Never the intention of its framers, PhilHealth enters 2025 with a bruised reputation. With zero subsidy from Congress, it has to rely on its savings to get by. Plus with the proposal for it to have a moratorium on collecting premiums, this can be a death sentence in itself to an institution that only 30 years ago, in 1995, was filled with promise when it was created by law to implement the State’s National Health Program. What happened to PhilHealth that led to its troubled state?

The creation of PhilHealth is our widely democratic (and loosely controlled) country’s foray into socialism, or the philosophy wherein economic systems are owned by the workers, not private businesses. There is a school of thought on whether democracy and socialism are compatible — the history of PhilHealth can be your test case, as well as other forms of social insurance in Philippines, such as SSS, GSIS, Pag-IBIG, and other mandatory deductions from your daily wages.

The concept of social health insurance dates back to the late 19th and early 20th centuries, emerging in response to the industrialization of society and the rise of urban poverty. Prior to this, most health care was paid for directly by individuals or was provided through charitable organizations. However, as industrialization brought about more hazardous working conditions, people began to realize that health care needed to be a collective responsibility.

The first significant development in social health insurance came from Germany under Chancellor Otto von Bismarck. In 1883, Bismarck implemented the Sickness Insurance Act, a pioneering move to provide workers with health coverage. This law established the principle of health insurance as a social right and required that workers contribute to a state-managed insurance fund. It was aimed primarily at industrial workers and became a model for other countries.

The spread of social health insurance systems to developing countries took longer, but the 20th century saw increasing efforts to extend coverage, especially as health conditions in these nations worsened due to poverty, lack of sanitation, and poor access to care. Countries like Brazil, Mexico, and the Philippines began implementing versions of social health insurance, often tailored to their specific needs and economic circumstances.

In the Philippines, social health insurance is meant to ensure that ordinary citizens, especially the underprivileged, have access to essential medical services, and aims to safeguard the health and well-being of individuals by offering affordable coverage for medical expenses. For the ordinary Filipino, particularly those in the lower-income brackets, paying out-of-pocket for hospitalizations, medications, and even basic health services can be financially devastating.

PhilHealth acts as a safety net, helping to cover the cost of medical treatments, from consultations to surgeries, thereby reducing the financial burden on individuals and families. PhilHealth is not just a convenience but a necessity. It allows for early detection and treatment of health conditions that may otherwise go undiagnosed due to the cost of medical care.

The decision by Congress to impose zero subsidy from the national budget for PhilHealth in 2025, and the proposed moratorium on premium collection, are blows to its ordinary operations, which, to my knowledge, have never happened before since its inception in 1995. It sends a strong signal for PhilHealth to clean up its act, as it has been always in the media for the wrong reasons. An efficient social health system should and can uplift the lives of ordinary Filipinos, not cause stress and pain in an already troubled public health system, which we all saw during the Covid years.

For comments, email him at darren.dejesus@gmail.com.