Ang Hirap Maging Mahirap (PhilHealth under fire)

By Limuel Celebria

It’s difficult to be poor!

This was the graphic and powerful lamentation of my favorite Senator Christopher ‘Bong” Go as he

scoured PhilHealth, the country’s principal health insurance provider for.. well, miserably failing in its mandate “to provide health insurance coverage and ensure affordable, acceptable, available and accessible health care services for all citizens of the Philippines.”

Bong Go lamented that while PhilHealth is awash in cash, many of its members are underserved. He cited the case of a cancer patient who incurred millions of pesos in hospital bills but received less than P30 thousand in PhilHealth deductions despite being a member who regularly paid his dues for decades already. And there was the pregnant woman in Cebu who chose to give birth on the sidewalk, because she had no money to pay for hospital bills.

Sen. Bong Go, principal author and sponsor of Republic Act 11463, or the Malasakit Centers Act of 2019 which provides financial assistance to sick Filipinos especially those facing steep hospital bills, expressed his frustration over the transfer of the excess PhilHealth funds to the National Treasury,

saying that the amount is part of the P500 billion reserve fund that remains untapped.

While the PhilHealth reserves keep growing, many Filipinos “continue to struggle with accessing health care and often resort to selling their possessions or taking loans for their medical expenses,” Go said.

“This is unacceptable,” Sen. Go thundered. “The funds for health should be used for health,” he said added as called for several reforms in PhilHealth’s policies, including increasing case rates, expanding program benefits, and scrapping unwelcome policies, including the single period of confinement.

Senator Go’s sentiments resonated loudly in the lower chamber as AGRI Party List Representative Wilbert E. Lee . The congressman from Sorsogon stressed that “instead of just increasing PhilHealth’s support for only selected diseases, there should be an increase in all the hospitalization fees it covers for its members.”

“These increases and expanded health benefits are urgently needed as PhilHealth’s case rates are no longer responsive to the hospitalization cost. Napakalaki pa rin ng binabayaran ng mga pasyente sa pagpapa-ospital (Patients still pay a lot for hospitalization),” Lee added.

A staunch health advocate, it will be recalled that it was Cong. Lee who persistently pushed for the 30% increase in PhilHealth benefits which was implemented last February 14. Last August 8, the solon from Bicol also filed House Resolution No. 1900 to call for another 30% increase in PhilHealth benefits as well as expanded coverage to also include diagnostic procedures such as PET Scan, CT scan and the like.

“Every day, there are patients who learn too late that their health status are already on a severe condition because they are unable to pay for very expensive diagnostic tests. Families have to grapple with loss of lives because parents can’t afford to pay for heart operations while there are other who die without seeing a doctor or setting foot inside a hospital simply because they fear the cost of hospitalization.”

An irate Cong. Lee threatened to filibuster against approval of the PhilHealth budget in plenary session, if the agency does not include another 30% increase in its coverage and expand its services now.

Cong. Lee disclosed that he is running for the senate next and, if destiny favors his being in the senate, he will continue to hound PhilHealth to improve its services.

Personally, as a cancer patient, I consider Senator Bong Go and Cong. Wilbert Lee my “Heroes of Health Care.” Their tirades against PhilHealth strikes a very familiar chord in my personal experiences.

I have been in and out of the hospital for the past two and a half years. My left kidney was removed in March 2022 and spent weeks in the hospital in September 2022, September 2023 and December 2024. Throughout these ordeals, my hospital bill amounted to several hundred thousand pesos each time. PhilHealth came to my “rescue” with less than P30,000 in deductions each time. My Senior Citizen discount amounted to more than double the PhilHealth deduction.

Lately, after my 9th chemotherapy session, my Oncologist Dr. Dolly Ann Pedregosa Arnaiz, advised me to undergo a PET Scan. She said she is ruling out the usual CT scan which follows my chemotherapy protocol because of my high creatinine count. The chemicals used in a CT Scan with high contrast may seriously impair my remaining kidney.

The problem is there is no PET Scan machine in Iloilo. I would have to go to Manila to avail of this procedure. The PET Scan costs over P60,000 at the National Kidney and Transplant Institute (NKTI).

Immediately, I asked my friend and former colleague in media, Larry Tabsing, recently appointed PhilHealth Regional Director, if a PET scan procedure is covered by the agency. Sadly, it is not. PhilHealth considers the PET Scan as diagnostic and not a procedure (whatever that means). I argued that, in my case as a confirmed cancer patient, the PET Scan is no longer diagnostic. The answer: No dice. The same policy applies, the PET Scan is diagnostic – not a procedure, therefore, non-compensable. WTF!!!!

Sen. Bong Go and Cong. Lee are on the right track pontificating against PhilHealth. It is not performing according to its purpose. It is not using the funds it receives from sin taxes and other government subsidies to pay for the poor Filipinos’ health woes but would rather “invest” its excess fund elsewhere as if it were a bank.

When I recall how PhilHealth officials tried to give themselves fat bonuses during the term of Sen. Risa Hontiveros, I shudder to think how hopeless our country had become. This is why we need more of Sen. Bong Go and now Cong. Wilbert Lee in the senate.