PhilHealth urged to expand member benefits over investments

The state-run Philippine Health Insurance Company (PhilHealth) should prioritize expanding benefit packages for its members over investments, lawmakers said Wednesday.

House Assistant Majority Leader and Ako Bicol party-list Rep. Raul Bongalon and House appropriations panel senior vice chairperson and Marikina Rep. Stella Quimbo made the call after PhilHealth's briefing on its financial status before members of the chamber.

The briefing was conducted amid the Congress’ decision to remove P74 billion of government subsidy to PhilHealth due to its billions of reserve funds.

“We appreciate the efforts of increasing the benefit package on case rates wherein PhilHealth committed to have an increase of 50% by next month. Another one we asked from them is the commitment to decrease the premium contribution because the law is clear that if they have excess funds, they should lower the premium contribution. But I would like to emphasize that it's now the best time for PhilHealth to act as a health insurer," Bongalon said.

“Hindi naman sila negosyo (They are not a business enterprise). You are a service provider [first]. And therefore...I guess this is the legacy that the President would like to leave, especially to the 115 million members of PhilHealth...[that] even without the subsidy from the government, sobra-sobra po ang pera ng PhilHealth. Ano gagawin natin sa pera (PhilHealth has a lot of funds even without government subsidy. What will they do with that)? We really need to use it and [for PhilHealth to] act as a health insurer upang mas malaki ang makikinabang at mababawas sa mga hospital expenses (for the members to benefit from and reduce their hospital expenses),” he added.

Bongalon said that with PhilHealth having at least P489 billion of investible funds as of November 2024, it is in the perfect position to heed the lawmakers’ call.

“What are we going to do with all this money?  It is all about prioritization. Investment should not be PhilHealth’s priority. Its priority should be the expansion of healthcare benefits of our fellow Filipinos. That is being efficient,” he added.

Quimbo agreed with Bongalon, saying that the PhilHealth’s target spending of P155 billion for its members benefits for 2024 alone is paltry given its huge amount of investible funds.

“Why are you accumulating so much investments funds? Sa halip na social health insurance program ang pinapatupad ng PhilHealth, ang pinapatupad po ng PhilHealth sa ngayon ay investment program. And the reason for that is because of the very slow benefit expansion,” Quimbo said during the briefing.

(Instead of a health insurance program, you are engaged in an investment program because your benefit expansion program is very low.)

“Napakadami po ng problema sa implementation. Napakatipid ng pagtaas ng case rates. Ang bagal-bagal ng pagbayad sa hospitals. In which case, napakalaki po ng mga pagkakautang ninyo sa hospitals,” she added.

(You have a lot of problems with the implementation, and the members take a pittance out of the case rates. Your hospital dues are paid late and you have accumulated a lot of such unpaid dues.)

PhilHealth president Manny Ledesma, in response, said they are set to increase their target spending for member benefits to P271 billion in 2025.

“This year, we're targeting to be around P155 [billion], P160 [billion]. And then, next year, will be P271 [billion]. That’s doable because we've already factored in all of this benefit expansion and benefit increases to 80%,” he said.

Likewise, Ledesma said PhilHealth is already addressing the 2023 Commission on Audit findings wherein the state insurer recorded erroneous or duplicate data entry for 15.55% of enrolled beneficiaries, 266,665 enrolled senior citizen members with duplicate entries and 4,062 deceased senior citizen members still in database.

“We need to reconcile it with the Department of Budget and Management and treat them [overpayments] as deferred credits. We can recover the amount, and we are now in the reconciliation process,” Ledesma said.

“We will submit [data] to the committee [once we recover the amount],” Ledesma added.—AOL, GMA Integrated News