Fixing PhilHealth and the future of Filipino healthcare

When you’ve walked the corridors of our hospitals for years, you develop a sixth sense for systems on the brink. It’s in the hushed conversations at the nurses’ station, the families quietly wondering if they can afford one more test, and the patients clinging to their PhilHealth cards like lifelines.

Yet, in government halls, decisions can seem detached. Cutting PhilHealth’s subsidy in the 2025 national budget may look tidy on paper, but the real cost will be paid in delayed care, shuttered clinics, and families teetering on financial collapse.

A system on the brink

PhilHealth is supposed to be the backbone of Universal Health Care (UHC), a promise that no Filipino would need to choose between their health and their future. But that promise has been repeatedly tested, and the subsidy cut threatens to widen existing cracks. Nearly 47 percent of health spending in the Philippines still comes directly from patients, far above the global average of 18 percent. Even insured families often face staggering bills, as PhilHealth reimbursements rarely cover the full cost of treatment. Families are left scrambling for loans — or forgoing care entirely.

In rural areas, where healthcare options are already scarce, PhilHealth’s delays hit especially hard. In past years, unpaid claims reached P21 billion, forcing smaller hospitals to delay payroll or cut services. These statistics represent parents delaying a child’s surgery, senior citizens skipping life-saving medication, and entire communities left behind. When families must choose between treatment and putting food on the table, the social fabric itself begins to tear.

Why modernization must go beyond the buzzword

PhilHealth’s eClaims system was supposed to streamline reimbursements and reduce inefficiencies. Instead, it has become a source of frustration, plagued by glitches, slow payments, and poor technical support. Digital systems are only as good as the infrastructure and training behind them. Without robust servers and sufficient bandwidth, even the best software will fail. Meanwhile, hospital staff and PhilHealth personnel need proper training to navigate and troubleshoot the system. Technology without capacity-building only worsens delays.

One critical improvement is introducing real-time dashboards that let hospitals and patients track the status of claims. Imagine the relief for a family if they could log in and see exactly when a claim has been processed or approved. Countries like India have shown how centralizing digital health systems can improve access and transparency, even in remote areas. Adapting those lessons could reduce administrative bottlenecks and let healthcare providers focus on saving lives.

Accountability and oversight

PhilHealth’s credibility has been battered by scandals and inefficiencies, leaving many skeptical of its ability to deliver. Restoring trust requires transparency and accountability. An independent oversight council — composed of representatives from the medical community, civil society, local governments, and private businesses — could regularly audit PhilHealth’s operations. Publishing key metrics, such as reimbursement turnaround times and backlog resolution, would ensure the public remains informed.

Leadership accountability is equally important. PhilHealth executives should be held to measurable targets, such as cutting reimbursement delays and reducing out-of-pocket costs. Leadership that consistently falls short must face real consequences, not polite apologies. Publishing these figures and addressing problems swiftly sends a clear message: mismanagement won’t be tolerated, and public trust isn’t negotiable.

Why the private sector should step in

Healthcare doesn’t exist in a vacuum. When communities are unwell, businesses suffer through reduced productivity, lower consumer spending, and instability. Companies that invest in healthcare aren’t just fulfilling social responsibility — they’re protecting their long-term viability. Tax incentives and matching grants could reward businesses that sponsor mobile clinics, preventive care programs, or vaccination drives. Meanwhile, tech firms could help refine PhilHealth’s systems, introducing analytics to flag bottlenecks and inefficiencies.

These public-private collaborations aren’t just about money — they’re about leveraging expertise. For example, retailers might sponsor free check-ups in the neighborhoods that sustain their business, strengthening ties to the community while improving public health. Healthy communities support strong economies, creating a virtuous cycle that benefits everyone.

Bridging the rural divide

Rural hospitals face unique challenges — delayed reimbursements can push them to closure. Prioritizing faster reimbursements for smaller hospitals is essential to ensure they can maintain staff and keep essential services running. Investing in reliable Internet connections for remote clinics is also crucial. Without connectivity, digital claims are nearly impossible to file.

Another key solution is investing in manpower development.Offering scholarships or loan forgiveness for healthcare workers willing to serve in underserved areas can ensure that even isolated communities have skilled professionals. These measures are simple but critical steps to prevent rural areas from falling further behind.

The way forward

PhilHealth is not a lost cause — it’s a foundation that needs careful rebuilding. To fulfill the promise of Universal Health Care, we must recommit to funding, modernize with purpose, and demand accountability from leadership. Collaboration across sectors, from private businesses to NGOs and local governments, is also vital. No single entity can solve these issues alone.

Every time I see a family weighing the cost of treatment against basic needs, I’m reminded of the promise PhilHealth was built on. It’s supposed to be a safety net, ensuring no Filipino is left behind. But if we don’t address its failures, that promise will remain out of reach for far too many.

Healthcare isn’t a privilege — it’s a right. Reforming PhilHealth isn’t just about fixing inefficiencies; it’s about honoring the commitment to protect every Filipino. If we stand together, we can still deliver on that promise. And that’s a future worth fighting for.