https://www.canva.com/design/DAGf0E0mKdw/L5uvveCwJK-GEPbvpo8M5A/edit?
utm_content
=DAGf0E0mKdw&utm_campaign=designshare&utm_medium=link2&utm_source=sharebutton
Philippine Health Insurance Corporation (PhilHealth), covering its background, Major
Final Outputs (MFOs), mission and vision, a topical discussion, and an analysis of the alignment
between its conceptual framework and actual practices.
1. Background of PhilHealth
The Philippine Health Insurance Corporation (PhilHealth) was established in 1995
through Republic Act No. 7875, known as the National Health Insurance Act of 1995. Its primary
mandate is to provide social health insurance coverage to all Filipinos within 15 years of its
inception, ensuring that every citizen has access to affordable and quality healthcare services.
PhilHealth operates as a tax-exempt, government-owned and controlled corporation (GOCC)
attached to the Department of Health (DOH). It serves as the administrator of the National
Health Insurance Program (NHIP), aiming to reduce the financial burden of medical expenses
on Filipinos.
philhealth.gov.ph
2. Mission, Vision, and Core Values
● Vision: "Bawat Filipino, Miyembro; Bawat Miyembro, Protektado; Kalusugan ng Lahat,
Segurado." This translates to "Every Filipino is a member; Every member is protected;
Everyone's health is ensured."
philhealth.gov.ph
● Mission: "Benepisyong Pangkalusugang Sapat at De-kalidad para sa Lahat," meaning
"Adequate and quality health benefits for all."
philhealth.gov.ph
● Core Values:
○ Integridad (Integrity): Upholding honesty and strong moral principles in all
actions.
○ Inobasyon (Innovation): Continuously seeking and implementing new ideas
to improve services.
○ Agarang Serbisyo (Prompt Service): Delivering timely and efficient services
to members.
○ Taos-Pusong Paglilingkod (Sincere Service): Serving members with
genuine care and dedication.
○ Pagmamalasakit (Compassion): Demonstrating empathy and concern for
members' well-being.
○ Angkop na Benepisyo (Appropriate Benefits): Providing suitable and
relevant health benefits.
○ Panlipunang Pagkakabuklod (Social Solidarity): Promoting unity and
mutual support among members.
philhealth.gov.ph
3. Major Final Outputs (MFOs)
PhilHealth's Major Final Outputs are centered around its primary function of administering
social health insurance services. These outputs are designed to achieve seamless service delivery,
strengthen results-based management, and ensure that health insurance benefits are accessible
to all members. The key MFOs include:
● Social Health Insurance Services: Ensuring that members receive their entitled
health benefits promptly and efficiently.
● Accreditation of Healthcare Providers: Maintaining a network of accredited
hospitals and clinics to deliver quality healthcare services to members.
● Member Management Services: Overseeing the enrollment, updating, and servicing
of member accounts to ensure continuous coverage.
philhealth.gov.ph
4. Topical Discussion
In recent years, PhilHealth has faced challenges that have significantly impacted its operations
and public perception.
● Financial Management Issues: Reports of fund mismanagement and fraudulent
claims have raised concerns about the corporation's financial integrity. These issues have
led to investigations and calls for reforms to enhance transparency and accountability
within the organization.
● Universal Health Care (UHC) Implementation: The enactment of the Universal
Health Care Act has expanded PhilHealth's role in providing comprehensive health
coverage. This expansion requires robust systems and increased funding to
accommodate the broader scope of services and the larger member base.
● COVID-19 Pandemic Response: The pandemic has tested PhilHealth's capacity to
support members during a public health crisis. The corporation introduced benefit
packages for COVID-19 testing and treatment, but faced challenges in processing claims
promptly due to the surge in demand.
5. Relation of Concept vs. Agency Practice
PhilHealth's foundational concept is to offer universal health insurance to all Filipinos,
embodying principles of social solidarity and equitable access to healthcare. In practice, while
significant strides have been made toward this goal, discrepancies exist between the ideal and
the actual implementation:
● Coverage vs. Accessibility: While PhilHealth aims for universal coverage, not all
Filipinos are aware of or able to access their benefits fully. Barriers such as lack of
information, complex processes, and geographical limitations hinder optimal utilization.
● Benefit Availability vs. Utilization: The range of benefits offered is comprehensive
on paper; however, members sometimes face difficulties in availing these benefits due to
administrative bottlenecks, delayed reimbursements, and issues with accredited
healthcare providers.
● Financial Sustainability vs. Service Delivery: The ideal of providing adequate and
quality health benefits is challenged by financial constraints exacerbated by
mismanagement issues. Ensuring the sustainability of funds while meeting the
healthcare needs of members remains a critical balancing act.
In conclusion, while PhilHealth's mission and vision set a commendable standard for universal
health coverage in the Philippines, aligning its practices with these ideals necessitates
continuous reforms, enhanced transparency, and a steadfast commitment to serving its
members effectively.
1. Background of PhilHealth
Established on February 14, 1995, through Republic Act 7875, known as the National Health
Insurance Act of 1995, PhilHealth was created to provide social health insurance coverage to all
Filipinos within 15 years. This initiative aimed to ensure that every citizen has access to
affordable and quality healthcare services. PhilHealth operates as a tax-exempt,
government-owned and controlled corporation (GOCC) attached to the Department of Health
(DOH).
philhealth.gov.ph
2. Mission, Vision, and Core Values
● Vision: "Bawat Filipino, Miyembro; Bawat Miyembro, Protektado; Kalusugan ng Lahat,
Segurado." This translates to "Every Filipino is a member; Every member is protected;
Everyone's health is ensured."
● Mission: "Benepisyong Pangkalusugang Sapat at De-kalidad para sa Lahat," meaning
"Adequate and quality health benefits for all."
● Core Values:
○ Integridad (Integrity)
○ Inobasyon (Innovation)
○ Agarang Serbisyo (Prompt Service)
○ Taos-Pusong Paglilingkod (Sincere Service)
○ Pagmamalasakit (Compassion)
○ Angkop na Benepisyo (Appropriate Benefits)
○ Panlipunang Pagkakabuklod (Social Solidarity)
These guiding principles reflect PhilHealth's commitment to providing accessible and quality
healthcare services to all Filipinos.
philhealth.gov.ph
3. Topical Discussion: Financial Status and Budget Allocation
In the fiscal year 2025, PhilHealth is operating with a corporate budget of PHP 284 billion,
notably without government subsidy. Despite this, the agency maintains financial stability,
attributed to its PHP 150 billion surplus and investment income. The budget allocation includes
PHP 271 billion dedicated to benefit claims and approved increases in case rates, representing
an 11% increase from the previous year. Administrative expenses are set at PHP 12.5 billion, a
modest 3% increase from 2024.
philstar.com
President Ferdinand Marcos Jr. has emphasized the importance of uninterrupted PhilHealth
services, instructing the Department of Health to ensure that the lack of government subsidy
does not affect healthcare delivery.
pco.gov.ph
4. Conceptual Framework vs. Agency Practice
PhilHealth's conceptual framework is built on the principle of universal health coverage, aiming
to provide equitable healthcare access to all Filipinos. In practice, the agency has made
significant strides toward this goal, achieving substantial coverage and offering a range of
benefits. However, challenges persist, including financial sustainability, efficient fund
utilization, and addressing healthcare disparities. The recent decision to operate without
government subsidy in 2025 tests PhilHealth's resilience and commitment to its mission.
Ensuring that financial constraints do not compromise service quality remains a critical area
where the agency's practices must align closely with its foundational concepts.
In summary, PhilHealth continues to navigate the complexities of providing universal
healthcare in the Philippines, striving to uphold its mission and vision amidst evolving financial
and operational landscapes.
PhilHealth (Philippine Health Insurance Corporation)
However, concerns have been raised regarding the sustainability of PhilHealth's funds without
government subsidies. Some groups argue that reducing or eliminating government support
could weaken the financial stability of the state health insurer, potentially affecting its ability to
provide comprehensive coverage.
rappler.com
- The budget is allocated for claims payments, administrative costs, and
healthcare improvement programs.
- Issues like fund mismanagement, fraud, and unpaid hospital claims affect its
financial stability.
In summary, PhilHealth plays a crucial role in the Philippines' healthcare system by
administering the NHIP, facilitating member access to healthcare services, and managing funds
sourced from member contributions, government subsidies, and sin tax revenues.
Understanding its functions, processes, and funding mechanisms provides insight into how the
agency operates to fulfill its mandate of universal health coverage.
