DOH pushes UHC Law amendments to fix health financing gaps

THE Department of Health (DoH) on Monday pushed for sweeping amendments to the Universal Health Care (UHC) Act to address bottlenecks in the implementation of health financing and expand the Zero-Balance Billing program.

In a hearing, Health Undersecretary Albert Francis E. Domingo said several provisions of the UHC law need to be amended to expedite the use of funds and make the implementation of programs at the local level more effective.

“To fully realize Universal healthcare, our current legal frameworks must evolve,” Mr. Domingo told lawmakers.

Among the amendments the DoH pushed are changes to premium rates of the Philippine Health Insurance Corp. (PhilHealth), use of reserve funds, strengthening of Special Health Funds, and improvement to the National Electronic Health Record System.

Mr. Domingo said that a broader Zero-Balance Billing expansion is also important, which is why the department will submit a proposal of around P15 billion in the next budget season.

“We are actually going to propose, when the budget season comes at the right forum, for around P15 billion,” he said.

Currently, Mr. Domingo said that 83 DoH-retained hospitals and government specialty centers are covered by the Zero-Balance Billing policy, which aims to eliminate additional patient costs for basic hospital accommodation.

The DoH also reported that 6.3 million Filipinos have been reached by the PuroKalusugan Program in 8,435 Barangays, including 110 UHC integration sites and more than 36,000 health infrastructure projects nationwide.

“One hundred percent… is our coverage. But the question is, do all Filipinos know if they are a member? Our current percentage, based on the Year 1 UHC Survey 2024, is at 74.5%,” Mr. Domingo said.

The department also continues to expand its Bagong Urgent Care and Ambulatory Service Centers or BUCAS Centers, which have reached 62 facilities in 37 provinces and seven highly urbanized cities, serving 1.61 million Filipinos.

Meanwhile, PhilHealth President Edwin M. Mercado stressed the need for a larger baseline budget as the agency continues to expand its healthcare benefits.

“The key here is access, and access will depend on the supply side,” Mr. Mercado said.

According to him, PhilHealth’s average claims turnaround time has decreased by 46%, from 34.44 days in 2023 to about 18 days currently, with a target of 15 days this year.

PhilHealth also expects to process up to 22 million claims this year, while total benefit payments are estimated at P369 billion.

PhilHealth also expanded the YAKAP Primary Care Program, with about 55 million Filipinos now assigned as primary care providers in 4,287 accredited clinics.

“Last year, we focused on engaging the private sector to also deliver care because they are the main access point of our direct contributors,” Mr. Mercado said in Filipino.

He also said that PhilHealth has projected its benefit expansion over the next three years, in line with its target of reducing Filipino’s out-of-pocket health spending to about 27% to 38%.

However, Mr. Mercado stressed that achieving this goal would not be able to roll out additional benefit programs, adding that PhilHealth would align its benefit payments with revenues collected to ensure financial sustainability.

SPECIAL HEALTH FUND
Lawmakers, meanwhile, questioned the current structure of the UHC Law’s financial system, particularly the distribution and management of the Special Health Fund across local government units.

During the hearing, Party-list Representative Henry F. Oaminal, Jr., cited Singapore’s MediFund as an example of a centralized health assistance system and asked whether similar centralized mechanisms could be considered for the Philippines while balancing decentralization under the UHC framework.

Mr. Domingo said the main challenge lies in financial integration, not technical implementation.

The DoH also explained that conflicts arise because health facilities generate reimbursement but do not fully control how these funds are later allocated under the Special Health Fund.

“They work on reimbursement, but they don’t control where the funds go,” Mr. Domingo said in Filipino.

To address this, the DoH proposed the creation of a UHC Coordinating Council that would help resolve disputes on fund distribution and set clearer guidelines for allocating health funds. — Pexcel John Bacon