‘A JOKE’: Pia slams PhilHealth’s target 18% hospitalization coverage rate

National

A LAWMAKER slammed the Philippine Health Insurance Corporation (PhilHealth) for its plan to cover only 18 percent of hospital expenses by 2025.

Sen. Pia Cayetano criticized the coverage goal, stating that it falls short of the public’s basic expectations. She called the target “a joke,” pointing out that it disregards the purpose of the Universal Health Care (UHC) Law.

The senator made her remarks after PhilHealth’s statement during recent Supreme Court oral arguments, where the agency admitted it only aims to cover 18 percent of hospitalization costs next year.

PhilHealth also announced plans to increase the coverage to 28 percent by 2028.

“This is a joke,” Cayetano said, expressing frustration over the agency’s low target.

She emphasized that the UHC Law was designed to make healthcare more affordable for all Filipinos, not to provide minimal support.

PhilHealth Senior Vice President Renato Limsiaco Jr. made the statement during questioning from Associate Justice Jhosep Lopez, who pressed the official to explain how the agency is using its accumulated funds.

Lopez also questioned PhilHealth’s compliance with the UHC Law, which took effect in 2019 and promises financial protection and greater access to health services for all Filipinos, particularly the poor and vulnerable.

Cayetano, who chaired the Senate Committee on Health for nine years and handled the national health budget for the past five years, stated that the agency’s goal falls drastically short of the law’s mandate.

She warned that with such a low target, PhilHealth is failing its members and making healthcare more financially burdensome for ordinary Filipinos.

The senator pointed out that many Filipinos, especially those from low-income families, are already struggling with daily expenses, and a mere 18 percent coverage does little to ease their financial burden during illness.

She argued that the agency’s plan contradicts the spirit of the UHC Law, which aims to minimize out-of-pocket costs for patients.

Cayetano also highlighted PhilHealth’s access to substantial government funding. From 2014 to 2024, the agency received over P534 billion from sin tax revenues.

Given this level of support, she questioned why the agency could only commit to covering such a small portion of hospital bills.

To illustrate the real-world implications of PhilHealth’s limited coverage, Cayetano cited examples from the Supreme Court proceedings and her office’s experience.

Justice Lopez used his personal case to highlight the issue, revealing that when he fell seriously ill, his hospital bill reached P7 million, with PhilHealth covering only about 2 percent.

Cayetano also recounted the case of a mother who sought assistance after her infant was hospitalized for pneumonia.

The hospital bill reached P1 million, but PhilHealth only covered P25,000. Even if the bill had been lower, such as P100,000, the mother would still have needed to pay P75,000 out of pocket, she said.

The senator warned that discussions and hearings on the health sector’s funding would be meaningless if PhilHealth continued to set such low benchmarks.

She urged the agency to realign its goals with the full implementation of the UHC Law and deliver on its promise to protect Filipinos from the financial hardship caused by medical expenses.

Cayetano stated that it is unacceptable for an institution with billions in public funds to set goals that barely provide assistance to patients.(MyTVCebu)