RETHINKING OUR HEALTH INSURANCE SYSTEM
RETHINKING OUR HEALTH INSURANCE SYSTEM
Many years ago, when I was still the Director General of the National Computer Center (NCC), I approved the very first Information Systems Strategic Plan (ISSP) of the Philippine Health Insurance Corporation—PHILHEALTH. But before I signed off, I imposed one non-negotiable condition: the ISSP had to be designed for an insurance company, not for a welfare agency.
My argument was simple. If PHILHEALTH is an insurance company—as its charter clearly says—then it must operate on the strength of its premiums, its actuarial science, and its financial discipline. Insurance lives or dies by mathematics. Once you distort the assumptions, the whole model collapses.
Later on, I learned that PHILHEALTH quietly modified that ISSP to reflect a different worldview—that it was practically a quasi-welfare agency. In principle, I have no objection to the government paying for the premiums of indigent Filipinos. In fact, that is the correct approach. But even if the State subsidizes poor members, the core identity of PHILHEALTH as an insurance company should never be erased.
This is where the trouble began. When you treat PHILHEALTH like a welfare agency, suddenly the rules of insurance accounting become optional. And when the government begins to take money out of the fund—as if it were a convenient piggy bank—the integrity of the entire actuarial foundation is shaken.
But let us ask the basic question that no one seems willing to say out loud: Does PHILHEALTH’s money belong to the government? Or does it belong to its members?
I will say it plainly. PHILHEALTH funds are contributions from workers, employers, OFWs, and voluntary members. They are not government savings. They are not national revenue. They are trust funds held on behalf of the Filipino people.
The government may subsidize indigent members, yes. But that generosity should never be used as an excuse to turn PHILHEALTH into a welfare office or to interfere in its internal operations without transparency and consultation. And certainly, the practice of siphoning PHILHEALTH reserves to fund unrelated national priorities must never happen again.
In fairness to PHILHEALTH, it deserves the chance to defend itself from allegations of insolvency. But credibility cannot be restored by press releases. We need structural reform, not cosmetic messaging.
What exactly needs rethinking?
First, we need to move away from purely transactional fee-for-service models and shift toward preventive, capitated, and community-based care. We must reward health outcomes, not paperwork.
Second, decentralize stewardship. Allow LGUs and barangay health boards to co-manage funds, monitor service delivery, and prevent leakages. Local accountability often works better than distant bureaucracy.
Third, treat health as a public commons, not a commodity. Education, indigenous wellness practices, nutrition, and environmental health should all be part of the equation—not just bills in a hospital corridor.
Fourth, harness transparent, tech-enabled monitoring. Platforms similar to DIME, BuildTrust, or Bisto Proyekto can trace every peso, every result, every claim. Visibility breeds trust.
Finally, dignity must be the core metric. Does our system respect the patient? Zero Balance Billing sounds good on paper, but the poor should not be humiliated or neglected in our hospitals. Health insurance should restore dignity, not strip it away.
The future of PHILHEALTH must be modular, scalable, and community-informed. And reform should not be left to technocrats alone. The patient, the barangay health worker, the frontliner—all must have a voice.
Let us rethink the system not only to heal bodies, but to heal the social fabric itself.
RAMON IKE V. SENERES
www.facebook.com/ike.seneres iseneres@yahoo.com senseneres.blogspot.com 09088877282/07-24-2026