HMOs suffer P1.44 billion loss as benefits, claims surge

MANILA, Philippines — The health maintenance organization (HMO) industry swung to a net loss of P1.44 billion last year as benefits and claims by its members soared.

Latest data from the Insurance Commission showed that the HMO sector incurred a net loss of P1.44 billion in 2022 as against an income of P5.14 billion in 2021.

This, even as revenues improved by six percent to P56.51 billion as the industry increased its membership fees, which comprised 98 percent of the sector’s total revenues.

Last year’s net loss was attributed to the higher benefits and claims released by 25 HMO firms covered in the report, which jumped by 34 percent to P43.76 billion from P32.72 billion in 2021.

Eight of the 25 HMO firms incurred net losses, led by Maxicare Healthcare Corp. with P1.33 billion. Maxicare released the most number of benefits and claims last year at P18.67 billion.

Medicard Philippines Inc. also recorded a P955.63 million loss in its bottomline after disbursing P7.49 billion in benefits and claims.

Other HMO firms that suffered losses include EastWest Healthcare Inc., Forticare Health Systems International Inc., Health Care and Development Corp. of the Philippines, Health Delivery System Inc., Insular Health Care Inc. and Optimum Medical and Health Care.

Further, total assets handled by HMOs declined by 12 percent to P54.29 billion while total invested assets dropped by 41 percent to P16.66 billion. Liabilities also went down by nine percent to P43.22 billion.

HMO equity slipped by 23 percent to P11.07 billion while the industry’s total capital stock increased by 33 percent to P5.06 billion.

Firms regulated by the IC issued more than P20 billion in COVID claims since the start of the pandemic, with HMOs accounting for over a third.

HMOs are the second largest contributor to COVID-19-related payouts by the IC’s regulated entities since COVID started.

HMOs used to be monitored by the Department of Health until the late president Benigno Aquino III transferred regulation to the IC eight years ago.