The Philippine Health Insurance Corporation (PhilHealth) Technical Advisory Council (TAC) convened recently to discuss improving actuarial assumptions and refining disease coverage selection.

The meeting, led by PhilHealth president and CEO Dr. Edwin Mercado, centered on strengthening actuarial projections to benefit PhilHealth members.

Experts stressed the need for detailed, market-based assumptions to assess healthcare provider capacity.

“By improving our actuarial assumptions, we can better predict healthcare costs and utilization patterns,” Mercado said. “This means we can expand benefits in a sustainable way while ensuring members can actually access the care we’re promising.”

The TAC supported expanding coverage for high-cost, high-burden diseases to increase access to critical services. This aims to provide greater financial protection against catastrophic health expenses.

“Going granular means understanding if our current healthcare infrastructure can deliver the services we’re covering, and developing strategies to create robust markets where they don’t exist,” Mercado added.

He also stressed the importance of knowing the location and capacity of healthcare professionals to ensure members can access care without excessive out-of-pocket expenses or long travel times.

Council members committed to developing a framework to guide this expansion while ensuring service delivery capability.