COA: PhilHealth’s All Case Rate Payment Scheme sped up reimbursement process but lacked control mechanisms to detect and prevent improper payments

The Commission on Audit (COA) conducted a performance audit of the Philippine Health Insurance Corporation (PhilHealth) All Case Rate (ACR) Payment Scheme covering the period since its implementation in 2011 until June 30, 2020.

Previously, PhilHealth utilized the Fee-for-Service payment scheme, health care institutions (HCIs) such as hospitals and clinics were reimbursed an amount based on the actual charges for the patient’s treatment. This led to delays in the reimbursement due to differences in rates and fees charged by each HCIs and the difficulty in validating such charges. In some instances, this also resulted in bloated charges.

Under the ACR Payment Scheme, PhilHealth pays all claims using a case rate which is a predetermined fixed rate for each covered case or disease. For example, natural childbirth has a case rate of ₱5,000, which will be paid uniformly among all HCIs. The result is that instead of undergoing the process of computing the reimbursements based on actual costs, the HCI will be reimbursed a fix amount, which may be more or less than the actual cost. The idea behind the ACR, which is utilized in other jurisdictions as well, is to incentivize HCIs to be more efficient.  If the case rate for a specific treatment is lower than the actual cost, the HCI will try to be more efficient in the costing of the treatment. On the other hand, if the case rate is higher than the actual cost, the HCI gets to keep the difference as a form of “efficiency gains.”

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New Office Space of the Performance Audit Office Inaugurated

The Commission on Audit (COA) inaugurated the new office space for its Performance Audit Office on 2 March 2021 as part of its project to strengthen performance auditing operations. Enhancing performance auditing enables the Commission to focus more on helping government agencies provide better services to the Filipino people.

COA Chairperson Michael G. Aguinaldo with Commissioner Roland C. Pondoc, Assistant Commissioner Alexander B. Juliano, Retired Director Emelita R. Quirante and OIC- Director Michael L. Racelis led the ribboncutting ceremony during the office inauguration of the Performance Audit Office.

Retired Performance Audit Office (PAO) Director Emelita R. Quirante opened the ceremony by recounting the journey of the PAO which began with the Performance Audit Initiative, a partnership between COA and the United States Agency for International Development (USAID) in 2016. While the journey was arduous at first, the Performance Audit Office is now here with a new home.

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Commissioner Pondoc is key speaker for NUJPIA’s career path event

Look at our society. Everyone wants to be thin, but nobody wants to diet. Everyone wants to live long, but few will exercise. Everybody wants money, yet seldom will anyone budget or control their spending- John Maxwell

 

Commission on Audit (COA) Commissioner Roland C. Pondoc quoted American author John Maxwell during his online presentation as the keynote speaker for the National University Junior Philippine Institute of Accountants (NUJPIA) career path event with the theme, "UPSTREAM 2021: Streamlining the Realm of Accountants" held on 10 and 17 February 2021.

NUJPIA’s two-day series of webinars and activities aimed to help students and participants to know the different fields of Accounting and help them assess their core competencies and skills which are in line with their chosen profession.

 

Commissioner Pondoc’s talk was the fifth webinar topic. He discussed Public Accounting and its differences with Private Accounting. "Principally, there should be no difference among these two accounting systems, as both systems follow the same rules, same principle for debiting and crediting the transactions. However, the objectives of government institutions and private undertakings are quite different," Commissioner Pondoc explained.

 

The Commissioner said the objective of commercial undertakings is to earn profit, while the objective of government accounting is to present the true picture of the financial statement of government including the presentation of the annual budget, allocation, and monitoring of expenditures to ensure their best utilization for public purpose.

 
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Working Group on Public Debt records many ‘firsts’ in 2020

The Working Group on Public Debt (WGPD), under the auspices of the International Organization of Supreme Audit Institutions (INTOSAI), recorded many ‘firsts’ in Calendar year 2020.

 

Chaired by the Philippine Commission on Audit (COA) for three years since 2017, the WGPD’s mandate is to publish guidelines and other informational materials to be used by Supreme Audit Institutions to encourage proper reporting and sound public debt management.

 

While the COVID-19 pandemic gave rise to reassessments and changes in priorities and undertakings the overall direction for WGPD remained in accordance with its mandate set under INTOSAI Knowledge Sharing and Knowledge Services Committee (Goal 3). Looking back, WGPD takes pride in accomplishing the following feats:

 

GUID 5250 officially released

Now available in all INTOSAI languages, WGPD’s priority project formally-named the Guidance on the Audit of Public Debt or GUID 5250 gained the approval of the INTOSAI during the November 2020 Governing Board meeting. GUID 5250 is the first official document contributed by the SAI Philippines-led WGPD for the INTOSAI Framework of Professional Pronouncements.

 

It aims to effectively support INTOSAI goals and objectives to improve, develop, and adopt audit guidance and contribute to independent, high-quality public debt audits. SAI Philippines’ Technical Working Group (TWG) and four sub-task teams led by member-SAIs of Chile, India, Russia and the United States committed to a series of careful drafting of proposals, revisions of draft versions, quality reviews, finalization followed by the endorsement and translation.

 

Cooperative efforts with World Bank

In September 2020, the TWG proposed topics including ”Exploring SAIs' Roles in the Implementation of Sustainable Development Goals (SDGs) in the light of COVID-19” as well as ”Challenges and Opportunities for Public Debt Auditors in Audit of Public Debt and its Management” to the World Bank for future collaborations. WGPD and World Bank will steer series of webinars by 2021.

 

The collaboration will be the first partnership of WGPD outside INTOSAI in an effort to engage major global public debt stakeholders while working its way to become a leading forum on audit of public debt practices and debt management issues. (WGPD Vision)

 
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