A new study under the PhilHealth STUDIES program, a joint initiative of the Department of Science and Technology – Philippine Council for Health Research and Development (DOST-PCHRD) and the Philippine Health Insurance Corporation (PhilHealth), reveals that while the PhilHealth No-Balance-Billing (NBB) policy significantly eases hospital costs, more consistent nationwide implementation is critical to eliminating heavy out-of-pocket expenses for vulnerable Filipino patients.

The research, titled “Landscape Analysis on the PhilHealth No Balance Billing,” was led by Dr. Michael Caampued of the Alliance for Improving Health Outcomes (AIHO). It evaluated the policy’s real-world execution across selected Department of Health (DOH) hospitals nationwide to identify gaps and areas for optimization.

While PhilHealth currently covers an average of 75% of hospital costs, the study highlighted that inconsistencies in how the policy is applied across different hospitals leave patients vulnerable to unexpected charges.

• Catastrophic Expenses: Approximately 22% of remaining out-of-pocket expenses are classified as “catastrophic”—meaning these large health costs severely impact and drain household finances.
• Implementation Disparities: Varied hospital-level practices directly affect how effectively patients are shielded from additional costs, underscoring the need for standardized enforcement.

“We need to support more research on aligning PhilHealth financing with available government subsidies to strengthen the implementation of the Universal Health Care (UHC) Act,” said DOST Secretary Dr. Renato U. Solidum, Jr. “Every Filipino deserves access to healthcare without being burdened by avoidable costs. We commend Dr. Caampued, his team, and AIHO for providing the data needed to guide these vital reforms.”

To transform these insights into action, the study outlines several actionable recommendations aimed at reducing the financial burden on patients:
• Unified Coordination: Stronger collaboration among PhilHealth, the DOH, and private insurers to provide more predictable hospital billing and robust financial safety nets.
• Rate and Access Updates: Regular updates to PhilHealth case rates alongside improved access to affordable medicines and emerging health technologies.
• Policy Consistency: Standardizing hospital-level compliance and expanding service coverage to aggressively drive down out-of-pocket spending.

Mr. Dennis S. Formadero, Acting Senior Manager of PhilHealth’s Corporate Planning Department, emphasized the agency’s commitment to these reforms during the presentation of the findings.

“Kailangan nating palawakin ang access sa tamang impormasyon, palakasin ang proteksyong pinansyal, at patuloy na pagbutihin ang ating mga serbisyo sa kalusugan (We must improve access to accurate information, strengthen financial protection, and continuously improve health services),” Formadero stated.

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About the PhilHealth STUDIES Program: The PhilHealth STUDIES (Supporting the Thrust for Universal Health Care through Data, Information, and Knowledge Exchange Systems) Program is a partnership between DOST-PCHRD and PhilHealth. It funds and supports rigorous research aimed at guiding evidence-based policies and improving healthcare delivery across the Philippines.