Amid complaints, Yamsuan urges DOH to set clear standards on doctors’ professional fees covered by MAIPFIP program

Parañaque 2nd District Representative Brian Yamsuan has called on the Department of Health (DOH) to ensure transparency and institute clear standards that would prevent doctors from inflating their professional fees paid through the government’s Medical Assistance to Indigent and Financially Incapacitated Patients (MAIFIP) program.

Yamsuan echoed the concerns raised by fellow lawmakers over complaints about doctors who substantially increase the professional fees they charge upon learning that these would be paid through MAIFIP. This practice often leads to higher hospital bills for MAIFIP beneficiaries instead of cutting their medical expenses.

“Kailangan natin tingnan ang transparency and accountability rin ng mga doctors. Kailangan mag-set up [ang DOH] ng mekanismo para to make sure na yung mga kababayan natin hindi malagay sa alanganin,” Yamsuan said during the House Committee on Appropriations hearing on the Department’s proposed budget for 2027.

(We also need to look at the transparency and accountability of doctors. The DOH should set up a mechanism to make sure that our countrymen are not placed in a precarious situation).

The MAIFIP, coursed through senators and congressional representatives, is a financial aid program of the DOH to provide assistance to financially incapable patients. It applies to medical expenses exceeding applicable Philhealth benefit packages or other available funding sources.

DOH Secretary Edwin Mercado said the Department has implemented a three-pronged mechanism to prevent doctors from resorting to this practice.

First was to speed up Philhealth’s reimbursement of doctors’ professional fees when he was still the president and CEO of the state health insurance corporation This reform has encouraged doctors to stick to the usual fee they charge instead of marking them up to include inflationary factors resulting from long-delayed Philhealth payments. Reimbursing doctors within a 15-20 day period has made them more amenable to setting limits on their professional fees, Mercado said.

Second, the DOH and Philhealth have teamed up to establish a “Single Source of Truth” (SSOT) system or database that would check whether doctors remain consistent in setting rates for their professional fees.

Mercado said that as a third step, the DOH has also begun consultations with medical specialty societies, such as the Philippine College of Surgeons, to set standards on professional fees and determine the benefits and incentives that would encourage medical specialists to serve in rural areas and far-flunged communities.

Yamsuan welcomed the initiatives being undertaken by the DOH and Philhealth to correct the practice as he pointed out that the professional fees charged by doctors through MAIFIP are “pera pa rin ng taumbayan (still paid for with taxpayers’ money).

He assured the DOH that Congress is ready to assist the Department in providing it with the necessary resources to institute these mechanisms as well as in ensuring that DOH programs for indigent patients, such as the Zero Billing scheme and the provision of free essential medicines, are efficiently implemented.

“Kami sa Kongreso, sa BARSc (Budget Amendments and Review Subcommittee) and also at the bicameral conference committee (Bicam), we will help you. We should be constructive now. We should help each other,” said Yamsuan, who is a member of both the BARSc and the Bicam tasked to finalize the possible institutional amendments to the 2027 national budget.