The Philippine Health Insurance Corporation (PhilHealth) celebrates its 30th anniversary on February 14, 2025, with the theme 'PhilHealth@30: Panatag Kami Dito,' reaffirming its commitment to improving the National Health Insurance Program.
But how can Filipinos feel 'panatag' when the government has denied PhilHealth a budget?
All government sectors have an allocation from the 2025 National Budget, except PhilHealth. Sen. Grace Poe, the national budget’s sponsor in the Senate, explained in December 2024, that PhilHealth must first exhaust its reserve funds. “For now, PhilHealth will not be given a budget, because they must first use their reserve funds,” Poe stated.
Budget of PhilHealth in the Region VIII
From December 27, 2024, to January 25, 2025, PhilHealth disbursed 20.1 billion pesos to hospitals, representing a 38% increase compared to the previous year. In the regional context, PRO VIII disbursed 5.6 billion pesos in timely payments during 2024 higher than PHP3.7 billion last year.
The most significant number of claims in the region for 2024 was attributed to moderate-risk pneumonia, totaling P751,799.18, as reported by Dr. Rosario Suyom, the Chief of the Healthcare Delivery Management Division at PhilHealth 8.
“Although we have paid more for moderate-risk pneumonia, hemodialysis remains the top procedure in terms of claims count. It continues to remain the number one procedure that PhilHealth has been paying for in the region since the creation of all case rates in 2012,” she said.
PhilHealth expanded its coverage, particularly for marginalized groups, and introduced 13 new enhanced benefits packages which include Hemodialysis; Konsulta + SDG Package; Severe Dengue Hemorrhagic Fever; COVID-19 inpatient benefits; Kidney Transplantation (Z Benefit Package); Ischemic Heart Disease – Acute Myocardial Infarction; Peritoneal Dialysis (Z Benefit Package); Cataract Extraction; Outpatient Emergency Care; Preventive Oral Health Services; Physical Medicine, Rehabilitation, and Assistive Devices; Pediatric Optometric Services; and Case Rate Adjustments, in September 2024, not only to enhance benefits but to establish a stronger foundation for Universal Health Care, prioritizing the right of every Filipino to receive quality and equitable healthcare.
In 2025, PhilHealth will be launching packages for Diagnosis Related Groups (DRG); the Comprehensive Outpatient Benefit Package (COBP), Z Benefits Packages for Heart Valve Surgery, Children with Disabilities, Prostate Cancer, Cervical Cancer, and Open Heart Surgeries (STEMI); Rationalized Case Rates for Chemotherapy (Lung, Liver, Ovarian, and Prostate); Diagnostic Services; and Enhanced Z Benefits for Prostate and Cervical Carcinoma.
Transfer of Funds
The Marcos government has stood firm on the financial soundness of the order to transfer the funds to what they say are other worthwhile projects. However, the oral arguments on January 4, Tuesday, revealed the nuances of how this can negatively impact PhilHealth and, as a result, the services it can offer Filipinos.
Taking away P89.9 billion from PhilHealth will weaken the financial stability of the government health insurer, leading to uncertainty that may result in more cautious spending and higher out-of-pocket expenses for Filipinos, according to physician Beverly Ho, a former undersecretary of the Department of Health (DOH).
Dr. Ho told the Supreme Court that rather than transferring the funds to the national treasury, PhilHealth ought to "maximize" its legal tools and financial assets, "not only to offer insurance coverage to every Filipino but also to enhance benefits to a level that is essential to finance and deliver the healthcare that Filipinos deserve."
"The opportunity to have our healthcare system that Filipinos can be proud of is actually here. The opportunity is before our eyes and we need to make sure that the resources are actually translated to actual benefits…,” she said.
There is no budget set for PhilHealth, yet how can the government be so heartless and greedy as to transfer PhilHealth's unused funds to the National Treasury? What could be more important than the health of the Filipino citizens?
The transfer of these funds would have jeopardized the benefits of many Filipinos who rely on PhilHealth for essential health services. PhilHealth plays a crucial role in providing accessible healthcare to millions of Filipinos, particularly marginalized groups.
“Reducing PhilHealth’s finances makes it more difficult to meet already unmet targets,” said Sonny Africa, the executive director of the independent think tank Ibon Foundation, who also serves as an amicus curiae. Africa pointed out that this financial state is worsened by Marcos’ 2025 national budget allocated no subsidies to PhilHealth.
But PhilHealth-8 seems unbothered by the transfer of funds, and not affected by it.
PhilHealth assures the members that there are enough funds to provide new healthcare benefits in 2025, pay claims, and increase case packages.
“We are very liquid. We can provide all the increases as promised,” said Acisclo B. Militante Jr., PhilHealth-8 chief for Field Operations, during the Kapihan sa Bagong Pilipinas on Tuesday, February 11.
Militante mentioned that they prioritize sustaining essential services such as inpatient care, outpatient consultations, and preventive health programs. By concentrating on vital services, particularly for those requiring them the most, they can reduce the effects of funding difficulties.
Currently, there are approximately 4.9 million members and dependents of PhilHealth in the Eastern Visayas region.
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