State-run policy think tank Philippine Institute for Development Studies (PIDS) warned that while the use of Philippine Health Insurance Corp. (PhilHealth) outpatient benefits has grown significantly over the past five years, structural challenges continue to limit access, particularly in poorer and remote areas.

In a Jan. 7 discussion paper titled “Analyzing Outpatient Care in the Philippines: Evidence from Social Health Insurance Data,” researchers from PIDS noted that outpatient claims now make up a larger share of total PhilHealth claims, reflecting a shift toward outpatient services and expanded financial protection.

“The increase in the utilization rate may also be attributed to supply-side expansion enabled by the guaranteed financing from the PhilHealth,” PIDS said.

The paper, authored by Sarah Reem D. Hesham Mohamed Hagag, Henrietta Marie M. Rodriguez, and Valerie Gilbert Ulep, noted that while outpatient benefit use has risen, it remains uneven across local government units (LGUs) due to differences in service availability, geographic access, and awareness of entitlements.

The think tank added that the uneven distribution of PhilHealth-accredited primary care facilities helps explain lower utilization rates in poorer areas.

PIDS noted that outpatient benefits are mostly used by middle-aged and elderly patients, with day treatments—particularly dialysis for end-stage renal disease—making up about 60 percent of all outpatient claims, making it a major driver of PhilHealth’s costs.

To improve access and reduce costs, PIDS recommended investing more in preventive care, rebalancing benefit packages toward cost-effective primary health services, and expanding preventive screenings for hypertension and diabetes.

The think tank also urged broader implementation of curative care such as peritoneal dialysis, noting that the Yaman ng Kalusugan Program (YAKAP) remains limited and uneven nationwide.

PIDS emphasized that nationwide expansion of preventive services could lower long-term chronic disease costs and support the goals of the Universal Health Care (UHC) Act of 2019. It further recommended rationalizing outpatient benefits and strategically expanding the supply of services to address inequities.

Ultimately, PIDS urged the government to expand cost-effective outpatient benefits and ensure high-quality primary health care through incentives for remote areas, support for health workers in underserved communities, and measures to encourage both public and private providers to participate in the YAKAP program.