Unutilized Philippine Health Insurance Corp. (PhilHealth) funds will now be rechanneled to greater universal healthcare (UHC) access, a move welcomed by the Department of Finance (DOF).

In a statement on Saturday, Sept. 20, the DOF commended President Ferdinand R. Marcos Jr. for ordering the return of the state-run PhilHealth’s ₱60 billion in excess funds. These funds had earlier been remitted to the national treasury under the 2024 General Appropriations Act (GAA).

The DOF said the President’s decision reflects PhilHealth’s improved financial performance and its expanded service coverage.

“The expansion of services requires the infusion of funds, and we in the revenue sector will do our job so that such an important public service will be financed,” the DOF noted.

The DOF explained that it had earlier recommended to the President the restoration of PhilHealth’s reverted funds, citing higher revenues that could sustain the expansion of benefits and services.

It also pointed out that the fiscal space allowing this move was made possible by the termination and suspension of certain flood control projects.

“The restoration of the money will allow PhilHealth to meet its Zero Balance Billing program obligations,” the DOF said.

Under the 2024 GAA, Congress directed the DOF to sweep idle and unused balances from government-owned and/or -controlled corporations (GOCCs) to help finance priority programs. Before carrying out the sweep, the DOF secured clearances from the Office of the Solicitor General (OSG), the Office of the Government Corporate Counsel (OGCC), the Governance Commission for GOCCs (GCG), and the Commission on Audit (COA).

Of the ₱60 billion remitted by PhilHealth, the largest share—₱27.45 billion—went to pay health emergency allowances (HEAs) of Covid-19 frontliners. Other key programs supported included:

- ₱10 billion for medical assistance to indigent and financially incapacitated patients;

- ₱4.1 billion for medical equipment procurement for Department of Health (DOH) and local government unit (LGU) hospitals and primary care facilities;

- ₱3.37 billion for three DOH health facilities; and

- ₱1.69 billion for the Health Facilities Enhancement Program.

Around ₱13 billion was also allocated for counterpart financing of foreign-assisted infrastructure and “social determinants of health” projects aimed at improving food security and accelerating the delivery of healthcare to remote areas.

The DOF said that the readjustment of funds has triggered an upward expansion of PhilHealth benefits.

“A combination of management change and system overhaul led to significant improvements in PhilHealth services to its members,” it added.

The DOF highlighted several notable enhancements under PhilHealth:

- Cancer treatment: Package rate for breast cancer patients rose from ₱100,000 to ₱1.4 million, a 1,300-percent increase.

- Dialysis & transplants: Dialysis sessions and medications are now free for an entire year; peritoneal dialysis coverage increased nearly fourfold from ₱270,000 to ₱1.27 million; kidney transplant reimbursements grew from ₱600,000 to ₱2.1 million; post-kidney transplant care for children expanded to ₱1.77 million in the first year and ₱810,732 in the succeeding year.

- Common illnesses: Severe dengue coverage increased from ₱16,000 to ₱47,000; cataract benefits surged over 826 percent from ₱20,200 to ₱187,100.

- Disability care: Therapy, rehabilitation sessions, and mobility aids for persons with disabilities (PWDs) are now covered up to ₱40,000.

- Children’s health: Optometric services for children up to 15 years old (₱2,500) and therapeutic care for severe acute malnutrition for children under 60 months (₱7,500 to ₱17,000) are now included.

- Major surgeries: Open-heart procedures such as ventricular septal defect and tetralogy of fallot (TOF) correction are now covered up to ₱614,000 each, while coronary artery bypass graft surgery rose to ₱960,000 from ₱550,000. Heart valve repair/replacement coverage now reaches up to ₱816,500 for pediatric patients and ₱825,000 for adults.

- Inpatient care: Benefits were expanded for neonatal sepsis (₱25,793 from ₱11,700), bronchial asthma (₱22,488 from ₱9,000), ischemic heart disease (₱523,853 from ₱21,900), and Covid-19 (₱55,000 from ₱43,997).

- Preventive care: Primary care services now cover preventive oral health care, with benefits ranging from ₱200 to ₱1,500 per tooth or visit.

With these reforms, the redirected funds are ensuring Filipinos gain broader access to healthcare while PhilHealth strengthens its ability to deliver on its mandate, the DOF said.

(Ricardo M. Austria)