HCWs demand reversal of admin’s transfer of unused P89.9-B PhilHealth funds
by Liandrei Crisostomo
Despite healthcare workers’ calls to halt the remittance of Philippine Health Insurance Corporation (PhilHealth’s) unutilized P89.9 billion funds and allocate them to the actual healthcare needs of the insurance’s contributors, the Department of Finance decided to transfer the funds back to the National Treasury.
Health reform advocate Minguita Padilla criticized this transfer, arguing that these are not excess funds, but funds essential for actual healthcare needs.
Nagkaisa Labor Coalition filed a motion before the Supreme Court last Sept. 27 to stop the transfer of the funds to the National Treasury stating that they received no reply from the motions they filed months ago to President Ferdinand Marcos Jr. and Finance Secretary Ralph Recto. The final installment of the remittance, P10 billion, is set for November this year.
During a Senate hearing, PhilHealth appealed for a P79 billion subsidy for the 2025 budget, but was opposed due to their unutilized funds and mismanagement, which opened a discussion over why a huge amount of funds was unused when the out-of-pocket hospital expenses of Filipinos remain high.
PhilHealth members’ burden
Multiple senators and party representatives raised concerns about PhilHealth’s insufficient benefits to its members despite increased payroll contribution rates of members from 4% to 5% effective this year according to the updated provisions of the Universal Health Care Law.
This burdens members, requiring them to diligently pay higher monthly contributions to receive the benefits. Members who fail to settle at least nine months of contributions within the 12-month period before their confinement months become ineligible for benefits, forcing them to pay for their hospital bills.
Despite being eligible for the benefit, members still faced financial difficulties as the government only covered about 25% of the total medical expenses while 48% were out of their own pockets, as stated in the study of the Philippine Institute of Development Studies in May 2024.
AGRI Party-list Representative Wilbert Lee highlighted a case during the Department of Health (DOH) budget deliberations where only P24,000 was given as a subsidy, despite the medical bill amounting to P470,000. This showed that the benefits covered only a small fraction of the members’ expenses.
To add to the chronic problem of the healthcare system in the country, members are required to fulfill several requirements to be submitted two days before the scheduled surgery. These include the Certificate of PhilHealth Contribution, Claim Form 1 (CF1), and Claim Signature form, revealing how PhilHealth’s bureaucratic system constrains the benefits of the members to receiving a subsidy in medical procedures.
Spending discrepancies
In 2023, PhilHealth spent P75.8 billion for the benefit pay-outs, this is almost half of the pay-out they released of P142 billion and P140 billion for 2021 and 2022, respectively.
PhilHealth Executive Vice President Eli Dindo Santos reasoned that the excess spending in 2021 and 2022 is due to the COVID-19 pandemic. Recto refuted this claim with evidence that PhilHealth spent no cents on vaccine and healthcare emergency allowances for hospital workers during the COVID-19 pandemic.
Moreover, the Commission on Audit flagged PhilHealth for inappropriately handling the P500 million COVID-19 National Vaccine Indemnity Fund as the corporation failed to utilize the budget intended to compensate those hospitalized, disabled, and died.
Calls for reform
Lee asserted that PhilHealth should either decrease the monthly contributions of the members or increase the benefit packages they offer by 30%.
PhilHealth President Emmanuel Ledesma promised a 30% increase in the benefit packages of PhilHealth before year’s end, making the total of the benefit up to 60%. The Senate announced that PhilHealth plans to raise benefits by 50% in November, a month earlier than promised.
With the corporation’s unutilized funds taken away by the National Treasury and until the corporation has yet to fulfill its promises of reform, Filipinos are left with no choice but to seek alternatives to cover their hospital expenses, bearing the heavy burden caused by the government’s insufficient subsidies and lack of support on healthcare.
