ILOILO CITY — Preventable illnesses continue to drain public health funds in Western Visayas, prompting the Philippine Health Insurance Corp. (PhilHealth) to push harder for early consultations under its expanded primary care package.

As of 31 October 2025, PhilHealth has already paid out P790.64 million for moderate-risk pneumonia, P203.97 million for hypertension, and P153.09 million for chronic kidney disease, according to regional public affairs head Janimhe Jalbuna.

“These conditions could have been addressed much earlier,” Jalbuna said at a media forum Tuesday, stressing that many of the cases ballooned because patients failed to seek care while symptoms were still manageable.

Under the Yaman ng Kalusugan Program (YAKAP) — PhilHealth’s enhanced primary care benefit — members can avail themselves of free consultations, medicines, and basic laboratory tests. Even low-risk pneumonia, she noted, is treatable at the primary care level.

“But once pneumonia reaches the moderate stage, the patient needs hospital admission — and that’s when the costs spike,” she added. “If YAKAP is maximized, the overall picture of our inpatient payments would be very different.”

Dialysis still the biggest spender

For procedures, hemodialysis remains the top cost driver, with PhilHealth disbursing over P2.86 billion in claims. Jalbuna said the increase is tied to the expanded coverage — from 90 to 156 sessions a year — and higher benefit rates, leading to more availments.

Enrollment rising but still short of full coverage

PhilHealth data show that 36.5 percent of the region’s more than 8 million residents are now registered under YAKAP — equivalent to 93.49 percent of the 2025 target. Of these members and dependents, 772,739 or 56.28 percent have already completed their first patient encounter, a key requirement to activate the benefit.

The region currently has 210 YAKAP-accredited providers, including 138 rural and city health units, 52 government hospitals, and 20 private hospitals and clinics.

Jalbuna said the agency aims to reduce the burden of advanced illnesses by shifting more members toward early detection, preventive treatment, and regular primary care visits.