MANILA, Philippines – Supreme Court Associate Justice Jhosep Lopez said that one of the mandates of the Universal Health Care (UHC) law was to ensure that “no Filipino family should suffer as a consequence of one’s sickness.”
The law was passed in 2019 — although discussions in the recently concluded oral arguments on the Philippine Health Insurance Corporation (PhilHealth) showed that the law’s potential has yet to be fully realized.
During the oral arguments at the SC, Lopez shared his own experience availing of coverage from the state insurer. He dealt with esophageal cancer two years ago, and the justice had to stay in the hospital for over two months after his surgery, racking up nearly P7 million in hospital bills.
“Justices of the Supreme Court shelled out money just to help me, and it’s not from PhilHealth. I got some money also from our healthcare provider, but [a] bulk of it, I got from Supreme Court justices who are more than willing to help their colleague,” said Lopez.
PhilHealth only covered P50,000 — less than 1% (only about 0.71%) of his total hospital bill.
Lopez also added that his post-surgery procedure, which cost P40,000 per session, was no longer covered by PhilHealth.
“I went to see PhilHealth personally,” he said. “I asked how much can be covered by PhilHealth and PhilHealth told me I’ve run out of money.”
“They cannot answer any of the P40,000… despite the fact that I have been regularly paying PhilHealth for the last… I’ve been in government service for more than 40 years,” Lopez added.
The UHC law was supposed to help lower out-of-pocket expenses for Filipinos, but this is still not the case for many. And unlike Lopez, not everyone is a justice of the Supreme Court.
Promise of 18%
PhilHealth Senior Vice President Renato Limsiaco Jr. said the state insurer is already working on improving its benefit packages, targeting to cover 18% of hospital bills by 2025 and up to 28% by 2028.
PhilHealth chief Edwin Mercado, who was appointed on the first day of oral arguments on February 4, also recently announced the increase of coverage in some of the insurer’s benefit packages.
Among these is the increased coverage for coronary artery bypass graft (CABG) surgery, which now amounts to P660,000 for standard risk cases and P960,000 for expanded risk. PhilHealth used to cover just P550,000 of the surgery.
Lopez was not the only one who shared his disappointing PhilHealth experience during the oral arguments. Katrin Jessica Distor-Guinigundo, one of the counsels of the petitioners, recently gave birth by emergency cesarean section.
“I was fully aware of the potential cost,” she said. “But I was nevertheless hopeful that as a consistent contributor for several years, PhilHealth would help decrease some of our expenses.”
“Regrettably, PhilHealth only shouldered less than 10% of our total expenses, constraining us to dip into our savings and settle the remaining amount.”
Emmanuel Ledesma Jr., Mercado’s predecessor, said that PhilHealth benefit packages were left untouched for over a decade. For instance, it was only in 2024 that the state insurer bumped up its coverage for breast cancer, which now stands at P1.4 million from the measly P100,000.
Out-of-pocket expenses remain high
Out-of-pocket expenses for Filipino patients remain high, according to data from amici curiae (friends of the court) or experts invited to share insights during the oral arguments.
Sonny Africa, executive director of Ibon Foundation, said that on average, PhilHealth only covers 10.2% of a patient’s hospital bill. At one point, in 2014, PhilHealth covered 19.4% of a bill — the highest in its history, Africa said.
To add to the burden of Filipinos, there are now also more private hospitals compared to public health institutions, making healthcare more expensive altogether.
PhilHealth fell under scrutiny after it was ordered to return P89.9 billion of unused funds in 2024 to help fund government projects listed under unprogrammed appropriations. This was met with uproar from the public, with many arguing that the funds should only be used to improve healthcare services for the Filipino people.
During the oral arguments, Limsiaco even admitted that the state insurer had failed to settle all pending claims before making the transfer.
Finance Secretary Ralph Recto defended the government’s move to collect idle funds, saying that it would be better off being spent on healthcare projects instead of bering left unused.
“We cannot in good conscience allow funds to languish in bank accounts as our nation’s needs multiply daily,” Recto said.
Africa said PhilHealth contributions are “greatly outpacing the claims being paid.” This means that the state insurer was receiving more from paying members versus the amount it was shelling out to help pay for health services availed of.
“That there is money on the table means that benefits have not been provided,” said economist Orville Jose Solon, another expert invited to the oral arguments.
“That’s equally deplorable than this whole idea of removing money away from PhilHealth.” – Rappler.com