Villanueva calls PhilHealth’s IRM program inequitable; Criticizes use of mechanism to favor dialysis clinics, maternity centers

Senator Joel Villanueva took issue with PhilHealth’s lack of urgency for favoring some clinics and not releasing sufficient funds to COVID hospitals under its Interim Reimbursement Mechanism (IRM) program.

Villanueva pointed out that PhilHealth should have ensured the hospitals treating COVID-19 patients were prioritized in the grant of IRM, instead of allowing other medical facilities to utilize the same program for their claims.

“Ito pong IRM o Interim Reimbursement Mechanism n’yo, sa totoo lang, ang tingin natin dito – Inequitable Reimbursement Mechanism. Paano pong hindi eh ginagamit po ang IRM para sa mga ‘pinagpalang’ clinics ng PhilHealth,” Villanueva said at the hearing of the Senate Committee on the Whole.

“The numbers would speak for themselves: Lahat ng freestanding dialysis clinics, ang mga release ay 100% ng kanilang IRM limit, samantalang napakaraming hospital na 60% to 70% lang ng limit nila ang na-i-release,” he continued.

The lawmaker also pointed out that several Level 2 and 3 hospitals—which treat COVID-19 patients—around the country were not able to get in full their IRM grants, unlike some freestanding dialysis clinics and maternity centers which received their IRM funds in full.

“Wala naman po sigurong ospital ang papayag na maging COVID-referral hospital nang hindi PhilHealth Accredited kaya importante ang provisional accreditation ngayong may krisis. Pero convenient din po kasi ito sa mga non-COVID referral hospital para makakuha ng pondo mula sa PhilHealth kahit kulang-kulang ang requirements nila sa kanilang ordinary claims,” he said.*