by: Jerome Carlo Paunan
MANILA, (PIA) — Senator Loren Legarda has called for a stringent and transparent rollout of the Philippine Health Insurance Corporation’s (PhilHealth) recent increases in benefit packages for its members.
The enhancements, which include coverage for treatments related to ischemic heart disease, emergency outpatient services, and kidney transplants, feature a 50% adjustment in select case rates.
Despite welcoming these reforms, Legarda expressed concern over PhilHealth’s inconsistent implementation.
“Although these reforms are welcome, we still need to see how PhilHealth will implement them effectively,” Legarda said, as she highlighted the ambiguity surrounding which cases would be covered and the corresponding allocations, noting that such uncertainty breeds distrust among PhilHealth members, many of whom delay seeking medical treatment until emergencies arise.
Legarda observed that even with PhilHealth coverage, many Filipinos feel hesitant to go to hospitals due to unclear coverage amounts.
“An ordinary Filipino, despite being covered by PhilHealth, feels insecure to go to the hospital because the amount PhilHealth will cover is often unidentified and, when provided, is often low,” she explained.
This situation forces many patients, especially those from poorer backgrounds, to turn to other government assistance programs or loans to meet their healthcare costs.
The senator emphasized that PhilHealth’s success should be gauged by the confidence of its members in seeking treatment, asserting that genuine universal healthcare cannot thrive with inadequate and uncertain coverage.
“PhilHealth must reassess its organizational values and invest in our most valuable asset—our people’s health and trust,” she said.
Legarda pointed out that, while the recent reforms are a positive step, PhilHealth has yet to clarify how these increases in benefits will lead to tangible improvements.
She stressed the importance of evidence-based decisions, urging PhilHealth to target increases in areas where they are most needed, rather than applying blanket adjustments.
Concerns about the financial strain on regular PhilHealth contributors were also raised, as mandatory salary deductions continue without significant increases in coverage.
“Put yourself in the shoes of a person who has been paying PhilHealth for years, only to find that when they finally need it, only 10 to 20% of their bill is covered. That is plain injustice,” Legarda asserted.
As the principal author of the National Health Insurance Act of 2013, she expressed worry over the projected impact of a budget cut for PhilHealth in 2025, which could adversely affect coverage for informal sector workers.
Legarda further addressed the issue of delayed reimbursements to hospitals and healthcare professionals, emphasizing that these delays undermine PhilHealth’s ability to serve effectively.
“Delayed payments demoralize medical practitioners and can lead to increased costs for patients,” she noted.
To enhance operational efficiency, the senator recommended measures such as increasing the number of case officers, digitizing claims processes, and establishing a transparent reporting mechanism to track liabilities.
Legarda also highlighted the need for improvements in the accessibility of healthcare services, particularly through the PhilHealth Konsulta program, which offers free annual check-ups and essential diagnostics.
She urged for the digitalization of registration processes to make services more accessible.
Legarda, meanwhile, called for a comprehensive overhaul of PhilHealth’s operations to fulfill its mandate of universal healthcare.
“We must prioritize the health and well-being of our people over financial growth,” she said, urging the agency to ensure that allocated funds are used effectively. (JCO/PIA-NCR)
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