Editorial: ‘Incentivized disease’

·3 min read

WHILE Covid-19 is a true story, there might also be some grain of truth to the claim of Cebu Gov. Gwendolyn Garcia that isolation facilities are making money from the pandemic.

Garcia said these facilities claim for a single patient P22,449, the maximum reimbursement from the Philippine Health Insurance Corp. (PhilHealth) granted to a beneficiary under the Covid-19 community isolation benefit package (CCIBP).

Covid-19 has become an “incentivized disease,” said the governor. “Isolation centers now are lucrative businesses. Because who wanted to spend P22,449 to feed and house a patient within 10 days?” the governor said.

Garcia cites, for instance, tuberculosis, a severe illnesses, which is being ignored because the attention has been focused on Covid-19 for reasons that it is covered by the Philhealth package. Under the insurance firm’s Circular 2020-0012, a DOH-certified community isolation unit (CIU) may claim reimbursements for services, medicines and diagnostic tests.

This benefit package, strengthened by the universal health care and the Bayanihan law, protects every citizen from being burdened from out-of-pocket expenses while in CIUs.

Government facilities can use the benefit package to cover operating expenses and care delivery, while privately owned ones can manage the funds on their own to cover for patient care.

Garcia’s beef is that the widespread tests tend to veer towards positives for the isolation centers to rake in more patients, and therefore more benefit packages.

“Having a high number of coronavirus-positive individuals is a lucrative business,” said the governor.

Former Cebu City councilor Jocelyn Pesquera, who now manages the City Government-owned New Normal Oasis for Adaptation and a Home (Noah) complex at the South Road

Properties begs to disagree to Garcia’s claim.

“I don’t find it lucrative because of the 2,000 patients we served, only about 300 claims were considered qualified and Philhealth only paid one claim,” Pesquera said in a Sun.Star Cebu report.

In a nutshell, Pesquera said the Noah complex had not been dependent on the Philhealth package not only because it is time consuming, but also because “no action (has been) taken by Philhealth office.

Dina Cinchez, public relations officer of Philhealth 7, said CIUs have to meet a list of clinical and social criteria in filing for benefit claims.

“We will process only those claims that meet the criteria,” she said.

For a CIU to qualify for the benefit package, it has to meet procedure requirements on the classification of cases, contact tracing protocols and community quarantine protocols.

To help provide a counter-narrative to the governor’s claim that facilities have been milking Philhealth funds in the name of Covid-19, the agency and the CIUs may provide the public an accounting of the claims that had been released. The question, however, still lies on the authenticity of test results on supposed Covid-19 cases. It may be close to impossible to institute a mechanism of check and balance given the current case load that our laboratories already have.

The questions that are being raised now are worth looking into considering the amount of public funds involved.