost of the hospital is threatened, it has a trickle down effect," Dr. Monteverde said. Among those also affected then are hospital staff, and even hospital supplies and medicines.
"Syempre mga suppliers namin hindi na rin magde-deliver kasi wala kaming pambayad (of course, our suppliers are not also delivering because we have no money to pay them)," another doctor said.
First to go are disposable gloves, sutures, and disinfectants -- all seemingly simple items but hold a lot of implications when in a hospital situation that requires utmost sterility for all patients and even hospital workers to be safe.
"Private hospitals will not be able to work well if wala silang masyadong funds for the operating cost," Monteverde added. "Kaya we are really appealing to Philhealth to do something about this."
The continued delay, they said, can prompt some really desperate doctors to not accept Philhealth insurance and will require all patients to pay the total amount of the medical services and supplies and be the ones to file for reimbursement with the Philhealth by themselves. This will be a great disservice to the public, they said.
Monteverde said this is an extreme scenario but will be possible if the situation remains the same after all even doctors have their daily expenses to attend to.
"When I inquired how much I might be able to collect next month, kasi Philhealth can give an estimate naman how much you can expect. I was told I will be paid for three patients. Three out of the 70 I had," one doctor said.
Election-related?
The doctors couldn't help but wonder if the delayed release has something to do with the elections as a similar scenario was experienced during the last elections season.
The distribution of free Philhealth cards, which has become a popular gift of politicians to poor constituents, also fans speculations that Philhealth may even be running out of funds considering that free Philhealth cards mean the recipients have not contributed a single centavo for the health insurance.
Sollesta refused to comment on the fund diversion issue, saying, "That is beyond me."(Sun.Star Davao/Sunnex)
For more Philippine news, visit Sun.Star Bacolod. (April 18, 2007 issue)
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