Bong Go urges PhilHealth to address insufficient case rates after tragic story of Walter, a health officer in Camarines Norte failed by the same system he promoted
August 29, 2024
Bong Go urges PhilHealth to address insufficient case rates after tragic story of Walter, a health officer in Camarines Norte failed by the same system he promoted
Senator Christopher "Bong" Go, Chairperson of the Senate Committee on Health, delivered a powerful privilege speech on Tuesday, August 27, highlighting the tragic story of Walter, a dedicated health officer from Camarines Norte who was failed by the very system he served and was mandated to promote.
Go used this heartbreaking example to call for urgent reforms within PhilHealth, demanding that the agency improve its services and fulfill its promises to the Filipino people.
Walter is a dedicated PhilHealth contributor and provincial health officer who served the public for 15 years in Camarines Norte, the hometown of fellow Senator Robinhood Padilla.
According to information given to Go, he was one of the most active personnel in promoting Universal Health Care (UHC) in the province. "Consistent contributor po sya ng PhilHealth, walang mintis," Go noted.
However, despite his years of service and contributions to PhilHealth both on a personal level and in relation to his work, Walter faced a tragic situation when he was diagnosed with pancreatic cancer.
Go recounted the devastating financial burden that Walter's family had to bear due to the insufficient coverage provided by PhilHealth. Walter's total accummulated contributions to PhilHealth over the years amounted to P200,000, yet when he needed assistance the most, the coverage provided was shockingly inadequate.
"Lumapit sa aming opisina, lumapit po sa Malasakit Center ang kanyang pamilya para humingi ng tulong sa hospital bill. Umabot sa apat na milyon ang kanyang huling bill sa ospital. P800,000 ang PWD discount," Go shared, emphasizing the immense hospital bill that Sir Walter's family faced.
Out of the P4 million hospital bill, PhilHealth only covered P29,120. "Tumataginting na P29,120. May barya pa!" Go exclaimed, expressing his frustration at the negligible amount covered by PhilHealth.
With more than two million pesos still left unpaid, Walter's family was left in a dire financial situation, struggling to find ways to cover the remaining costs. Go's office already provided medical assistance to help the family with the bill.
This situation was not an isolated incident. In an earlier confinement, Walter's hospital bill reached P6 million, yet PhilHealth only covered P27,000.
Go highlighted the injustice of this situation, stating, "Fifteen years po nagsakripisyo si Sir Walter para sa pamilya, para sa bayan. Umabot sa P200,000 ang total contributions nya sa PhilHealth bilang mamamayan. More than 10 million in hospital bills, namatay na halos P60,000 lang suma-total ang deduction ng PhilHealth sa kanyang huling dalawang confinement."
Go pointed out that PhilHealth currently has around 9,000 case rates, which represent the amount the corporation covers for specific illnesses or medical procedures.
PhilHealth President Emmanual Ledesma informed the Committee on Health that the agency had already increased the case rates by 30% in January 2024, with plans to implement an additional 30% increase before the end of the year.
"Paalala ko lang po sa PhilHealth, increase your case rates," Go urged, emphasizing the need for substantial changes in the health insurance system.
However, he questioned whether this 60% total increase would be sufficient to address the long-standing deficiencies in PhilHealth's coverage. He pointed out that PhilHealth had not enhanced its benefits for 12 years, leading to a potential mismatch between the current case rates and the actual costs of medical treatments.
"Kaya kahit magtaas tayo ng 60%, baka naman napakaliit ng PhilHealth benefits compared to the actual cost ng treatment sa ngayon. Ang mahal talagang magpa-ospital ngayon. Baka ang mangyari, eh pampalubag loob lang po ito," Go remarked, expressing his concern that the planned increases might not be enough to make a meaningful difference for Filipinos facing high medical expenses.
Go then cited data from the Philippine Statistics Authority, which revealed that the top causes of death in the country from January to November 2023 were heart disease and coronary artery disease.
He drew attention to the fact that angioplasty, a critical procedure for treating cardiovascular disease, only has a case rate of P30,000 to P39,000 under PhilHealth, while the actual cost of this life-saving treatment can reach up to P300,000.
"Kulang na kulang talaga," Go lamented, stressing the urgent need for PhilHealth to adjust its coverage to reflect the real costs of treatment.
He also shared a concerning example involving a PhilHealth employee in the Visayas who incurred a hospital bill of P800,000 but received only P30,000 in coverage from PhilHealth, the very agency that employs him. "'Yun lang po ang kinover," Go emphasized, highlighting the inconsistency and inadequacy of PhilHealth's support, even for its employees.
Go did not mince words when he described the treatment Walter and other patients received from PhilHealth as unjust and inhumane. He pointed out the painful irony that a man who had dedicated his life to public health and contributed significantly to PhilHealth was let down by the very system he helped support.
"Mali ito, Mr. President. Hindi po ito makatao," Go declared, emphasizing the gross injustice that had occurred.
"National Heroes Day po kahapon. Marahil isa sa mga heroes sa Camarines Norte si Sir Walter for his quiet but selfless service as a health officer. Pero ganito nalang ba parati? Aantayin natin mamatay ang bayani para lang magising sa katotohanan at sa bulok na sistemang nagpahirap sa buhay ng mga kababayan natin," Go said.
He lamented the fact that despite PhilHealth's substantial reserve funds, amounting to P500 billion, the agency still fails to provide adequate coverage when it is most needed. Go further elaborated on the fundamental issues with PhilHealth's insurance model.
"While we understand the concept of insurance, hindi ito katanggap-tanggap na hindi mo man lang mapakinabangan ang binayad mo sa oras na kailanganin mo. Hindi po ito tama. Nag-contribute ka, nagbayad ka, bawas na sa sweldo mo, nung namatay ka, lugi ka pa," Go passionately argued.
Go concluded by calling on PhilHealth to fulfill its promise to the Filipino people, particularly those who contribute diligently to the system, including overseas Filipino workers (OFWs) who work abroad to support their families back home.
"Bawat piso, bawat sentimo ay napakahalaga para sa ating Pilipino, lalo na po sa mga OFW na nagko-contribute po mula sa abroad. At dapat mabigyan po ng maayos na serbisyo ang ating mga kababayan. Kung ano ang kino-contribute nila, dapat po ay mapakinabangan nila," Go concluded, reinforcing his commitment to advocating for better healthcare coverage and ensuring that PhilHealth lives up to its mandate.
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