DBM cannot unilaterally remove PhilHealth coverage

As Medical Action Group co-chair and Universal Health Care (UHC) advocate I am appalled at the action of DBM to reduce indirect contributors in PhilHealth (PHIC) this year (2024) to P10.626 million. During budget deliberations on Sept. 4, it was disclosed that PHIC’s request to fund the premiums of 25.2 million indirect contributors was reduced to P10.626 million by DBM during its technical budget hearings last year. This has resulted to 14 million 4Ps, seniors, PWDs losing their PHIC membership because government will no longer pay their premiums. In contrast, in 2022 PHIC covered 39 million indirect members and dependents.

DBM has no power to reduce membership in PHIC. RA 10606 in Sec 29 authorized the payment of these premiums through the GAA. In 2022 alone, 5.9 million claims were made by indirect members or 15 percent of 39 million indirect members and beneficiaries. The reduction in membership numbers this year will leave 30 million Filipinos without health insurance.

“SEC. 29. Payment for Indigent Contributions. – Premium contributions for indigent members as identified by the DSWD through a means test or any other appropriate statistical method shall be fully subsidized by the national government. The amount necessary shall be included in the appropriations for the DOH under the annual General Appropriations Act.” (RA 10606, 2011)

Public health statistics show that up to 20 percent of the population need health services in a year and five percent need hospitalization. This means that six million of the 30 million deprived of health coverage will have to turn to local health services and pay for the services out of pocket. Since LGUs only cover 10 percent of health care, that leaves the poor, elderly and PWDs with 90 percent out of pocket costs.

RA 10606 requires premium payments to be updated before availing of benefits:

“SEC. 12. Entitlement to Benefits. – A member whose premium contributions for at least three (3) months have been paid within six (6) months prior to the first day of availment, including those of the dependents, shall be entitled to the benefits of the Program: Provided, That such member can show that contributions have been made with sufficient regularity: Provided, further, That the member is not currently subject to legal penalties as provided for in Section 44 of this Act.”

This means that PHIC will be able to pay the benefit claims of up to 30 million members and dependents this year, based on projected membership.

Medical Action Group and UHC advocates have called for a stop to anti-poor policies like these, including the removal of P89.9 billion from PHIC by Congress. The Executive branch led by the DBM and DOF are undermining the full and strict implementation of the UHC law by reducing coverage by PHIC of the poor, elderly and vulnerable sectors of the population. — Juan A. Perez III, MD, MPH, Medical Action Group co-chair, UHC Collective advocate