Legarda urges adherence to new PhilHealth case rates

Senator Loren Legarda has urged the Philippine Health Insurance Corporation (PhilHealth) to ensure the strict and transparent implementation of recent benefit package increases. These include expanded coverage for ischemic heart disease, emergency outpatient services, and kidney transplants, alongside a 50% adjustment to select case rates. While welcoming these reforms, Legarda expressed concerns over PhilHealth's inconsistent execution.

“Although these reforms are welcome, we still need to see how PhilHealth will implement them effectively,” Legarda said, emphasizing that unclear case coverage fosters mistrust among members.

Legarda highlighted that many Filipinos, despite having PhilHealth coverage, hesitate to seek hospital care due to uncertainty about what will be covered.

“An ordinary Filipino, despite being covered by PhilHealth, feels insecure to go to the hospital because the amount PhilHealth will cover is often unidentified and, when provided, is often low,” she explained.

Focus on universal healthcare and financial transparency

The senator stressed that PhilHealth’s success lies in fostering confidence among members.

“True universal healthcare cannot exist if the coverage remains insufficient and uncertain,” she said, urging the agency to prioritize spending on healthcare services over financial investments.

“PhilHealth must reassess its organizational values and invest in our most valuable asset — our people’s health and trust,” Legarda added, reiterating that funds should directly benefit Filipinos.

Legarda also pointed out that the government’s decision to cut PhilHealth’s 2025 budget could impact informal sector workers who depend on subsidies from the General Appropriations Act. She called on PhilHealth to ensure these adjustments do not burden regular contributors.

Addressing delayed reimbursements

The senator expressed concern over delayed reimbursements to hospitals and healthcare professionals, urging PhilHealth to streamline claims processing.

“Delayed payments demoralize medical practitioners and hospitals and can lead to increased costs for patients,” she said.

Legarda recommended measures such as increasing case officers, digitizing claims systems, and establishing transparent mechanisms to track liabilities. She also called for simplifying and integrating the PhilHealth Konsulta program to ensure accessibility to primary care services.

Finally, Legarda emphasized the need for a comprehensive overhaul of PhilHealth operations to fulfill its mandate of universal healthcare.

“We must prioritize the health and well-being of our people over financial growth, streamline processes to improve service delivery, and ensure that the funds we allocate for healthcare are used effectively,” she concluded.