PhilHealth urged to revisit 'indigent' definition

The Philippine Health Insurance Corporation (PhilHealth) should revisit the definition of the term “indigent” to better cater to Filipinos seeking health assistance, Senate President Francis “Chiz” Escudero said on Wednesday. 

“Insofar as the health of people is concerned, being indigent takes on a whole different meaning,” Escudero said. 

He stressed any person who is sick or who has a family member or loved one suffering from cancer, heart, kidney, or lung disease must be considered indigent. 

“Even if that individual is earning 28,000 pesos, 68,000 pesos, or even 100,000 pesos per month, given the daily expenses for food, housing, medicines, and other bills, that person is cancer indigent, heart disease indigent, lung disease indigent, or kidney failure indigent,” he further pointed out. 

Escudero said the government should consider a “new outlook toward healthcare.”

He then urged PhilHealth to take into account "the amount of contributions members are making on a regular basis" and align it to its current effort to adjust the case rates for inpatient members. 

Citing how various insurance products work, Escudero said the level of benefits received would vary based on how much premium is being paid by the clients.

In a Committee on Health’s public hearing, Escudero asked PhilHealth officials if they had calculated how much benefits a member should receive.

He criticized the lack of alignment between the actuarial study of contributions compared to the given benefits. 

“After several questions, why is it easy to say 30 percent? Why not 50 percent? Why not 100 percent? Is there an actuarial study that is based on?,” Escudero asked.

If the level of contributions to PhilHealth by employees was based on the amount of compensation they receive, Escudero questioned why PhilHealth has only a single case rate that applies to all members.

In 2013, PhilHealth started implementing the ‘All Case Rates’ policy following the fee-for-service provider mechanism.

Since then, most case rates have not been adjusted and so the PhilHealth Board, through PBR No. 2871, s. 2024 (Resolution Adopting a 30 percent Inflation Adjustment Factor for Select Case Rates), approved an inflation adjustment factor of 30 percent for existing case rates to account for price changes over the past decade.

Citing the current situation, Escudero lamented that most government employees are not considered indigent. 

“Whatever amount they earn, it’s never going to be enough to pay the medical expenses if you’re a cancer patient or if you need a heart operation,” he said. 

Escudero emphasized that saying “only indigent” will be assisted is “an old concept.”

He then argued that PhilHealth has sufficient funds to cover for the adjustments in its case rates as seen in the ballooning of its reserve fund over the years.

The country’s health insurer’s reserve fund has reached close to P500 billion, an amount that Escudero described as huge but left unutilized and is losing value due to inflation.

According to PhilHealth Circular No. 0003, s. 2014, the indigent is a person who has no visible means of income, or whose income is insufficient for family subsistence, as identified by the Department of Social Welfare and Development, based on specific criteria set for this purpose in accordance with the guiding principles set forth in Article I of the National Insurance Act of 2013.