Is PhilHealth Taking Over the DOH's Job?

Media Release

12 February 2016

“Is PhilHealth Taking over the DOH’s Job?”

Health group questions why PhilHealth, not the DOH, is regulating clinical practice

The group Health Alliance for Democracy (HEAD) is taking the Department of Health to task regarding two recently released circulars by the Philippine Health Insurance Corporation (PhilHealth) that the groups deems to be encroaching on clinical practice.

PhilHealth Circulars 2016-001 and 002, Policy Statements on the Diagnosis and Management of Acute Gastroenteritis (AGE) and Urinary Tract Infection (UTI), respectively, prescribe a minimum hospital stay of 3 days for AGE and 4 days for uncomplicated UTI. Otherwise, theclaims will not be reimbursed.

According to Dr. Joseph Carabeo, HEAD secretary-general, such measures are regulatory and run against the grain of accepted clinical practice. “PhilHealth is primarily a health financing institution, not a regulatory agency.”

The circulars have stringent requirements for diagnosis and dictates on the better judgement of clinicians in managing patients, without due consideration to the existing capacity of healthcare institutions. For instance, many primary and secondary hospitals that are run by local government units (LGU) will be hard-pressed to comply.

“In the meantime, what is the DOH doing? Health regulation is a function of the DOH, not PhilHealth!” Carabeo lamented.  

This is not the first time that PhilHealth has done this.

Last year, PhilHealth came up with Circulars 018 and 023 on uncomplicated cataract in adults and community-acquired pneumonia in immunocompromised adults, respectively. These already affected some LGU-hospitals. This time around, PhilHealth really overstepped its bounds.

“To date, AGE is still one of the top causes of morbidity in the country. Many will be affected because rather than make their lives easier, PhilHealth will be making their lives more miserable.

And worse, the DOH seems content in just watching.” ###