PhilHealth STUDIES, or “Supporting the Thrust for Universal Health Care through Data, Information, and Knowledge-Exchange Systems,” held its Landscape Analysis on the “No Balance Billing” (NBB) policy in a press conference on Thursday.

As a collaborative grant management program between the DOST-PCHRD and PhilHealth, the press conference focused on safeguarding patients from additional hospital costs and identified implementation gaps that can be strengthened.

This project, along with the Enhancing Member Awareness press conference, is aligned with the PhilHealth Research Agenda, geared towards the production of evidence-based policy recommendations for PhilHealth that will support the implementation of the Universal Healthcare (UHC) Law.

The meeting was led by Dr. Michael Caampued of the Alliance for Improving Health Outcomes (AIHO), who evaluated whether PhilHealth’s No Balance Billing (NBB) policy effectively safeguards patients from out-of-pocket expenses and identified implementation gaps that can be strengthened.

“From a communications standpoint, enrollment in PhilHealth serves as a safeguard against health-related financial risks,” Caampued said in Filipino.

During the meeting, it was revealed that PhilHealth accounts for approximately 75 percent of total patient expenses, including another 10 percent addressed through government subsidies and mandatory discounts.

“Even if a patient lacks sufficient funds during hospitalization, they can still receive medical services under the policy,” Caampued added.

However, the study revealed that patients are still burdened with out-of-pocket costs, primarily for expenses incurred outside of hospitals.

This follows the need for a more comprehensive and well-defined NBB coverage that is applied consistently across healthcare facilities. Members also expressed the need for policies to be more responsive to changing circumstances and called for more frequent dialogues between PhilHealth, healthcare providers, and patient advocacy groups.

“PhilHealth is currently reviewing healthcare performance studies to identify areas for improvement and strengthen policy implementation,” Dr. Anne Remonte said.

Developments include aligning the PhilHealth financing in the public sector with existing government subsidies, depending on the availability of funds, where private hospitals should also enforce the DOH-PhilHealth mandates regarding basic ward accommodations.

Secondly, adjusting coverage using updated costing, streamlining subsidy eligibility, and working with partners to offer better service packages, including exploring fixed co-payments and coordinating with private insurers for non-basic services.

Additionally, the use of co-pay systems is for fairness and stability, strengthening cooperation with private insurance companies to standardize benefits.

“Facilities that fail to implement policies are not immediately penalized. The primary course of action is to issue formal communications reminding them that such practices are inconsistent with PhilHealth policies,” Remonte said.