Marcos to DOH: Zero subsidy shouldn’t hobble PhilHealth
President Marcos on Tuesday directed the Department of Health (DOH) to ensure that the services of the Philippine Health Insurance Corp. (PhilHealth) for its nonpaying members will not be affected by the lack of a government subsidy in the 2025 national budget.
Mr. Marcos gave the order to Health Secretary Teodoro Herbosa in a meeting in Malacañang.
Under Republic Act No. 12116, or the 2025 General Appropriations Act, the state-run health insurer, an attached agency of the DOH, did not receive an allocation for budgetary support from the government.
“Make sure that services of PhilHealth remain unhampered. [The lack of subsidy] should not affect the delivery of health-care services,” the President told Herbosa.
Justification
Mr. Marcos reiterated the government’s commitment to prioritize the delivery of social services in the P6.326-trillion national budget for this year, with a focus on key sectors such as education, health, economic services, infrastructure and agriculture.
Mr. Marcos, who signed the budget law on Dec. 30 last year, earlier justified Congress’ decision to remove the subsidy, noting that PhilHealth had ample reserve funds that could be used for its operations and health-care insurance coverage.
In a press briefing last year, Finance Secretary Ralph Recto said PhilHealth had P280 billion in reserve funds, a surplus of P150 billion, and more than P400 billion in investments.
Recto also said PhilHealth’s corporate operating budget was sufficient and that the Department of Finance would closely monitor how PhilHealth spends its budget.
Expanded services
Despite receiving zero subsidy, PhilHealth announced another expansion of its coverage earlier this week: It will now pay for emergency procedures and other services for patients who do not need to be confined in hospitals.
Under its Outpatient Emergency Care Benefit (OECB) package which took effect on Jan. 1, all outpatient services and commodities given at the emergency department and accredited health-care facilities will be covered, including services provided before a patient’s arrival, such as transport to the hospital.
The package also applies to patients who do not require hospital admission and are discharged within 24 hours after arriving at the emergency department or die while seeking emergency treatment.
Increase in benefits
Last month, it also approved a 50-percent increase in almost all of its benefit packages.
Under a circular signed by PhilHealth president Emmanuel Ledesma Jr. on Dec. 23, it made another round of adjustments “to increase support value, decrease out-of-pocket payment, increase financial risk protection, and ensure the effective delivery of high-quality health services.”
The new rates took effect on Jan. 1, 2025, and will apply to almost all of the estimated 9,000 medical and procedural case rates offered by PhilHealth.
Small coverage
Among those included in the increased rates is moderate-risk pneumonia, which has consistently been the No. 1 benefit package claimed by members in recent past years.
It was only the second time that PhilHealth adjusted its benefit packages across the board since 2013, when it shifted the way it pays accredited health providers from fee-for-service (where they are paid for each service they perform) to case-based payment, now known as the All-Case Rates (where they are reimbursed of a predetermined fixed rate for each treated case).
A study published by the Inquirer last year found that PhilHealth had only shouldered a measly 14 percent of the total health expenditure of Filipino households, with the bulk of the health-care expenses at 45 percent still paid for by Filipino households out of their own pockets.
