Wazzup Pilipinas!?
The Philippine Health Insurance Corporation (PhilHealth) has been in the spotlight following a recent admission by its president, Emmanuel Ledesma, that longstanding policy differences between PhilHealth and the Department of Health (DOH) have resulted in inefficiencies and unnecessary suffering for millions of Filipino members. During a heated hearing on January 22, 2025, before the House Committee on Good Government and Public Accountability, lawmakers criticized the coordination failures between the two agencies, pointing out issues of duplication, inefficiency, and underutilized government subsidies.
Acknowledging the Problem
House Deputy Majority Leader and Iloilo 1st District Rep. Janette Garin, a former health secretary, pressed PhilHealth officials on the coordination gaps between PhilHealth and DOH that have led to a number of problems within the healthcare system. In a candid exchange, Garin stated, "In other words, hindi kaya ng PhilHealth na lahat ng problema sa kalusugan ay siyang sumalo. Hindi rin naman kaya ng DOH na yung mga gastusin sa loob ng hospital ay sa DOH." This statement reflects the ongoing tension between the two agencies and the need for clearer role distinctions.
PhilHealth officials, including Ledesma, acknowledged these issues, admitting that there are overlaps in their functions and those of DOH, leading to inefficiencies and complicating service delivery. In response, Ledesma committed to conducting an internal review to address discrepancies in past enrollment practices.
The Need for Role Clarity
One of the core concerns raised during the hearing was the lack of clarity between the responsibilities of DOH and PhilHealth. Garin stressed the importance of maintaining distinct functions for each agency to avoid redundancy and unnecessary delays. She suggested, "DOH is for promotive and preventive healthcare, while PhilHealth should focus on curative healthcare and catastrophic illnesses." However, this simple distinction has been blurred in practice, creating confusion and inefficiency.
A major example of these overlaps was cited by Garin during her questioning of medical supply procurement. According to Garin, the roles of the two agencies in purchasing medical supplies are often muddled, with the DOH purchasing supplies that should not be reimbursed by PhilHealth. "Ang binibili ng DOH hindi dapat nire-refund ng PhilHealth. Ang packages ng PhilHealth ay hindi nagdodoble sa packages ng DOH," she said, underlining the need for better coordination to prevent the duplication of healthcare efforts and funds.
Enrollment and Eligibility Issues
PhilHealth Vice President Lemuel Untalan revealed that the agency was in the process of refining its enrollment lists to eliminate redundancies and remove ineligible beneficiaries. Untalan confirmed that efforts were underway to update the enrollment data to prevent unnecessary premium payments for individuals no longer eligible for coverage.
However, this process is far from flawless. One of the key issues discussed was the legality of past retroactive enrollments, particularly for senior citizens before the full implementation of the Universal Health Care (UHC) Act. Garin questioned whether it was lawful to enroll seniors multiple times, prompting PhilHealth officials to concede that they would need to review documentation from previous years.
Another significant issue raised was the failure to regularly update the list of indigent members. Untalan noted that the list provided by the Department of Social Welfare and Development (DSWD) under the National Household Targeting System (NHTS) is only updated every four years, causing inefficiencies in allocating government subsidies and contributing to an underuse of available funds.
Unutilized Funds and Financial Mismanagement
A critical point brought up by Garin was the failure to reconcile outdated member lists, which has led to millions of pesos in unutilized funds. These funds, if used properly, could expand healthcare benefits or reduce premiums for Filipino citizens. Ledesma acknowledged the issue of excess funds resulting from policy misalignment between the DOH and PhilHealth. He promised to provide Congress with a detailed report on how these funds had been allocated over the years, though many lawmakers expressed concerns about the transparency and efficiency of PhilHealth's financial practices.
Concerns About Healthcare Costs
The hearing also shed light on a longstanding issue: the alleged inflation of prices by hospitals when PhilHealth is the payer. Garin described how hospital costs for medications and laboratory tests often increase when PhilHealth is involved. "Kapag PhilHealth ang magbabayad, biglang tumataas ang presyo ng mga gamot at laboratory tests," she said, adding to the growing concern about financial abuse within the healthcare system.
Dr. Israel Francis Pargas of PhilHealth acknowledged the issue, assuring lawmakers that their legal and investigative teams were monitoring such practices. However, there is still uncertainty about how effectively these practices are being addressed.
Moving Forward: Coordination and Reform
The call for reform within PhilHealth is louder than ever. Lawmakers are urging the government to address inefficiencies and ensure that policies between PhilHealth and DOH are better aligned. The public, especially the most vulnerable members of society, should not continue to bear the brunt of these inefficiencies.
PhilHealth's commitment to conducting an internal review of its enrollment practices and improving coordination with the DOH is a step in the right direction. However, much work remains to be done. Streamlining the relationship between the two agencies, updating enrollment lists regularly, ensuring financial transparency, and addressing price inflation within hospitals are all crucial steps toward building a healthcare system that serves the needs of the Filipino people more effectively.
The ongoing hearings signal that lawmakers are serious about holding PhilHealth accountable and pushing for the much-needed reforms to enhance the quality of healthcare for all Filipinos. As the situation unfolds, it is hoped that these policy differences will be resolved for the sake of the millions of members who rely on PhilHealth for their healthcare needs.
Ross is known as the Pambansang Blogger ng Pilipinas - An Information and Communication Technology (ICT) Professional by profession and a Social Media Evangelist by heart.
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