PhilHealth clarifies fund transfer to national government

MANILA, Philippines — In response to the allegation of former presidential spokesman Harry Roque that P90 billion in surplus Philippine Health Insurance Corp. funds was remitted to the Bureau of Treasury (BTr), PhilHealth defended its transfer of funds to the national government, saying it was given consent by authorities.

“The administration appears to be undermining the funding for UHC (Universal Health Care)’s implementation,” Roque noted in his July 6 column in The STAR.

Roque said that “the fund transfer between PhilHealth and BTr is illegal under Section 11 of Republic Act 11223 or the UHC Law.”

He pointed out that the UHC Law or Republic Act No. 11223, particularly Section 11, states that “...whenever actual reserves exceed the required ceiling at the end of the fiscal year, the excess of the PhilHealth reserve fund shall be used to increase the Program’s benefits and to decrease the amount of members’ contributions. No portion of the reserve fund or income thereof shall accrue to the general fund of the national government or to any of its agencies or instrumentalities, including government-owned or controlled corporations.”

PhilHealth vice president for corporate affairs Rey Baleña said: “We would like to clarify that said fund to be returned to the national government has been approved by our Board of Directors in compliance with the 2024 General Appropriations Act (GAA) as implemented by Department of Finance (DOF) Circular No. 0003-2024.”

“We did our due diligence on this, and received proper guidance from relevant government regulators,” he stressed.

Baleña pointed out that “only unused portion of the national government subsidy released to PhilHealth through the GAA as contributions of indirect contributors are the subject of this (transfer)” and that “no funds from contributions of paying members were included.”

“The crux of the matter really lies in our ability to use these funds, that is why PhilHealth is now in the midst of an aggressive benefit enhancement program which we started last year,” the PhilHealth official said.

He noted that with regards to UHC implementation, excess funds are indeed being used to increase benefits.

Baleña cited the increase in benefit package for hemodialysis. “We did not just expand to 156 (from 90) sessions, we even enhanced financial coverage to P4,000 (from P2,600) which translates to a total of P624,000 per patient per year,” he said.

Baleña likewise mentioned the rationalization of six packages for conditions that are high-burden diseases such as breast cancer (from P100,000 to P1.4 million), hemorrhagic and ischemic stroke, high-risk pneumonia, bronchial asthma and neonatal sepsis. For the rest of the case rates, PhilHealth said the increase was 30 percent.

“There will be more in the pipeline, including open heart surgeries, two more cancer packages and COVID-19 packages,” said Baleña.

Meanwhile, independent health reform advocate Dr. Tony Leachon said the DOF Circular goes against the spirit of the UHC Law.

“The excess PhilHealth funds that will be returned to the unprogrammed fund of the national budget are revenues from taxes on tobacco, vapes, alcohol and sugar-sweetened beverages, which are specifically earmarked for health programs,” Leachon said in a Viber message.

He said premiums of direct contributors increased this year for the first time since the COVID-19 pandemic and benefit packages have not sufficiently been expanded to reduce out-of-pocket expenditures, especially for the poorest of the poor.