Dennis Gasgonia

Article (news)

Philhealth

Francis Orcio

ABS-CBN News

<p>MANILA — Dr. Edwin Mercado, Philippine Health Insurance Corp. president and CEO, on Wednesday unveiled sweeping reforms to make healthcare more affordable and accessible.</p><p>These include a major shift to primary care, faster claims processing, and a push to lower Filipinos’ out-of-pocket spending, all while seeking stronger collaboration with the private sector and exploring shared risk payments with hospitals.</p><p>Speaking before the Management Association of the Philippines (MAP), Mercado outlined a multi-pronged strategy to reduce Filipinos’ out-of-pocket health expenses, noting that despite universal health coverage on paper, actual access remains unequal. </p><div><a href="https://www.abs-cbn.com/news/health-science/2025/6/22/philhealth-s-support-for-kidney-transplant-patients-for-lifetime-doh-clarified-1302"><strong>Kidney transplant patients entitled to PhilHealth support &#x27;for life&#x27;, DOH clarifies<br/></strong></a></div><p>“It [does] not [automatically] translate to access. Kasi you go to a hospital, hindi naman available iyong service. You are given this opportunity to access healthcare in a region, hindi naman available iyong equipment. So it’s not automatically translated to access,” Mercado told business leaders.</p><div><a href="https://www.abs-cbn.com/news/business/2025/2/20/philhealth-now-covers-outpatient-emergency-services-1213"><strong>PhilHealth now covers outpatient emergency services</strong></a></div><div><br/></div><div><strong>BRINGING DOWN SPENDING </strong></div><p>He pointed out that 44 percent of health expenses of Filipinos still come from their own pockets. </p><p>“Health economics states that we should be lowered down to 25 percent. Even the middle class will feel as just a sickness away from poverty,” he said.</p><p>Mercado said PhilHealth is now pushing to raise its support value so basic accommodations, which are the wards, in the government and even in the private sector hospitals, are covered.</p><p>Currently, PhilHealth covers up to 85% in public hospitals but only around 35-45% in private hospitals. </p><p>“So, our intent is really to bring it down to 25 to 35 [percent],” Mercado said, referring to the target out-of-pocket share. </p><div><br/></div><div><strong>PIVOT TO PRIMARY CARE AND EARLY DETECTION </strong></div><p>Part of PhilHealth’s new push is shifting from a hospitalization-centric model to preventive primary care.</p><p>“So, ipi-pivot nga po namin into primary care. Manatiling malusog para hindi po tayo gumastos ng mga healthcare expenses. So, ang mabibigyang pansin po namin ay preventive,” Mercado later told reporters. </p><p>(We will pivot to primary care. We will stay healthy so we will not have to spend on healthcare expenses. So we will focus on preventative)</p><p>The agency’s budget for primary care jumpedto P35 million-P40 million this year from just P1.8 million last year to expand the Konsulta program, which now includes screening for cancers and lifestyle diseases.</p><div><a href="https://www.abs-cbn.com/news/health-science/2025/3/21/philhealth-scraps-45-day-benefit-limit-1128"><strong>PhilHealth scraps 45-day benefit limit</strong></a></div><p>“Not all the patients will require medicines. Not all patients will require labs. Not all patients will be sick. The very concept of a primary care keeper is to make sure you stay healthy and not get sick. Because this is not going to be sustainable,” he explained. </p><p>He cautioned that PhilHealth is expecting to pay out P70 billion to P80 billion by next year for benefits, saying it is critical to reduce hospitalization so savings can be diverted to primary care. </p><div><br/></div><div><strong>FASTER CLAIMS PROCESSING</strong></div><p>Mercado also announced measures to ease hospitals’ administrative burden and improve payment speed. Among these is an “amnesty” on nearly P9 billion in claims from January 2018 to December 2024 that were delayed due to late filing.</p><div><a href="https://www.abs-cbn.com/news/health-science/2025/6/22/philhealth-s-support-for-kidney-transplant-patients-for-lifetime-doh-clarified-1302"><strong>Kidney transplant patients entitled to PhilHealth support &#x27;for life&#x27;, DOH clarifies</strong></a></div><p>The agency also scrapped the 45-day confinement cap, citing that PhilHealth now pays via case rates.</p><p>He also revealed that compliant hospitals might soon enjoy payments as fast as seven days, with PhilHealth piloting a “post-audit” for trusted providers. </p><div><br/></div><div><strong>A &#x27;NEW&#x27; PHILHEALTH </strong></div><p>Mercado said it will take about two to three years to fully complete PhilHealth’s reorganization, aligning it with its expanded mandate under universal healthcare. </p><p>&quot;Mas bibilis po iyong claims payment kasi meron po kaming bubuoing separate na benefit claims group kung saan po talaga ang focus nila ay iyong benefit claims,” he said. </p><p>Meanwhile, with zero subsidy for this year from the national budget, Mercado said they have appealed to Malacañang and Congress for additional funding for 2026.</p>

<p>Dr. Edwin Mercado, Philippine Health Insurance Corp. president and CEO, on Wednesday unveiled sweeping reforms to make healthcare more affordable and accessible.</p>

Dr. Edwin Mercado, Philippine Health Insurance Corp. president and CEO, on Wednesday unveiled sweeping reforms to make healthcare more affordable and accessible.

PhilHealth pivots to preventive care to cut costs, keep Filipinos healthy under new reforms

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PhilHealth pivots to preventive care to cut costs, keep Filipinos healthy under new reforms

Francis Orcio,

ABS-CBN News

Published Jul 16, 2025 09:08 PM PHT

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