CASE-BASED PAYMENT SYSTEM NG PHILHEALT PINAA-AUDIT

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(NI NOEL ABUEL)

IPINASASAILALIM sa audit ni Senador Risa Hontiveros ang ginagamit na case-based payment system ng Philippine Health Insurance Corporation (PhilHealth) upang matiyak na hindi magagamit sa katiwalian at korapsyon ang pondo nito.

“Serious allegations of fraud and financial mismanagement erode public trust in our healthcare institutions and endanger the lives of people by denying them the medical treatment they need. We need to have more stringent procedures to protect the public health sector against bad and abusive practices. And if these procedures are already in place, they sorely need to be revisited and implemented. And those who have failed to implement these processes should also be held accountable,” ani Hontiveros.

Paliwanag nito na lumabas sa ulat na ilang kaso ng overpayment sa mga kaso ng pneumonia, caesarian section, at ang Z package, ang natuklasan ng Commission on Audit (COA) simulan nang iimplementa ang case-based system.

Suportado rin ni Hontiveros ang plano ng PhilHealth na gumamit ng strategic provider payment mechanism tulad ng Diagnosis Related Group (DRG) na kasama sa inamiyendahan sa Universal Health Care (UHC) Law.

“The DRG is a system used to classify various diagnoses for in-patients into groups and subgroups so that insurance can accurately pay the hospital bill. The main idea behind this mechanism is to ensure that reimbursement adequately reflect the fundamental role which a hospital’s case mix plays in determining its costs and the magnitude of resources that the hospital needs to treat its patients,” sabi ni Hontiveros.

Pagpapaliwanagin din ni Hontiveros ang PhilHealth sa kasalukuyang sitwasyon nito at ang anomalya umano sa ahensya.

Samantala, nakatakdang ihain umano nito ang PhilHealth Insurance False Claims Bill upang mapigilan at maiwasan na mangyari muli ang anomalya sa PhilHealth at mapalakas ang anti fraud detection systems nito.

 

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