DBM Press Statement
The Department of Budget and Management (DBM) wishes to correct the false, misleading, and malicious statement issued by a certain Medical Action Group.
We strongly condemn the move of the said group to instill fear and cause unnecessary alarm to PhilHealth contributors by posting unverified information through its social media platform.
In light of this, allow us to clarify and answer its false claims point by point:
1. It is not true that the DBM "unilaterally removed" Philippine Health Insurance Corporation (PHIC) coverage for 30 million 4Ps members, seniors, and PWDs and their dependents this year.
The DBM can neither unilaterally remove PHIC coverage, nor reduce the number of its members, as it only follows what was provided in the approved FY 2024 General Appropriations Act (GAA).
It may be noted that in the FY 2024 National Expenditure Program (NEP), which the Executive (through the DBM) submitted to Congress, the PHIC has an allocation of P101.5 billion, of which P80.283 billion is for the National Health Insurance Program (NHIP), covering the annual premiums of 21,161,308 indirect contributors (exclusive of PAMANA beneficiaries).
We would like to emphasize that the DBM recommended the coverage of 21.1 million beneficiaries and it was Congress, in the exercise of its power of the purse, that deemed it necessary to reduce the recommended budget of PHIC in the FY 2024 GAA to P61.5 billion, of which P40.283 billion is for the NHIP.
Hence, the revised number of target beneficiaries of 10,626,874 (exclusive of PAMANA) came from the PHIC itself, not from DBM, given their reduced budget level in the FY 2024 GAA.
Therefore, the group’s claim that the DBM unilaterally reduced the number of PHIC beneficiaries is completely false, baseless and misleading. Such unfounded claims not only undermine the integrity of public discourse but also pose a significant threat to informed decision-making among citizens.
2. In the same post, the Medical Action Group inaccurately said, “DBM has no power to reduce membership in PHIC. RA 10606 in Sec 29 authorized the payment of these premiums through the GAA. In 2022 alone 5.9 million claims were made by indirect members or 15% of 39 million indirect members and beneficiaries. That will leave 30 million Filipinos without health insurance.”
This allegation is without merit since the Universal Health Care Act mandates the health insurance coverage of ALL FILIPINOS. Thus, the PhilHealth is likewise mandated to cover all Filipinos in its health insurance program, whether they are direct or indirect contributors.
The national government not only provides premium subsidy for indirect contributors but it also provides subsidy for those that are financially incapable to pay for health insurance premiums through the provision of subsidy for Point-of-Service patients.
To reiterate, the DBM is not reducing membership, it merely follows and executes the FY 2024 GAA. Further, Republic Act No. 10606 does not identify the specific number of beneficiaries which is subject to two conditions: 1) those identified by DSWD and 2) those included in the appropriations under the annual GAA.
To note further, the said statement is plainly illogical. If only 5.9 million claims were made from the 39 million indirect members, then it does not mean 30 million Filipinos will be left without health insurance.
3. “Public health statistics show that up to 20 percent of the population need health services in a year and five percent need hospitalization. This means that 6 million of the 30 million deprived of health coverage will have to turn to local health services and pay for the services out of pocket. Since LGUs only cover 10% of health care, that leaves the poor, elderly and PWDs with 90% out of pocket costs,” the group continued.
This is another inaccurate claim. As the existing PHIC policy stands, Philhealth coverage does not mean 100% coverage of expenses and there are cases where there are out-of-pocket expenses. Even without a premium, indirect contributors may still be covered through the Point of Service allocation which is provided in the FY 2024 GAA.
4. "This means that PHIC will be not able to pay the benefit claims of up to 30 million members and dependents this year, based on projected membership," it added.
This has no basis in fact. The Philhealth can very well pay the benefit claims of its members as it is the corporation's obligation to do so as it has over P500 billion in investible funds that PHIC can utilize to support universal health care.
In fact, in its recent budget hearing held on 4 September 2024, PhilHealth President and CEO Emmanuel Ledesma committed to increase the benefits by up to 50% within the year. This just goes to show that PhilHealth can still very well afford to improve the benefits of its members.
Remember that what the government provides is the subsidy for the insurance premiums of indirect contributors and since they are already covered by this health insurance, it is now incumbent upon the Philhealth as the insurer to pay the valid claims of its members.
It must be emphasized that insurance premiums and benefit claims are two different things. One is a payment for the coverage of an event that is to happen in the future while the other is the payment for when the event occurs. Having said that, the national government's role is to provide the subsidy for the insurance premium, while the Philhealth's obligation is to pay the benefit claims of its members.
Please note that the DBM is now consulting with its legal team for possible filing of legal actions against this group for purveying malicious and misleading information to the public. This kind of dissemination of fake news exploits fears and anxieties, fostering mistrust between the government and the Filipino people.
We are also calling upon all individuals, including social media users to critically evaluate the sources of information they encounter and to reject irresponsible reporting that characterizes these false narratives.
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DBM Press Statement
ika-06 Setyembre 2024
Sa malisyoso at fake news na ipinapakalat ng Medical Action Group sa social media
Nais ng Department of Budget and Management (DBM) na bigyang-linaw at itama ang mga fake news at malisyosong pahayag na isinagawa ng isang grupo na nagpapakilala bilang Medical Action Group.
Mariin naming kinokondena ang hakbang ng nasabing grupo na nagtatanim ng takot at pagkabahala sa mga PhilHealth contributors sa pamamagitan ng pagpost ng hindi beripikading impormasyon sa social media platform nito.
Kaugnay nito, hayaan n'yong linawin at sagutin namin ang mga maling pahayag nito punto por punto:
1. Hindi po totoo na tinanggal ng DBM "unilaterally" ang Philippine Health Insurance Corporation (PHIC) coverage para sa 30 million 4Ps members, seniors, at PWDs at kanilang mga dependents ngayong taon.
Hindi maaaring magtanggal ang DBM unilaterally ng PHIC coverage, o bawasan ang bilang ng mga miyembro nito, dahil sumusunod lamang ang ahensya sa kung ano ang nakasaad sa inaprubahang FY 2024 General Appropriations Act (GAA).
Mapapansing sa FY 2024 National Expenditure Program (NEP), na isinumite ng Ehekutibo (sa pamamagitan ng DBM) sa Kongreso, may alokasyong P101.5 bilyon (B) ang PHIC, kung saan ang P80.283 bilyon ay para sa National Health Insurance Program (NHIP), na sakop ang annual premiums ng 21,161,308 indirect contributors (hindi kasama ang PAMANA beneficiaries).
Nais naming bigyang-diin na inirekomenda ng DBM ang coverage ng 21.1 milyong beneficiaries at ang Kongreso, sa pagkakaroon nito ng tinatawag na power of the purse, ang nagpasya na kailangang bawasan ang inirekomendang budget ng PHIC sa FY 20224 GAA sa P61.5 bilyon, kung saan P40.283 bilyon ay para sa NHIP.
Kaya naman, ang bagong bilang ng target beneficiaries na 10,626,874 (hindi kasama ang PAMANA) ay nagmula mismo sa PHIC at hindi sa DBM, bunsod ng kanilang reduced budget level sa FY 2024 GAA.
Samakatuwid, ang pahayag ng grupo na ang DBM ang nagbawas ng bilang ng mga benepisyaryo ng PHIC ay fake news, walang basehan at mapanlinlang. Ang ganitong mga walang batayan na pahayag ay hindi lamang nagpapahina sa integridad ng public discourse ngunit nagdudulot din ng malaking banta sa informed decision-making ng mga mamamayan.
2. Sa parehong post, inaccurate ang sinabi ng Medical Action Group na, “DBM has no power to reduce membership in PHIC. RA 10606 in Sec 29 authorized the payment of these premiums through the GAA. In 2022 alone 5.9 million claims were made by indirect members or 15% of 39 million indirect members and beneficiaries. That will leave 30 million Filipinos without health insurance.”
Ang alegasyong ito ay walang merito dahil nakasaad sa Universal Health Care Act na bigyan ng coverage ang LAHAT NG PILIPINO. Kaya naman, inaatasan ang Philhealth na sakupin ng health insurance program ang lahat ng Pilipino, direct o indirect contributor man sila.
Hindi lamang nagbibigay ng premium subsidy ang national government para sa mga indirect contributors ngunit nagbibigay din ito ng subsidya para sa mga hindi kayang magbayad ng health insurance premiums, sa pamamagitan ng pagbibigay ng subsidya para sa mga pasyente ng Point-of-Service patients.
Bilang pag-uulit, hindi binabawasan ng DBM ang membership, sa halip ay sinusunod at ipinatutupad lamang nito ang FY 2024 GAA. Dagdag pa rito, hindi tinutukoy sa Republic Act No. 10606 ang tiyak na bilang ng mga benepisyaryo na nakabatay sa dalawang kondisyon: 1) ang mga tinukoy ng DSWD at 2) ang mga kasama sa mga appropriations sa ilalim ng taunang GAA.
Bukod pa dito, mapapansin na ang nasabing pahayag ay illogical o 'di makatwiran. Kung 5.9 milyon lang ang claims na naitala mula sa 39 milyong indirect members, hindi ibig sabihin na 30 milyong Pilipino ang naiwang walang health insurance.
3. “Public health statistics show that up to 20 percent of the population need health services in a year and five percent need hospitalization. This means that 6 million of the 30 million deprived of health coverage will have to turn to local health services and pay for the services out of pocket. Since LGUs only cover 10% of health care, that leaves the poor, elderly and PWDs with 90% out of pocket costs,” pagpapatuloy ng grupo.
Isa pa itong sa inaccurate na pahayag. Gaya ng umiiral na patakaran ng PHIC, hindi nangangahulugang 100% coverage ng expenses ang sakop ng Philhealth, at may mga pagkakataon kung saan may mga out-of-pocket expenses. Kahit na walang premium, maaari pa ring ma-cover ang indirect contributors sa pamamagitan ng Point of Service allocation na pinaglaanan sa FY 2024 GAA.
4. "This means that PHIC will be not able to pay the benefit claims of up to 30 million members and dependents this year, based on projected membership," dagdag pa nito.
Wala itong basehan. Kayang bayaran ng Philhealth ang benefit claims ng mga miyembro nito dahil obligasyon ito ng korporasyon na may higit P500 bilyon na investible funds na maaari nitong gamitin para suportahan ang universal health care.
Sa katunayan, sa pinakahuling budget hearing na ginanap noong ika-4 ng Setyembre 2024, nangako si PhilHealth President and CEO Emmanuel Ledesma na tataasan ang benefits ng hanggang 50% sa loob ng taon. Ipinapakita lamang nito na kayang mapabuti ng Philhealth ang mga banepisyo ng mga miyembro nito.
Tandaan na ang ibinibigay ng gobyerno ay subsidya para sa insurance premiums ng indirect contributors at dahil sakop na sila ng health insurance na ito, tungkulin na ngayon ng Philhealth bilang insurer na bayaran ang valid claims ng mga miyembro nito.
Kailangan ding bigyang-diin na ang insurance premiums at benefit claims ay dalawang magkaibang bagay. Ang isa ay bayad para sa coverage ng isang kaganapan na mangyayari pa lang sa hinaharap habang ang isa ay ang pagbabayad sa kung kailan naganap ang pangyayari. Dahil dito, ang tungkulin ng national government ay magbigay ng subsidy para sa insurance premium, samantalang ang obligasyon ng Philhealth ay magbayad ng benefit claims ng mga miyembro.
Kasalukuyan ng kumukonsulta ang DBM sa legal team nito para sa posibleng pagsampa ng legal na aksyon laban sa grupong ito para sa pagbibigay ng malisyoso at mapanlinlang na impormasyon sa publiko. Ang mga ganitong uri ng pagpapakalat ng fake news ay nagdudulot lamang ng takot at pangamba sa mga tao na nagreresulta sa kawalan ng tiwala sa pagitan ng gobyerno at ng mamamayang Pilipino.
Nananawagan din kami sa lahat ng indibidwal, kabilang na ang mga gumagamit ng social media na maging kritikal at suriin ang mga pinagmumulan ng impormasyon na kanilang nababasa at isawata ang iresponsableng pag-uulat na inilalarawan sa pamamagitan ng mga maling salaysay na ito.
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