Senator Alan Peter Cayetano criticized the outdated Philippine Health Insurance Corporation (PhilHealth) packages, which he said no longer account for high inflation and rising healthcare costs.
Cayetano directly raised this issue with Health Secretary Ted Herbosa during the Senate plenary debate on the Department of Health’s (DOH) 2025 budget recently arguing that the government’s commitment to a No Balance Billing policy had not been fulfilled.
“As Health Secretary and PhilHealth chairman, you should know this issue. When was the last time na nagkaroon ang PhilHealth ng comprehensive survey para sa case rates?” the veteran legislator asked Herbosa at the plenary floor.
The health chief replied that the survey was last accomplished a decade ago.
“Napag-iwanan na tayo ng presyo.”
In response, the seasoned lawmaker said, “Napag-iwanan na tayo ng presyo… I envy 2013 and 2014 where the case rates were close to the real price and people actually started believing in No Balance Billing. But now it’s a joke!”
The senator also scored PhilHealth for increasing its coverage rates by 30 percent earlier this year despite having an P89-billion excess fund, which he said could have been used to implement the No Balance Billing policy.
“The idea is that if I’m a patient and my treatment is covered by the case rate, I shouldn’t have to pay anything extra. I should be able to use my PhilHealth and go in and out of the hospital with no additional charges,” he said.
“But because the case rates are outdated, No Balance Billing is almost impossible,” Cayetano added.
He also pressed the DOH’s increased allocation of funds for the Medical Assistance to Indigent Patients (MAIP) when the department has stated that its priorities are to address the low rates of immunization, stunting of children, and maternal mortality.
Cayetano also lamented how the current DOH budget reflects more of the opinion of politicians rather than of scientists and doctors.
“Napopoliticize tayo.”
“Napopoliticize tayo. Politicians would rather have patients ask for help at may maibigay sila. Pero kung aayusin ang presyo (sa PhilHealth) at No Balance Billing, hindi na natin kailangan ng ganyang kalaking MAIP. The technocrats and doctors shouldn’t see it that way. You should fix it,” he said.
Cayetano urged Herbosa to update the PhilHealth case rates to reflect current healthcare costs and to shift focus from increasing MAIP funding to ensuring the effectiveness of No Balance Billing.
“You are the Secretary of Health and Chairman of the PhilHealth board. If you move the PhilHealth board to do the survey for case rates, kung aayusin natin sa taong ito, it’s going to be less hassle for everyone,” he told Herbosa, who agreed to look into the matter.
