PhilHealth Seeks P170B for 2027 to Boost Benefits, Reduce Out-of-Pocket Health Costs

The Philippine Health Insurance Corp. (PhilHealth) is seeking an additional P170 billion in the proposed 2027 national budget to help cover projected health insurance claims and expand benefits, supporting the government's aim to reduce Filipinos' out-of-pocket medical expenses. During a budget briefing for the Department of Health (DOH) by the Senate Finance Committee on Friday, PhilHealth president and CEO Beverly Lorraine Ho stated that the agency currently has P74 billion allocated under the 2027 National Expenditure Program (NEP). However, PhilHealth anticipates its payments for claims from indirect contributors to reach approximately P244 billion, prompting its appeal for an additional P170 billion. "For next year, currently, ang allocation po sa amin ay total 74 billion, but we expect, based on the projected payout po namin this year, our payments for the claims of indirect contributors will already be around P244 billion. So next year po, our appeal would be 170 billion on top of the 74 billion that has currently been provided to us by the NEC," said Ho. According to Ho, the additional funding would bolster efforts to expand PhilHealth coverage and increase its share of the country’s total health expenditure. Senator Joel Villanueva highlighted that 41.2% of total health expenditure in 2025 came from out-of-pocket payments, questioning how the proposed health budget would translate into lower costs for patients. PhilHealth aims to increase its share of total health expenditure from the current 19% to as much as 30%. "Yes, Chair. Yung increasing ng PhilHealth share to as much as 30% of the total health expenditure. Ngayon po kasi nasa 19% siya," said Ho. The agency has a realistic target of bringing down the out-of-pocket share to 37% by 2028, from the current 41%. "For the CARE hours, currently, as of end 2025, the percentage of out-of-pocket payment as share of total health expenditure is currently at 41%. Our realistic, I guess, target, based on the trend of how much is being allocated to PhilHealth and our payouts, realistically at 37% of total health expenditure by 2028," she added. Furthermore, PhilHealth intends to expand its zero-balance-billing (NBB) coverage, particularly in public hospitals. The current policy mandates that 90% of beds in public hospitals (excluding GOCC hospitals) should be NBB beds, while 10% of private hospital beds are covered by the mandate. PhilHealth said this translates to a target of 66,055 NBB beds nationwide—59,790 in government hospitals and 6,265 in private hospitals. Ho acknowledged, however, that implementation has been difficult in the past because hospital reimbursements were not always commensurate with the cost of services. She said PhilHealth is now working with hospitals to make NBB more workable, including through negotiations on rates and payment arrangements. The proposed 2027 budget also includes an additional P19 billion for PhilHealth, primarily covering Local Government Unit (LGU) hospitals, though this amount is not solely for zero balance billing. The funding is also earmarked for other programs, including mental health and severe malnutrition. Ho said the proposed amount would cover 368 LGU hospitals. PhilHealth’s data showed that it currently covers around 80% to 85% of the total bill in LGU hospitals. Ho noted that the agency is still working out the details of how the additional funding would be used, including agreements with hospitals to ensure that patients actually receive zero-balance billing where applicable. Villanueva, meanwhile, stressed the need for clearer communication so patients would know whether they would still need to prepare money for hospital bills.—LDF, GMA News