Around 70 medical societies and healthcare organizations on Friday, July 19 urged President Marcos to order the return of the P89.9 billion unused funds to the Philippine Health Insurance Corp. (PhilHealth) for the individual healthcare needs of the poor.

An appeal was signed by the organizations led by the Healthcare Professionals Alliance Against Covid-19 (HPAAC) demanding urgent intervention to safeguard and properly utilize the P89.9 billion unused funds, that had been diverted to the National Treasury.

“We denounce the failure of the Philippine Health Insurance Corporation to use its reserve funds as prescribed by the Universal Health Care (UHC) Act. This has led to insufficient patient benefits, unnecessary increases in premiums, and an ‘inappropriate fund excess’ that could have been used for the health care of individuals in need of financial aid,” the groups said.

The groups explained that PhilHealth's unspent funds should not be labeled as excess funds, saying the funds have accumulated due to PhilHealth's “inefficiencies.”

They added that PhilHealth has not adequately expanded its benefit packages or reduced out-of-pocket expenses as required by law, leading to underspending rather than a deliberate surplus.

“Every day, we see patients deprived of essential healthcare due to the inefficiencies within our social health insurance system,” they said.

“It is incomprehensible how PhilHealth can accumulate such an excess of funds while so many Filipinos suffer without the care they desperately need,” they added. 

They suggested reforms, which include “an urgent increase in the scope and coverage of inpatient benefits, outpatient benefits, including benefits for preventive care,” and “provision of premium relief or reduction for those in difficulty.”

They also called for “immediate enhancement of benefit development capacity within the corporation, using existing government research and academic institutions in the interim, and forming an independent agency for this if necessary.”

The groups also pointed out the importance of easing bureaucratic burdens in claims processing to encourage prompt delivery of essential primary care services, particularly for the poor.

They also denounced the decision of the Department of Finance (DOF) to divert P89.9 billion from PhilHealth’s funds for purposes other than the healthcare needs of Filipinos.

“We strongly believe that this move by the DOF violates Section 11 of the Universal Healthcare Act (Republic Act 11223) which states that ‘the excess of the PhilHealth reserve fund shall be used to increase the Program’s benefits and to decrease the amount of members’ contribution; no portion of the reserve fund or income thereof shall accrue to the general fund of the National Government or to any of its agencies or instrumentalities, including government-owned or -controlled corporations,’” they added.

They also noted that remitting PhilHealth’s fund to the national budget violates Republic Act 11346, which specifically designates revenues from excise taxes on tobacco products and sugar-sweetened beverages solely for PhilHealth’s Universal Healthcare program.

In addition, the organizations highlighted concerns over potential repercussions if the government retracts subsidies intended for premium payments to disadvantaged populations. 

They said that such actions would disproportionately burden formal payors who are already financially strained.

They urged the President to issue a directive promptly returning the P89.9 billion unused fund to PhilHealth.

The urgent need for decisive measures to enhance health benefits across the board was also raised.

They proposed the formation of an independent agency if necessary, tasked with overseeing the efficient allocation and utilization of healthcare funds to ensure equitable access and improved healthcare outcomes nationwide.