PhilHealth chief urges primary care reform to sustain benefit expansion

MANILA — PhilHealth's newly appointed chief has issued a stark assessment of the challenges facing the state-run health insurance provider, cautioning that aggressive benefit expansion without systemic reform could undermine the agency's sustainability.

The official pointed to the outsized burden of expensive treatments in the current benefit structure, noting that dialysis alone accounts for 15 percent or more of the insurer's total benefit payouts. This concentration of resources on costly tertiary care procedures raises questions about whether PhilHealth's coverage model adequately prioritizes preventive health services.

According to the PhilHealth chief, establishing a "working primary care system" is essential to manage costs and improve health outcomes across the country. A robust primary care network could reduce the need for expensive advanced treatments by catching diseases earlier and managing chronic conditions more effectively at the community level.

The remarks reflect ongoing tensions within PhilHealth as stakeholders push the agency to expand coverage to more procedures and populations, even as the insurer grapples with budget constraints. Health officials have increasingly emphasized that sustainable universal health care requires investments in preventive medicine and primary health services alongside expanded benefit packages.