The state-run Philippine Health Insurance Company (PhilHealth) should prioritize expanding benefits for its members over investments, lawmakers said Wednesday.

House Deputy Majority Leader and Ako Bicol Party-list Rep. Raul Bongalon and House Appropriations Committee Senior Vice Chairman and Marikina Rep. Stella Quimbo made the call after the PhilHealth briefing on his financial situation in front of the members of the chamber.

The briefing came as Congress decided to cut P74 billion in government subsidy to PhilHealth due to its billions in reserve funds.

“We appreciate the efforts to increase the overall benefit package on case rates, in which PhilHealth has committed to have a 50 percent increase by next month. We also asked them to commit to reducing the premium contribution, because the law is clear: if they have excess funds, they must reduce the premium contribution. But I would like to emphasize that now is the best time for PhilHealth to act as a health insurer,” Bongalon said.

“Hindi naman sila negosyo (They are not a commercial enterprise). You are a service provider (first). And so…I guess that’s the legacy that the President would like to leave, especially to the 115 million members of PhilHealth…(this) even without the government subsidy, sobra-sobra to operate PhilHealth. Ano gagawin natin sa pera (PhilHealth has plenty of funds even without government subsidy. What are they going to do with it)? We really need to use it and (for PhilHealth) to act as a health insurer to minimize hospital expenses (so that members can benefit and reduce their hospital expenses),” he added.

Bongalon said that with PhilHealth having at least P489 billion in investable funds as of November 2024, it is in the ideal position to answer the lawmakers’ call.

“What are we going to do with all this money? It’s all about prioritization. Investment should not be PhilHealth’s priority. His priority should be the expansion of health benefits for our fellow Filipinos. It’s about being efficient,” he added.

Quimbo agreed with Bongalon, saying PhilHealth’s spending target of P155 billion for its members’ benefits for 2024 alone is paltry considering the enormous amount of investable funds.

“Why do you accumulate so much investment funds?” This is a social health insurance program of PhilHealth, which is also an investment program of PhilHealth. And the reason is the very slow expansion of benefits,” Quimbo said during the briefing.

(Instead of a health insurance program, you are engaged in an investment program because your benefit expansion program is very weak.)

“Napakadami poses an implementation problem. Napakatipid ng pagtaas ng cas rate. Most important for hospitals. In this case, I will have to update my hospitals,” she added.

(You have a lot of problems with implementation, and members are taking a pittance on case rates. Your hospital dues are being paid late and you have accumulated a lot of these unpaid dues.)

In response, PhilHealth President Manny Ledesma said they are set to increase their spending target for member benefits to P271 billion in 2025.

“This year we are targeting around 155 (billion) pesos, 160 (billion pesos). And then next year it will be 271 (billion) pesos. It’s doable because we’ve already factored in all this expansion of benefits and increasing them to 80%,” he said.

Likewise, Ledesma said PhilHealth was already responding to the findings of the 2023 Commission on Audit that the public insurer recorded erroneous or duplicate data entries for 15.55 percent of registered beneficiaries, 266,665 registered senior members with duplicate entries and 4,062 deceased senior members still in the database.

“We need to bring it closer to the Department of Budget and Management and treat them (overpayments) as deferred credits. We can recover the amount and we are now in the reconciliation process,” Ledesma said.

“We will submit (the data) to the committee (once we recover the amount),” Ledesma added.—AOL, GMA Integrated News