Gov’t: Zero hospital bill also for middle class
Middle-class Filipinos who are one hospitalization away from bankruptcy should also equally benefit from the zero balance billing (ZBB) policy being implemented in selected government hospitals, according to Executive Secretary Ralph Recto.
In a statement on Sunday, Recto said he met with officials of the Department of Health (DOH) and state-run Philippine Health Insurance Corp. (PhilHealth) to ensure that the Marcos administration’s ZBB program for patients admitted in selected government hospitals will be properly implemented with additional funding under this year’s national budget.
He said the meeting with Health Secretary Teodoro Herbosa and PhilHealth president and CEO Edwin Mercado in Malacañang on Jan. 20 discussed “system-wide solutions that will ensure the ZBB is genuinely felt by Filipino patients.”
Recto urged the officials to expand PhilHealth’s benefit packages, “especially for the middle class who consistently pay their taxes and contributions, emphasizing the need for contributors to see commensurate benefits.”
Accommodations
The ZBB is among the programs that drew cheer when President Marcos mentioned it in last year’s State of the Nation Address.
Under the program, all patients, regardless of their economic status, will no longer have to pay out of pocket when they are admitted at the basic ward of any of the 87 DOH-operated hospitals.
Hospital and professional fees incurred by a patient under the ZBB are shouldered by the applicable PhilHealth benefit package, while the balance is charged to the DOH hospital’s budget for maintenance and other operating expenses.
The ZBB, however, only applies to basic or ward accommodation.
When a patient chooses to be transferred to a private room, regular PhilHealth benefits with copayment will apply, which means the patient must pay a portion of the bill based on room rates and services.
While private hospitals may implement the NBB, only 10 percent of the bed capacity in private hospitals can be allocated to ward accommodations, thus limiting the program’s coverage compared with DOH-retained hospitals.
The DOH’s ZBB is different from the “no balance billing” (NBB) of PhilHealth, which was implemented in 2011.
This policy, however, only covers members and dependents who are considered indigent, sponsored, domestic workers, senior citizens and lifetime PhilHealth members.
Bigger funding
Based on a study by the Philippine Institute for Development Studies, middle class families comprise 46.8 percent of the country’s population of almost 114 million in 2025.
To be considered a member of the middle class, a family of five members should have a monthly income ranging from P18,200 to P109,200.
In comparison, the poverty threshold—or the amount needed by a typical household to cover basic food and non-food expenses and not be considered poor—is at P688 per day or P20,040 a month.
According to the DOH, more than 1.3 million patients in DOH hospitals across the country paid no hospital bills in 2025 due to the ZBB.
From July to December 2025, total hospital bills amounting to P74.65 billion were fully covered for patients admitted under basic or ward accommodation.
The 2026 General Appropriations Act (GAA) allocated P448 billion for the health sector, but this was still P2 billion short of the P450 billion in annual funding estimated for the full implementation of the Universal Health Care Act.
Controversial policies
Under the DOH budget, P1 billion has been allocated for the expansion of the ZBB in selected secondary and tertiary hospitals run by local government units (LGUs).
The controversial Medical Assistance for Indigent and Financially Incapacitated Patients program has received a funding of P51.6 billion under the 2026 GAA, a 25-percent increase from P41.16 billion last year.
It is at par with the P53.13-billion government subsidy to PhilHealth this year for the premiums of more than 41 million indirect contributors, who are senior citizens, persons with disability, indigents, 4Ps beneficiaries, and those without the capacity to pay.
Another P60 billion is allocated to PhilHealth after the Supreme Court ordered the return of the same amount of “excess” funds of the state insurer that was remitted to the national treasury in 2024.
It was Recto, as then finance secretary, who issued the circular authorizing the return of the fund balance or excess reserve funds of government-owned and -controlled corporations, particularly PhilHealth and Philippine Deposit Insurance Corp., to fund unprogrammed appropriations under the 2024 GAA.
Meanwhile, each of the four specialty hospitals—namely the Lung Center of the Philippines, National Kidney and Transplant Institute, Philippine Heart Center and Philippine Children’s Medical Center—will also receive an additional funding of P1 billion to expand the ZBB.
The University of the Philippines-Philippine General Hospital has also been provided with P800 million for ZBB.
Recto said closer coordination among national agencies and LGUs is key to ensuring that health-care financing reforms translate into tangible relief for patients across income groups. —WITH A REPORT FROM PNA
