PhilHealth Statement on the 18% coverage

PhilHealth continues to be committed in its mandate to deliver Universal Health Care (UHC) for every Filipino. The latest Philippine National Health Account (2023) reports that 44.4% of the country’s Current Health Expenditure (CHE) was paid through out-of-pocket (OOP) means.

Meanwhile, the government — which not only includes PhilHealth services but as well as other health financing government initiatives such as the Medical Assistance for Indigent Patients (MAIP) — contributes 42.6%. Although this is an aggregated figure, we are cognizant of PhilHealth’s significant role in alleviating the still-heavy financial burdens that Filipinos face when accessing health services.

Hence, we have set out to reduce the OOP expenditure to around 25-35% over the next three (3) years, which would entail a series of regular reviews and refinement of our processes. For PhilHealth alone, this translates to an increase of the current CHE share to around 25-35% by 2028 — which necessitates focusing our benefit releases to prioritize high burden, and high cost diseases that commonly affect Filipinos, as evidenced by data.

This calls for alignment with our healthcare providers — professionals and institutions alike — to ensure preparedness for the implementation of benefits, allowing our members to promptly access care and financial risk protection. Benefits have been and will be expanded, but we need the health care supply-side to match these efforts.

Gayunpaman, nililinaw natin na ang kontribusyon ng PhilHealth sa CHE (o gastos pangkalusugan ng bansa) ay iba pa sa support value o halagang sinasagot ng PhilHealth sa bawat pagpapaospital o pagpapatingin ng ating mga myembro. Halimbawa, isa sa ating adhikain ay, sa susunod na tatlong taon, ang lahat ng maa-admit sa wards — publiko man o pribado — ay wala na dapat dagdag na babayaran sapagkat sakop na ito ng PhilHealth (100% support value). 

Ngunit, sa mas malawak na pambansang pananaw, maaaring ang 25-35% na gastos na manggagaling pa rin sa bulsa ng mga mamamayan ay napupunta sa iba pang serbisyong pangkalusugan gaya ng upgraded rooms at provider preference. Sa ating target na pagtaas ng kontribusyon ng PhilHealth sa CHE, atin nang labis na mapabababa ang panganib ng kahirapang dala ng gastos sa pagpapagamot para sa maraming pamilyang Pilipino.

However, reducing the OOP expenditure requires concerted, multisectoral efforts in strengthening the health system’s financing strategies. Kaya naman, patuloy rin po tayong nakikipag-tulungan sa iba’t ibang ahensya kabilang na ang Kagawaran ng Kalusugan (DOH), National Economic and Development Authority (NEDA), Local Government Units (LGUs), at iba pa.

Only through synchronized efforts among government agencies could we successfully achieve health financial risk protection for every Filipino. Kaisa po kami ni Sen. Pia Cayetano sa hangaring bawasan ang gastusing pangmedikal na kailangan pang ilabas ng mga Pilipino mula sa kanilang bulsa. 

Kaya naman, kami ay direktang nakikipag-ugnayan sa opisina ng mahal na Senadora upang mas lalo pang paigtingin ang aming serbisyo. Makakaasa po kayong patuloy na naglilingkod ang PhilHealth upang sama-sama nating maiangat ang antas ng kalusugan sa isang Bagong Pilipinas.