The government-ordered revamp of Philippine Health Insurance Corp. (PhilHealth), which aims to address inefficiencies and operational challenges within the state health insurer, will last up to three years before services see substantial improvements.

Last month, the Governance Commission for Government-Owned or Controlled Corporations (GCG) ordered the restructuring of PhilHealth as a measure to rectify the agency’s outdated workforce, fragmented data, and issues related to strategy execution and benefits claims. 

The revamp will update PhilHealth’s organizational structure to include 503 units and 7,149 positions.

The GCG stated that this is designed to improve service delivery and fulfill the agency’s expanded mandate under Republic Act (RA) No. 11223, also known as the Universal Health Care Act.

As part of the restructuring, the GCG has ordered the streamlining of PhilHealth’s finance, legal, information technology, procurement, human resources, and general administration services.

“The centralization of these administrative functions is seen to address the inconsistencies and conflicts in the current operational framework of PhilHealth,” it said.

PhilHealth President and Chief Executive Officer (CEO) Edwin Mercado stated that the agency has been given one year to implement the changes outlined in the GCG order. 

Within this period, Mercado said PhilHealth will update the organizational structure among employees, deciding the lines and limits of authority.

However, he said the total revamp will take two to three years, as the agency will still need to match previous positions with the new roles ordered by the CGC, as well as open new positions to interested applicants.

Once PhilHealth completes its full overhaul, Filipinos can expect faster services, including quicker processing of the tedious claim payments.

Mercado said the restructuring will introduce the benefit payment appeals office to improve efficiency in the disposition of benefit claims and reduce turnaround times.

Based on the GCG order, PhilHealth was also tasked to strengthen its internal audit office in response to the complexity of its operations.

To ensure checks and balances, the GCG said that the office shall report to the Audit Committee of the Board of Directors and shall administratively report to the PhilHealth head.

To further strengthen PhilHealth, Mercado said the agency will appeal for government subsidy in the upcoming budget deliberations in Congress.

To recall, the state health insurer received zero subsidies for this year’s budget. The agency continues to operate due to its retained earnings and surplus funds.

“Based on the benefit payments that we expect for the next year, we are really asking for additional funds,” he told reporters.

If they get additional funding from the government, Mercado said PhilHealth will utilize this to bolster its collection efficiency.

He said the agency’s revamp will also get funding, although nothing has been earmarked so far.