Corrupt doctors

EDITORIAL

Reports of 10 physicians, nine of them eye doctors, who claimed a total amount of P500 million from the state-owned Philippine Health Insurance Corp. last year has put the profession and the latter on the public spotlight with a clamor for an intensive probe on the matter.

With corrective laser surgery costing about P30,000 per eye, it may be plausible for an eye doctor to claim P50 million a year in health insurance payments from PhilHealth. Officials of PhiliHealth, who are looking into the claims, noted that one of the eye doctors, who claimed P36 million, passed the licensure exam only last year. Some reports said mere eye drop treatments were passed off as major surgeries. PhilHealth officials also said some patients were made to undergo unnecessary cataract surgeries so doctors could make higher claims, with one patient going blind because of the procedure.

PhilHealth may have been expanding its coverage to the poor, and the biggest losers when doctors make padded or fraudulent claims. The state health insurer can be expected to conduct a more thorough scrutiny of claims, which can slow down the payment process. Fraudulent claims also take away funds that can be used for more benefits especially for impoverished patients.

Reports said last year PhilHealth paid P78 billion in health insurance claims, with P7 billion for pneumonia, P3 billion for dialysis, P3 billion for caesarean section procedures and P2 billion for cataract operations.

Health care in this country is so expensive the bulk of one’s salary can be eaten up by treatment for degenerative diseases such as diabetes. An employee nearing retirement can see his life savings wiped out if he suffers a stroke and requires long-term therapy. For millions of Filipinos, a blocked heart valve is a death sentence; life-prolonging heart surgeries are beyond their reach.

Greater PhilHealth coverage is a boon to millions, and fraudulent claims steal from those who need state-funded health care most. The nation badly needs doctors and other health professionals. But those who abuse the system and pocket benefits meant for the less privileged for be sanctioned and given the necessary penalties.