This is one of those random commentary posts I make about what's going on in my country. There's an issue about PhilHealth having no subsidy from the government.
The Philippine Health Insurance Corporation (PhilHealth) is a tax-exempt, government-owned and controlled corporation (GOCC) of the Philippines that provides health insurance to the country. - Wikipedia
CoA: PhilHealth faces distress: Reserves fund a liability to members
TL:DR
Despite the assurance that PhilHealth has a lot of reserves to cover it's liabilities, the audits show that it's unlikely they have enough funds to actually do.
But despite the PH government not allocating some subsidy over this institution, PhilHealth members could still avail the present benefits and more benefits to follow next year as what's mentioned from the below article.
FACT CHECK: PhilHealth member benefits to continue despite zero subsidy in 2025
Philhealth has funds to supposedly cover those medical expenses it's members incurred in availing health care services. However, the narrative as to whether they'll be able to deliver these services without financial constraints becomes a shaky subject.
From an average middle class working their backs and having part of their paycheck go to PhilHealth contributions, we tend to fork money for those that couldn't pay for their contributions when they need the health care. How is this possible?
Philhealth makes it accessible for the indigents, senior citizens, and everyone to apply for membership and cover their availed health care services. This way, health becomes accessible to people who need it the most because now they have a means to get health care without paying for it with money they don't have upfront.
Question: who do you think actually foots the bill when people who don't have money to pay for health care get health care? right, every member who pays for their contribution and hopes not to get sick.
There's plenty of people out there that need affordable health care. There's no shortage of it. But there's a shortage of people capable of paying their contributions regularly and they themselves may not necessarily be able to use those benefits until they get sick.
We have an incentive to not get sick but for those that are prone to sickness and aren't contributing to the community coffers regularly but still get the benefits of paying contributors, do you understand how difficult it is to sustain this program? the contributions yearly have been raised and it will be raised to keep up with inflation of health care services and the rising population of person's with chronic diseases and disabilities.
It's great that we have a system that caters to people that are in need of health care they can afford but whenever I see a substance abuse case having a "no balance billing" status because their hospital stay is covered by PhilHealth, I think to myself, hmmm.. these people made a lifestyle choice to do meth or be an alcoholic now everyone else has to pay for their health care for free while those that are able to sustain for themselves and be a functional member of society have to lift more weights.
I'm not totally against this program since it actually helps patients become more compliant to treatment knowing they can now afford the medications prescribed but some part of the system just stings when I get news about potential contributions to be raised because it's not sustainable.
What do you expect when you have a growing yearly population of senior citizens who can't work or people living with poverty? it's the working class that foots the bill and we are forced to pay our taxes right. I know most people couldn't be bothered about the issue until they themselves get sick and in need of some financial subsidy from the program.
I love the line "I know, but people voted for the people calling the shots so we just get the consequences of our decisions for a few more years until someone else takes over and hope for the best" - some random co-worker I know.
Thanks for your time.
unfulfilled government' promises?
More like budget reallocation to different priorities.
Lots of people are just headline readers. It's really best to hear both sides and understand what was the thought process leading to this scenario. Please feel free to correct if my understanding is wrong.
1.) Leftover budget from 2024 can be used in 2025. Philhealth was able to acquire budget good for 2 years and was able to utilize only around 63%. There is still around 150B Php left. https://www.gmanetwork.com/news/topstories/nation/930094/doh-philhealth-still-has-p150b-even-with-no-subsidy-in-2025/story
They say that the lack of government subsidy only means no additional funds allocated, but there is an assumption that Philhealth still has a budget.
For me, I think this is fine and a matter of fund utilization. If the main proponents for additional subsidy claims that it is still underfunded, then they can argue if they have better projections.
I support Universal Health Care even though I know the middle class (salaried workers) mostly finance it. I'm sure anyone is willing to pay more as long as they see the value of where their taxes go. I also agree that gov't should look into the incentivization aspect of such policies. There should be countermeasures in order for these not to be abused.
One of the real problems in our society is that the majority is not picking the right candidates for certain roles. Congress and Senate should have politicians who are great and give focus in creating better laws. Unfortunately, I would wonder how many % really understand their role. They only think of politics as a platform but they don't abide to having systematic fixes. Always band aid solutions and always biased towards their favor.
It's not a question of whether they can make it without the subsidy, it's more along the lines of giving the idea that funds are going to be enough to cover the liabilities. PhilHealth already has backlogs from paying private hospitals yet boast about having enough funds to cover it in reserve. It also recently increased the member contributions yearly while increasing their point of care entries for new members that may or may not be able to pay.
I pay for my Philhealth because it's automatically deducted from my salary but I'm not looking forward to using it because I don't want to get sick. Meanwhile, for people that aren't able to work for their shares get to use the benefits, fine, for humanitarian reasons and whatever, just hope they don't spin a narrative to increase the contributions again because they advertised more benefits while the same working class foots the bill.
Great points there. On one side, gov't says there is surplus, but on the ground there is still a delay in payments. It would be interesting to understand what is the source of these delays. Seems to me it's a Philhealth issue more than just a funding issue (from National budget). So if we give gov't subsidy, what is the guarantee that such budget will be utililized properly?
Maybe the missing piece here is on how GOCC performance like Philhealth is being measured? Of course, the measure should not be profit-driven but more on efficiency.
a.) How much budget has been utilized? Over/Under?
b.) Efficiency rating of Philhealth payments - is this comparable to HMOs as well, I've heard those are late too?
c.) Sustainability - how many years can Philhealth reserve funds cover? I believe there are typical measures already within the insurance/actuarial industry.
etc...
Based on the above, if these questions can be answered, then we can proceed to the question whether or not Philhealth deserves gov't subsidy.