PHILHEALTH REFORMS EXPECTED TO CURB FRAUD AND IMPROVE BENEFITS
Fraud in connection with PhilHealth payments to health care providers first came to light in May, 2015. This resulted in a riveting Senate investigation in the latter part of 2015 that brought to the limelight even more details about this serious problem, particularly among eye centers and ophthalmologists. PhilHealth has since taken various concrete measures to curb fraud and to save the funds so that these can be used to improve the benefits of members who are estimated to be around 90-92% of the population. PhilHealth benefit payments have almost doubled in less than three years. In 2015, PhilHealth paid 97B in benefits from 55.5B in 2013. The shift from fee for service to Case Rates also streamlined the claims payment and reduced turnaround time by 50%. However, much has still to be done to reduce out of pocket payments for members. In order to achieve this, PhilHealth must improve collection efficiency, restruc...