THE Philippine Health Insurance Corporation (PhilHealth) announced its ambitious goal to significantly increase its coverage of hospital bills for its members in the coming years.
During a Supreme Court oral argument session concerning the transfer of PhilHealth’s excess reserve funds, PhilHealth officials revealed their target to raise coverage to 18 percent of hospital bills by 2025, and further to 28 percent by 2028.
This announcement came in response to concerns raised by Associate Justice Jhosep Lopez regarding the inadequacy of current PhilHealth coverage.
Justice Lopez shared a personal experience where PhilHealth covered only a small fraction (P50,000) of his substantial hospital bill (P7 million) incurred in 2023.
This prompted him to question PhilHealth’s ideal coverage rate, particularly in light of the Universal Health Care Act’s aim to prevent Filipino families from suffering financial ruin due to illness.
The Justice’s personal experience highlighted the significant gap between PhilHealth’s current coverage and the ideal level of protection envisioned by the Universal Health Care Act.
In response to the Justice’s inquiry, PhilHealth Senior Vice President Renato Limsiaco Jr. outlined the corporation’s phased approach to increasing coverage.
Limsiaco stated that PhilHealth aims to achieve an 18 percent coverage rate by 2025, followed by a further increase to 28 percent by 2028. This phased approach suggests a strategic plan for incremental improvements in PhilHealth’s financial capacity and operational efficiency.
However, Justice Lopez expressed skepticism about the relatively modest targets, questioning why PhilHealth wasn’t aiming for at least 50 percent coverage, which he considered an ideal case rate.
This disparity between the proposed targets and the perceived ideal highlights the ongoing challenges faced by PhilHealth in providing comprehensive healthcare coverage to all Filipinos. The Justice’s pointed question underscored the need for a more ambitious and comprehensive strategy to address the financial burdens of healthcare on Filipino families.
Limsiaco defended the targets by emphasizing that PhilHealth already achieves near-total coverage in government hospitals. He explained that there is no balance billing in government hospitals, meaning patients do not incur additional costs beyond what PhilHealth covers.
While this highlights a positive aspect of PhilHealth’s coverage in the public healthcare sector, it doesn’t address the significant coverage gap in private hospitals, where a large portion of the population receives healthcare.
The exchange between Justice Lopez and PhilHealth officials underscores the ongoing debate surrounding the effectiveness and adequacy of the Philippine healthcare system.
The ambitious targets announced by PhilHealth represent a step towards improving coverage, but the significant gap between current coverage and the ideal rate, as pointed out by Justice Lopez, highlights the need for continued efforts to improve the financial sustainability and operational efficiency of PhilHealth.
The ultimate success of these targets will depend on various factors, including increased government funding, improved efficiency within PhilHealth, and a comprehensive national health financing strategy.
