PhilHealth requests P170B for 2027 to enhance benefits, lower costs

Philippine Health Insurance Corp. (PhilHealth) is seeking an additional P170 billion in the proposed 2027 national budget to help cover the projected cost of health insurance claims and expand benefits, as the government seeks to reduce the amount Filipinos pay out of pocket for medical care.

During the Senate Finance Committee’s budget briefing for the Department of Health (DOH) on Friday, PhilHealth president and CEO Beverly Lorraine Ho said the agency currently has P74 billion allocated under the 2027 National Expenditure Program (NEP).

However, PhilHealth expects its payments for claims of indirect contributors to reach around P244 billion, prompting its appeal for an additional P170 billion.

“For next year, currently, ang allocation po sa amin ay total 74 billion, but we expect, based on the projected payout po namin this year, our payments for the claims of indirect contributors will already be around P244 billion. So next year po, our appeal would be 170 billion on top of the 74 billion that has currently been provided to us by the NEC," said Ho.

(For next year, our current allocation is a total of ₱74 billion, but based on our projected payouts this year, our payments for the claims of indirect contributors will already be around ₱244 billion. So next year, our appeal would be for ₱170 billion on top of the ₱74 billion that has currently been provided to us by the NEP.)

Ho said the additional funding would support efforts to expand PhilHealth coverage and increase its share of the country’s total health expenditure.

Senator Joel Villanueva pointed out that 41.2% of total health expenditure in 2025 came from out-of-pocket payments, asking how the government could ensure that the proposed health budget would translate into lower costs for patients.

PhilHealth said its share of total health expenditure is currently around 19%, intending to increase it to as much as 30%.

“Yes, Chair. Yung increasing ng PhilHealth share to as much as 30% of the total health expenditure. Ngayon po kasi nasa 19% siya,” said Ho.

(Yes, Chair. Increasing PhilHealth’s share to as much as 30% of total health expenditure. Right now, it is around 19%.)

Ho also said the agency’s realistic target is to bring the out-of-pocket share down to 37% by 2028, from 41% at present.

“For the CARE hours, currently, as of end 2025, the percentage of out-of-pocket payment as share of total health expenditure is currently at 41%. Our realistic, I guess, target, based on the trend of how much is being allocated to PhilHealth and our payouts, realistically at 37% of total health expenditure by 2028,” she added.

(Currently, as of the end of 2025, out-of-pocket payments as a share of total health expenditure are at 41%. Our realistic target, based on the trend of how much is being allocated to PhilHealth and our payouts, is 37% of total health expenditure by 2028.)

Zero balance billing

Ho said PhilHealth also wants to expand no-balance-billing (NBB) coverage, particularly in public hospitals.

Under the current policy, 90% of beds in public hospitals, except GOCC hospitals, are supposed to be NBB beds, while 10% of private hospital beds are covered by the mandate.

PhilHealth said this translates to a target of 66,055 NBB beds nationwide—59,790 in government hospitals and 6,265 in private hospitals.

Ho acknowledged, however, that implementation has been difficult in the past because hospital reimbursements were not always commensurate with the cost of services.

She said PhilHealth is now working with hospitals to make NBB more workable, including through negotiations on rates and payment arrangements.

P19B proposed for LGU hospitals and other programs

Ho also said the proposed 2027 budget includes an additional P19 billion for PhilHealth, primarily covering LGU hospitals, but clarified that the amount is not solely for zero balance billing.

The funding would also cover other programs, including mental health and severe malnutrition.

She said the proposed amount would cover 368 LGU hospitals.

PhilHealth’s data showed that it currently covers around 80% to 85% of the total bill in LGU hospitals.

Ho noted that the agency is still working out the details of how the additional funding would be used, including agreements with hospitals to ensure that patients actually receive zero-balance billing where applicable.

Villanueva, meanwhile, stressed the need for clearer communication so patients would know whether they would still need to prepare money for hospital bills.—LDF, GMA News