SEN. Loren Legarda has called for diligent and transparent enforcement of the recent enhancements to its members’ benefit package offered by the Philippine Health Insurance Corp. (PhilHealth).
These enhancements cover various medical services, such as treatments for ischemic heart disease (coronary heart disease), emergency outpatient services, kidney transplants and updates to 50 percent of specific case rates.
“Although these reforms are welcome, we still need to see how PhilHealth will implement them effectively,” Legarda said.
“For instance, while there’s a 50-percent increase in select case rates, PhilHealth has not clarified which cases will be covered and how much will be allocated. This uncertainty only contributes to the lack of trust among PhilHealth members, who often delay seeking medical treatment until emergencies arise,” she added.
Legarda also pointed out that despite having PhilHealth coverage, many ordinary Filipinos feel insecure about going to the hospital.
“An ordinary Filipino, despite being covered by PhilHealth, feels insecure about going to the hospital because the amount PhilHealth will cover is often unidentified and, when provided, is often low,” she said.
“Consequently, their out-of-pocket expenses consume a substantial part of the bill. Despite universal health care coverage, poor patients are forced to seek assistance from other government programs, such as Guarantee Letters, or resort to loans to cover the remaining health care costs,” she added.
The senator emphasized that PhilHealth’s success should be measured by patients’ confidence in seeking treatment, knowing that the public health insurer will meet their needs.
“True universal health care cannot exist if the coverage remains insufficient and uncertain,” she said.
Legarda also addressed the broader issue of PhilHealth’s priorities. She reminded the government corporation that its core mission should be providing accessible health care for all Filipinos, not making financial investments.
The senator emphasized that while the recent reforms are a step in the right direction, PhilHealth has yet to explain how the benefits increase will lead to real improvements. She acknowledged the need for adjustments due to inflation and rising health care costs but stressed that these increases must be grounded in data.
“While a 50 percent increase may seem like a significant boost, for certain conditions, the actual treatment costs should be a key consideration,” she noted.
She further called for evidence-based decisions, urging PhilHealth to ensure these reforms are not simply across-the-board increases but targeted to where they are needed.
Legarda also raised concerns about the financial burden on regular PhilHealth contributors, particularly with the ongoing mandatory deductions from workers’ salaries.
“The monthly contributions taken from workers’ salaries are significant, but we have yet to see a substantial increase in PhilHealth coverage,” she said.
“Put yourself in the shoes of someone who has been paying PhilHealth for years, or even decades, and then when they finally need to use it, only 10 to 20 percent of their bill is covered? That person could have saved that amount and paid for their hospital expenses themselves — and for sure, the money they saved would have been more than what PhilHealth covered. It’s plain injustice, and it needs to be addressed,” she said.
As the principal author and co-sponsor of Republic Act 10606, or the “National Health Insurance Act of 2013,” which expanded health coverage to indigents and the informal sector, Legarda expressed concern over the projected impact of PhilHealth’s 2025 budget cut.
“The government’s decision to cut PhilHealth’s budget will affect coverage for informal sector workers who depend on funding from the General Appropriations Act (GAA). With this funding now cut, we hope that regular contributors will not bear the burden of subsidizing health insurance for the informal sector. PhilHealth should ensure that other sources will be used to cover the costs,” Legarda pointed out.
She also focused on the urgent need to address delayed reimbursements to hospitals and health care professionals, which continue to undermine the agency’s ability to serve its stakeholders effectively.
“Delayed payments demoralize medical practitioners and hospitals and can increase patient costs,” she said.
“PhilHealth must streamline its claims processing to ensure timely payments and reduce the financial burden on health care providers and patients alike.”
The four-term senator recommended several measures, including increasing the number of case officers to expedite claims, digitizing the application and reimbursement systems, and establishing a transparent reporting mechanism to track liabilities and improve operational efficiency.
Legarda also underscored the importance of improving the accessibility of health care services, particularly the PhilHealth Konsulta program. This primary care benefit package, which covers the cost of free annual check-ups, selected diagnostics and medicines, is vital in ensuring that Filipinos have access to essential health services.
“Konsulta can greatly reduce the burden on hospitals and clinics, especially in underserved areas, but the current registration process is overly complex,” she noted.
Legarda called for digitizing registration processes and fully integrating Konsulta with PhilHealth’s existing systems. This would eliminate redundant registration layers and ensure services are easily accessible to all Filipinos.
The senator stressed the need for a comprehensive overhaul of PhilHealth’s operations to fulfill its universal health care mandate. “We must prioritize the health and well-being of our people over financial growth, streamline processes to improve service delivery, and ensure that the funds we allocate for health care are used effectively,” Legarda said.
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