PhilHealth claims all costs under case rates system in 2019 were incorrectly paid

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PhilHealth reveals that 100 percent of hospital costs in 2019 covered by its contested case rate system have either been underpaid or overpaid

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PhilHealth's case rate system means the payment for claims or costs for treating particular diseases, such as pneumonia, is fixed. In other words, if the illness is pneumonia, regardless of how much the patient accumulates in expenses for treatment, PhilHealth will only pay a fixed rate for it.

"For the overpayment in 2019, we have around 22%. For the underpayment... it is around 78 percent," said the PhilHealth vice president during a House Good Government and Public Accountability hearing on alleged corruption in the state-owned health insurer. Marikina 2nd District Rep. Stella Quimbo said this means zero cases were computed correctly and the hospital either lost or gained profit from the system.

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