Reduce PhilHealth premium

Last January, PhilHealth announced that the members’ premium contribution will increase to five percent from four percent in 2024, in line with the Universal Health Care Act.

A few months later, it is claiming they have excess funds and willingly turned over P90 billion to DOF for inclusion in the pool created from a GOCC sweep to fund congressional pork barrel allocations.

If PhilHealth has excess funds, why are our premiums being raised other than because the PhilHealth law requires it?

We, members, must be paying too much in premiums. So, Congress must amend the law and cut the premiums Filipinos must pay PhilHealth.

Overpaying was confirmed by Rep. Stella Quimbo, an economist.  In a House committee hearing, Quimbo said PhilHealth already gets enough money annually from its earnings and appropriated budget.

“So, what is our evidence here? For example, 2023 reports would show that PhilHealth is expected to generate a gross margin of P173.4 billion only from the social health insurance program – not including income from investments,” she noted.

“Every year, they not only collect premiums from workers. They also get very huge appropriations from Congress,” she explained. Around P80 billion is allocated for premium subsidies, and P20 billion for benefit expansion.

However, the services given to beneficiaries do not at all match the huge earnings, as evidenced by the high out-of-pocket expenses by patients, Quimbo observed.

The right thing to do, Quimbo said, is for PhilHealth to annually submit to actuarial studies so that we can really compute the right and actuarially-fair premiums, this means the correct premium on the basis of utilization rate and on the basis of actual costs,” she told lawmakers.

The problem with PhilHealth is it is not professionally run. It is really an insurance company, providing us medical insurance. But the government is treating it like an ordinary government financial institution that politicians can milk any time. That is why PhilHealth has failed in its mission of providing universal healthcare. Something ought to be done to fix that.

PhilHealth has been used for the political purposes of whoever is in Malacañang. It will be recalled that during GMA’s time, they gave out a lot of PhilHealth membership cards as a means to buy political support. That was so unfair to the paying members.

That’s why they started allocating funds to cover what would have been the premiums of these political membership cards. Now they are taking that allocation away but not the obligation to serve so called indigents who are non-paying members.

There are so many things PhilHealth can do to help its paying members. The health maintenance requirements of senior citizens, for instance, should be covered. At the very least, the cost of an annual general check-up should be covered by PhilHealth. Those laboratory and radiological tests are quite expensive but one needs to know the state of one’s health. The younger ones don’t need these tests as often. I hardly took advantage of my company’s executive check-up privileges when I was young. After retirement, I needed those check-ups and I am on my own paying for all the costs.

BBM announced some increases in coverage for breast cancer patients. Well and good. But there are many other cancer cases requiring expensive diagnostic and treatment procedures. There should be a “dreaded” disease benefit readily available for PhilHealth members.

In the light of the massive health needs of our people, how can PhilHealth even have “excess” funds?

Medical tourism

Still on healthcare, it was recently reported that St. Luke’s and Medical City, two of the top private hospitals in the county, are now into medical tourism. That should be good news but on second thought, it could mean a wider divide in the provision of healthcare services between the country’s rich and poor.

Our top hospitals are already inaccessible for even our middle class, now they will become even more inaccessible as hospitals and doctors raise rates because they will now think in dollar terms. Medical tourism pricing will crowd out local consumption of high technology procedures.

That probably doesn’t matter for our country’s extremely rich. I once traveled to Singapore with a taipan who regularly visits the city state for his check-up. And he isn’t the only one. I have heard of others who would rather go to Singapore, Hong Kong or the US because they don’t trust what they can get here. From my own experience, we have pretty good doctors and specialists here. The problem is affordability for our rather thin middle class.

Medical tourism has emerged as a lucrative business opportunity in some of our neighboring countries. Thailand has established a niche for cosmetic surgery and sex change operations, while Singapore is attracting patients at the high end of the market for advanced treatments like cardiovascular, neurological surgery and stem cell therapy.

One study I read observed that “the link between a growing private, for-profit sector that caters to medical tourists and access to such services by local consumers without the ability to pay is elusive.”

I am not convinced medical tourism is good for us. It breeds more of the kind of medical practitioners that are even now so detached to the needs of our population. It will make our medical profession more elitist than ever.

I don’t like the idea that we must compete for the attention of our medical services providers who will be more preoccupied with the higher paying foreign patients.

Or put another way, the best of our doctors with credible foreign training and experience will be attending to foreign patients and we will be left with the second or third tier with less qualifications and little or no experience with new medical technologies. Kawawa naman tayo sa sariling bansa.

Boo Chanco’s email address is [email protected]. Follow him on X @boochanco.