DBM disputes medical group’s claims on PhilHealth budget, coverage

The PhilHealth Local Health Insurance Office in Caloocan City.

MANILA, Philippines — The Department of Budget and Management (DBM) on Friday debunked the claims of the Medical Action Group about Philippine Health Insurance Corporation (PhilHealth) contributions, which may have caused panic among the state insurers’ members.

The group on Thursday said the DBM “unilaterally removed” the PhilHealth coverage for 30 million Pantawid Pamilyang Pilipino Program members, senior citizens, and persons with disabilities and their dependents in 2024.

“DBM has no power to reduce membership in [PhilHealth]. RA 10606 in Sec 29 authorized the payment of these premiums through the General Appropriations Act (GAA). In 2022 alone, 5.9 million claims were made by indirect members, or 15% of 39 million indirect members and beneficiaries. That will leave 30 million Filipinos without health insurance,” the group said.

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The DBM clarified that it cannot unilaterally remove the coverage or reduce the number of PhilHealth members.

“It may be noted that in the FY 2024 National Expenditure Program (NEP), which the Executive (through the DBM) submitted to Congress, [PhilHealth] has an allocation of P101.5 billion, of which P80.283 billion is for the National Health Insurance Program (NHIP), covering the annual premiums of 21,161,308 indirect contributors (exclusive of PAMANA beneficiaries),” the DBM said.

“We would like to emphasize that the DBM recommended the coverage of 21.1 million beneficiaries, and it was Congress, in the exercise of its power of the purse, that deemed it necessary to reduce the recommended budget of [PhilHealth] in the FY 2024 GAA to P61.5 billion, of which P40.283 billion is for the NHIP,” it added.

The DBM also said the Universal Health Care Act requires health insurance coverage for all Filipinos, so PhilHealth is also required to provide coverage to all Filipinos, whether they are direct contributors or not.

“To reiterate, the DBM is not reducing membership, it merely follows and executes the FY 2024 GAA. Further, Republic Act No. 10606 does not identify the specific number of beneficiaries which is subject to two conditions: 1) those identified by DSWD and 2) those included in the appropriations under the annual GAA,” it said.

“To note further, the said statement is plainly illogical. If only 5.9 million claims were made from the 39 million indirect members, then it does not mean 30 million Filipinos will be left without health insurance,” it added.

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Moreover, the DBM refuted the Medical Action Group’s statement that six million of the 30 million Filipinos deprived of health coverage will have to turn to local health services and pay for the services as local government units cover 10 percent of healthcare.

“This is another inaccurate claim. As the existing PHIC policy stands, Philhealth coverage does not mean 100% coverage of expenses and there are cases where there are out-of-pocket expenses. Even without a premium, indirect contributors may still be covered through the Point of Service allocation which is provided in the FY 2024 GAA,” the agency said.

The DBM said it is consulting its legal team for possible filing of legal actions against the Medical Action Group.

“This kind of dissemination of fake news exploits fears and anxieties, fostering mistrust between the government and the Filipino people,” it added.