Rise in PhilHealth reimbursements can’t keep up with hospital charges, PIDS says

THE Philippine Health Insurance Corp. (PhilHealth) recorded higher reimbursements in 2024, but these lagged the rapid rise in hospital charges, widening the gap in healthcare access between the rich and the poor.

“Hospital charges have increased significantly, decreasing the support value of PhilHealth,” the Philippine Institute for Development Studies (PIDS) said in a report on Jan. 7.

“This has likely contributed to the entrenched disparities in utilization of care among the rich and poor,” it added.

However, total reimbursements rose only 31.75% to P96.6 billion in 2024 from P73.3 billion in 2018.

“Despite this, overall PhilHealth support value and mean support value fell between 2018 and 2024,” it added.

As a result of the reduced support value, the portion of hospital bills not covered by PhilHealth had to be shouldered through alternative means — such as private insurance, medical assistance programs like the Medical Assistance to Indigent and Financially Incapacitated Patients, or direct out-of-pocket payments, it noted.

The “Utilization of Inpatient Care in the Philippines: Evidence from Social Health Insurance Claims Data” report was written by Sarah Reem D. Hesham Mohamed Hagag, Henrietta Marie M. Rodriguez, Frances Dominique V. Ho, Jhanna Uy, and Valerie Gilbert Ulep. — Aubrey Rose A. Inosante