Offer free health services, not PhilHealth coverage — health groups

“The growing dependence of the DOH on the role of PhilHealth for healthcare delivery manifests a very myopic approach to decades-old problems besetting the Philippine healthcare system.” – Network Opposed to Privatization


MANILA – “No one shall be denied access to basic health care services.” This is the promise of the new law expanding the coverage of the National Health Insurance or the RA 10606, An Act Amending the National Health Insurance Act of 1995. But for health groups, mandatory health insurance is not the solution to the problem of access to quality health care services for the poor majority.

“There is no need for a health insurance if the government is sincere in delivering health care services to the people. Funds for this program alone can be allocated to the improvement of deteriorating health care facilities and other equipment that are most needed by our government hospitals,” Dr. Geneve Rivera-Reyes, secretary general of the Health Alliance for Democracy (HEAD) told

On June 21, President Benigno S. Aquino III signed RA 10606 or the National Health Insurance Act of 2013 which mandates the State to provide comprehensive health care services to all Filipinos through a socialized health insurance program that will prioritize the health care needs of the underprivileged, sick, elderly, persons with disabilities (PWDs), and women and children and provide health care services to indigents. Under the law, the government will also shoulder the premiums for the health insurance of the indigent and informal sectors.
Before, members of PhilHealth are comprised of those who could pay the monthly premiums and sponsored members whose premiums are shouldered by the government.

Sen. Pia Cayetano, author of the Senate version of the law said the National Health Insurance Act of 2013 also aims to ensure lower out-of-pocket expenses for the poor by shifting to a case-based payment from the current fee-for-service arrangement.

The senator’s claim was countered by Reyes saying that even with PhilHealth, patients still shell out a big amount. The Network Opposed to Privatization, a network of health workers, patients, health professional and health advocates also said that World Bank data showed an increase in out-of-pocket share of patients, reaching as much as 83.5 percent.

“PhilHealth does not shoulder the entire bill of the patient. Paying members benefit more than the sponsored members. It specifies the type of illnesses to be covered by the benefits and the maximum amount for hospitalization. A member should have paid the premium for a minimum of nine months to be able to avail of the benefits. In far-flung areas where PhilHealth-accredited health facilities, necessary medicines and health professionals are absent, the insurance is certainly an ineffective and frustrating proposition,” the NOP said in its website.

PhilHealth, not the solution for the poor’s access to health services

Reyes said health services for Filipinos should be free. She said the people should not be paying for health services because it is an obligation of the government to provide accessible and affordable health services.

But since the government has started “modernization” projects of government hospitals, the people who are mostly indigent patients are left with no other choice but to pay for the high cost of health services. What’s worse, said Reyes, is that patients who cannot afford choose not to seek treatment. Reyes said that instead of spending a big budget on health insurance, the government should provide government hospitals with budgets for capital outlay and maintenance and other operating expenses or purchase essential medicines. “The budget should directly benefit the people,” Reyes told

According to the NOP, in the 2013 budget, the government allotted P12.6 billion ($289 million) for PhilHealth. This is in line with the 2011-2015 Philippine Development Plan and Universal Health Care target to enroll five million poorest families by the year 2015.

“The growing dependence of the DOH on the role of PhilHealth for healthcare delivery manifests a very myopic approach to decades-old problems besetting the Philippine healthcare system,” the NOP said.

The NOP said PhilHealth cannot cover-up the continuing failure of the Aquino administration to provide long-term solutions. The group explained that for one, PhilHealth has its own problems. “Its numbers regarding coverage, for instance, is highly suspect because PhilHealth has no reliable monitoring system. What PhilHealth projects as its percentage coverage are mainly estimates and because of this, many of the real poor will continue to be denied the health care they need. PhilHealth as a social health insurance has many limitations and restrictions.”

The group also stressed that for as long as the healthcare system remains neglected, the expanded coverage of PhilHealth is useless. The NOP explained that PhilHealth’s policy of “No Balance Billing” only applies to sponsored members who are confined in accredited state-run hospitals, and are suffering from 23 select medical & surgical conditions. However, the NOP said many provincial and district hospitals are not even equipped to provide services for these cases.

Worse, the group said, PhilHealth cannot mitigate the effects of privatization. “A recent study based on PhilHealth’s own projections shows that even if PhilHealth pays out all of its funds (P 103 billion or $2.3 billion) in 2015, this will account for only 20 percent of total health expenditure. And since the government’s share in health expenditures will continue to decrease due to privatization, Filipinos will still pay for more than half of their health expenses.” (

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