THE Philippine Health Insurance Corp. (PhilHealth) said it will seek a higher budget allocation next year to help fund a 30% across-the-board increase in benefit packages.
“Yes, I think so,” PhilHealth President and Chief Executive Officer Edwin M. Mercado said when asked if the health insurer will request more government subsidies next year.
“With the impact of the across-the-board 30% increase in benefits and compounded 50%, that’s basically 95% from 2024 levels. So this year the full impact of the 95% will be felt. That’s a significant increase from 2024. Now moving forward to 2025, we’re expecting the same benefit level, but we will be adding more benefit payouts for new programs,” Mr. Mercado told reporters.
PhilHealth received zero subsidies for 2025 after being asked to remit its reserve funds from the previous year to the government, which totaled P89.9 billion.
Mr. Mercado added that the subsidy for premiums for indirect members will be restored.
“I think we’re showing that the absorptive capacity of PhilHealth is improving. So we’re rolling out more benefit packages. We’re showing that our utilization is going up,” he said.
Mr. Mercado said the state health insurer is enhancing its IT programs to address the P10 billion in denied claims last year.
“The most common reason for denied claims is late filing. So we’re looking at that. It’s precisely why we retroactively ruled that we will pay the denied claims. But that’s retroactive. Moving forward… we’re ready to work with different hospitals to train their filing clerks or their billing clerks,” Mr. Mercado said.
However, he noted that PhilHealth’s current surplus is sufficient to cover the denied claims.
Mr. Mercado said PhilHealth’s full digitalization could take two to three years.
PhilHealth is also working with the Philippine Institute for Development Studies (PIDS) on how to expand its coverage by identifying the next set of diseases needing coverage.
“That’s why we’re working with PIDS to identify what are the next set of diseases that we will cover based on different factors like what are the most prevalent, what have the most out-of-pocket expenditure, or what have the most effective treatment technology already available,” he said.
PhilHealth and PIDS are looking to identify the next 10 to 20 most cost-effective health benefit packages.
“We are shifting field health’s direction towards a more value-based approach where we will prioritize high-burden and high-cost diseases,” he said.
PhilHealth also said it has lifted the 45-day benefit limit to accommodate conditions that require longer coverage.
“The 45-day benefit limit is an outdated cost-containment strategy. We understand why this was mandated before, but with our new payment mechanism. We cannot always predict or schedule our medical needs. We also have a lot of services that need more than 45 days of coverage,” PhilHealth Acting President and Chief Executive Officer Edwin M. Mercado said in a statement.
As such, PhilHealth is extending the sessions allowable for hemodialysis packages.
“We wish for Filipinos with critical sicknesses, chronic conditions or those needing long hospitalizations to continue to receive health services without having to worry that they will be buried in debt,” Mr. Mercado said.
PhilHealth’s net profit declined 41.66% to P46.43 billion in the first nine months of 2024. — Aaron Michael C. Sy
