Joint Statement of Medical Action Group and Action for Economic Reforms
The Medical Action Group and Action for Economic Reforms call the 2025 Corporate Operating Budget (COB) of the Philippine Health Insurance Corporation (PhilHealth) a “do nothing” budget. It’s a “do nothing” budget because it shows an increase of only 10 percent when its expenditure for 2024 was already higher by 22 percent over the previous year, with two months yet to go (Php 122 billion in 2023 vs. Php 155 billion as of October 2024). The new packages approved in the last six months are likely to increase reimbursements in 2025 to well over Php 200 billion.
Direct contributors–many of whom are from the working class, OFWs, and informal workers–are expected to cover Php 202 billion of the PhilHealth budget, which will cover their own reimbursements as well as the reimbursements of indirect contributors–the indigents, older persons, and persons with disabilities. Reimbursements by indirect contributors have exceeded those of the direct members in 2024, with seniors getting 30 percent of all reimbursements. This trend will likely continue in 2025.
PhilHealth’s 2025 COB can only support the existing packages since the increase of 10% from 2024 will be insufficient to cover the increase in benefits payouts which increased during the last six months of 2024. This limited budget will further delay any significant rollout of the primary care benefit package–the Konsulta package–that supports the mandate of the Universal Health Care (UHC) to register all Filipinos with a primary care provider.
Currently, Konsulta is providing reimbursements for only one percent of the Filipino population. The full implementation of the Konsulta package will cost PhilHealth Php 194 billion annually, providing a Php 1,700 primary care package for each of the 114 million Filipinos. The package was approved in 2022, and if it had been rolled out nationwide then, PhilHealth would not be accused of a “surplus” of Php 150 billion and reserves of hundreds of billions of pesos.
The Konsulta package can drastically change the face of primary care in the country, which the Department of Health (DOH) admits is underfunded. The country spends $6 per capita for primary care while average expenditure of primary care in ASEAN is $20 per capita a year.
Underspending in primary care has resulted in overcrowded government hospitals. DOH has reported that hospitals in Central Visayas, Eastern Visayas, and Bicol have occupancy rates of over 180%. This leaves no room for mass casualties and epidemic surges.
The actual premium contribution collected from 36,738,227 direct contributors now stands at Php 192 billion. Without any premiums for 25,340,992 indirect contributors from the government, the entire 2025 contribution of direct members will be fully expended next year on reimbursements alone. The bicameral conference committee’s defunding of PhilHealth destroys social health insurance, particularly the principle of solidarity and the pooling of resources, leaving the working class to carry the burden of funding PhilHealth through contributions deducted from their hard-earned monthly salaries.
In addition, even the full service coverage of longstanding and Sustainable Development Goals-related benefits and packages like the maternal care (covering only 50% of pregnancies) and newborn care package (covering only a third of all newborns) and TB (directly observed therapies or DOTS) Benefit (covering only 30,000 of 612,000 TB patients) will not be sufficiently funded in this status quo budget. This underfunding already manifests itself in the country’s increasing maternal and infant mortality rates, higher incidence of tuberculosis, and rising occupancy rates of DOH hospitals.
It is most shameful that the PhilHealth President, Emmanuel Ledesma, Jr. and concurrent PhilHealth Chairman, Health Secretary Teodoro Herbosa have condoned, and have even excused, the emaciated PhilHealth budget. We thus direct our appeal to President Ferdinand Marcos, Jr. to immediately correct this unfair and unlawful budget by ordering Congress to restore the full premium subsidy of PhP 150 billion for 25 million indirect contributors.#
