PhilHealth fund transfer: And then what?

A handful of us started sounding the alarm about the planned transfer of P89.9 billion from the Philippine Health Insurance Corp. or PhilHealth to the national treasury as early as the first week of July. It did not matter that we were like voices crying out in the wilderness. We could only speak out and pray that the issue would somehow reach the consciousness of many. And it has done that and more. The issue has caught fire and taken on a life of its own.

“Pagkain, kalusugan, trabaho” (Food, health, livelihood) are among the major concerns of Filipinos all over the country. Hence the transfer of so much money from PhilHealth, for use on “unprogrammed” projects of government, when much of the aspirations of our Universal Health Care Act have yet to be fulfilled; when most of our citizens have to shell out their own money for basic maintenance medicines that UHC is supposed to cover; when a multitude are still driven to financial crises when serious illnesses hit home; really felt like a major blow to our national heart. It is wonderful that many physicians’ organizations under the Philippine Medical Association as well as the Philippine Nurses Association, have signed an eloquent and emotional petition addressed to the President, pleading with him to reverse the order for the transfer. As health-care professionals, we see the suffering, the desperation, and we share the frustration of our patients for whom adequate, affordable health care is still elusive. Not a day goes by that we don’t hear of patients who forego tests, who delay visits to the hospital, who scrimp on medicines, and more, simply because they don’t have the funds to spare for such essential expenses that PhilHealth still does not cover or covers only a small fraction thereof. Yes, there is no doubt in my heart that P89.9 billion should not be taken from PhilHealth, and we are ready to question its legality in the Supreme Court. The money may be unused, but it is certainly not more than the actual needs of health care. It cannot be called excess. But say that it is returned to PhilHealth, then what? Will this result in the improvement of health-care funding? Will this translate to greater efficiency on the part of PhilHealth so that it will not have an obscene amount of unused funds sitting around when hospital reimbursements are still pending, and people must still shell out a considerable part of their hard-earned money for essential medicines, tests, and procedures? Things will not change unless major reforms are undertaken to address the systemic problems inside PhilHealth.

PhilHealth reform has been among my advocacies since 2005; more so after 2015 when I was appointed head executive staff for a short one and a half year period in the twilight of the administration of then President Benigno Aquino III. During my senatorial campaign in 2022, a PhilHealth overhaul was a major part of my platform. I find it wryly amusing that I am writing about this now.

The reforms should start with the board members. Our UHC Act states that all appointive PhilHealth board members must undergo training in health finance, health systems, costing health services, and health technology assessment. But as per inside sources, this is not yet being seriously implemented. Its information technology system has yet to be upgraded to the level befitting a national health insurance corporation. The qualifications of appointees to its top positions must be open for public scrutiny, especially given their sensitive positions and hefty salaries. PhilHealth must work with the Philippine Statistics Authority to ensure that as soon as persons pass away, they are automatically reported to PhilHealth so that unscrupulous groups can no longer charge for medical care rendered to dead people. It must also work closely with professional medical groups through regular consultations to keep health packages responsive to current realities. Corruption must be addressed and those responsible for mismanagement, malversation, and pilferage of PhilHealth funds should be held accountable once and for all. These are but some of the reforms needed.

But the problem isn’t just Philhealth. There are many good people inside PhilHealth. But even they cannot achieve UHC if many local executives resist the reforms necessary to implement UHC, and many politicians still insist on using health care for patronage politics, dangling it as a privilege in exchange for votes, rather than a right of every Filipino.

Yes, the P89.9 billion must be returned to PhilHealth so that it can be used to pay for health care, especially for the old, the poor, and the marginalized. But this must also be a wake-up call to all, particularly to our leaders in government. In the often ugly, compromise-filled “free-for-all” of realpolitik, some things should be held sacred for a country to prosper. Health is one of them.

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Dr. Ma. Dominga “Minguita” Padilla is a practicing ophthalmologist and health reform advocate. She is co-convener of Doctors for Truth and Public Welfare, and founder of the Eye Bank Foundation. She served as head executive staff of PhilHealth from March 31, 2015 to June 30, 2016 and as a spokesperson of the University of the Philippines Manila UHC Study group from 2017 to 2019. She is a recipient of multiple awards for her work in prevention of blindness, community service, COVID-response, and curbing insurance fraud.