PhilHealth disburses over P217 billion claims payment in the first 9 months

The Philippine Health Insurance Corporation (PhilHealth) has released over ₱217.93 billion in benefit claims to healthcare facilities nationwide from January to September 2025, marking a 94.18% surge compared to the ₱112.23 billion disbursed during the same period last year.

According to PhilHealth, the sharp increase in payments underscores its strengthened financial support for Filipino patients and healthcare providers, reflecting major progress in its goal to deliver prompt and reliable reimbursement services.

Of the total amount, private hospitals and clinics received ₱127.79 billion, while public healthcare facilities accounted for ₱90.14 billion in reimbursements.

As of 30 September, PhilHealth reported an average claims processing time of just 22 days, a significant improvement that aligns with President Ferdinand R. Marcos Jr.’s directive to enhance the agency’s efficiency and performance.

The state health insurer attributed much of the expenditure to payments for catastrophic conditions under its Z Benefit Packages, which cover major illnesses such as heart disease, cancer, and kidney failure. Rising costs for high-demand treatments like outpatient hemodialysis also contributed to the surge, reflecting the growing medical needs of Filipinos.

To further modernize its payment systems, PhilHealth reiterated plans to transition to the Diagnosis-Related Group (DRG) payment model—a patient classification and reimbursement framework that groups cases based on diagnosis, treatment, and resource utilization.

“DRG will more accurately reflect the severity and resources required for patient care, ensuring healthcare providers are fairly and sustainably compensated,” said PhilHealth President and CEO Dr. Edwin M. Mercado.

PhilHealth assured the public of its continued commitment to accelerate claims processing through digitalization and streamlined systems, upholding its promise to be “Mabilis, Tapat, at Mapagkakatiwalaan.”