PhilHealth questions high payouts for 3 conditions

The Philippine Health Insurance Corp. (PhilHealth) has observed unusually high payment for three particular conditions, eating up a quarter of all the claims that it paid during a fouryear period, an official said yesterday.

According to Roberto Salvador Jr. PhilHealth board member for the formal economy sector, it was found that pneumonia, sepsis and caesarian section were the leading causes of confinements from 2014 to 2017.

Heath Secretary Francisco Duque III said this is being investigated.

“We have to look into this because it could be a source of cheating, a source of up-casing and we should put a stop to this. Umubo lang, pneumonia na? Suminghot lang, pneumonia na (A cough, a sniffle and it’s pneumonia)?” he noted.

Duque maintained that this was uncovered because PhilHealth has adopted the Health Information Data Analytics system, which examines the data for each of the diseases for which members are hospitalized.