PhilHealth President and CEO Emmanuel Ledesma delivered his opening statement during a briefing with the House Committee on Good Government and Public Accountability on PhilHealth's zero subsidy in the 2025 national budget Tuesday, December 17, 2024.
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00:00Good afternoon, Honorable Members of Congress, esteemed colleagues, fellow public servants.
00:07Thank you very much for giving me the opportunity to address this inquiry and present the State
00:13of PhilHealth, a vital institution tasked with securing the health of every Filipino.
00:21As the leader of PhilHealth, I must acknowledge the challenges that persistently affected
00:27us as well as the progress we have made.
00:31Let me begin with a clear and candid statement.
00:36Despite areas that need significant work, PhilHealth is still a very healthy corporation
00:45at the moment.
00:47As of October 2024, PhilHealth holds a surplus of P150 billion pesos and a total reserve
00:57of P280 billion pesos, complemented by an investment fund nearing P490 billion as of
01:06November 2024.
01:10These figures clearly demonstrate that PhilHealth is financially robust, well-positioned to
01:18sustain operations, and fully capable of addressing the health care needs of our 115 million members.
01:27And we are steadily progressing with our objectives.
01:34In fact, we are about to implement another 50% increase in coverage for most of our case
01:42rate packages.
01:45That means that this year, we will have implemented a total of 80% increase across the board for
01:54almost all of the all case rate packages.
02:00Let me speak with candor, your honors.
02:03I am conscious that the PhilHealth institution has become a source of frustration for our
02:09colleagues in the government, particularly the legislators who are anxious for the well-being
02:17of your constituents.
02:20Those last six years before I was appointed to PhilHealth were particularly difficult
02:27as I understand.
02:30Leadership turnover, a new CEO almost every year, created instability and delayed much
02:41needed reforms.
02:45Critical challenges were compounded by even more issues that undermined public trust.
02:52During the last administration, PhilHealth has faced intense scrutiny and many of its
02:58shortcomings were exposed.
03:02These challenges brought us to a critical juncture, a need for comprehensive reforms
03:08at the corporation to rebuild both the institution and public confidence in it.
03:16It was in this context that I was appointed under the leadership of our beloved President
03:23Ferdinand Marcos.
03:26The vision for Bagong Pilipinas has given a clear mandate to bring about a renewed PhilHealth,
03:36an organization that is efficient and responsive to the needs of its members.
03:43This is not just a slogan for us, it is the why and wherefore of everything we do today.
03:56Over the past two years, we have taken significant steps to address these long-standing issues.
04:05First, we strengthened governance mechanisms to ensure that funds are properly safeguarded
04:13and channeled where they are needed most.
04:17Second, we launched initiatives to improve benefit delivery.
04:23Third, we have embraced digitalization to streamline our processes, minimize fraud,
04:31and make services more accessible.
04:35Under my tenure as President and CEO, our introduction of new benefits and enhancements
04:41of existing ones have been unprecedented in both speed and number.
04:50We began by adjusting the existing case rates by 30% last February 14 to account for inflation,
05:00ending a 12-year managerial shortfall.
05:05This review and adjustment to the old case rates meant fairer payments for high-cost
05:11treatments, addressing inequities that burden both patients and health care providers.
05:19The old case rates is set to be increased yet again, as I said earlier, by another 50%
05:25before the year ends.
05:30We have enhanced the Z-benefit package to include improved coverage for breast cancer
05:34– it is now up to $1.4 million from a low of $100,000 – post-kidney transplantation
05:41procedures and deceased organ donors.
05:45Hemodialysis sessions have been increased from 90 to 144 and most recently to 156 sessions,
05:56providing payments of up to $1 million per patient annually to provide more comprehensive
06:04support to patients with chronic kidney disease.
06:08Rationalized case rates have been introduced for critical conditions such as bronchial
06:13asthma, bacterial sepsis of newborns, ischemic heart disease with myocardial infarction,
06:20ST-elevation myocardial infarction and severe dengue.
06:25We also enhanced packages for acute myocardial infarction, bypass surgeries and heart procedures
06:31alongside upcoming coverage for emergency care and optometric services.
06:36Of the top 10 high-burden and mostly claimed health conditions that we have prioritized
06:41for rationalizations, we have so far completed enhancements of 7 packages with increases
06:49ranging from 1 to even more than 200%.
06:55We also released implementing guidelines for the rates adjustment of the inpatient benefits
07:01package for COVID-19.
07:04For children under 5 years old, we have rolled out outpatient therapeutic care services for
07:10severe acute malnutrition, demonstrating our commitment to holistic care.
07:17We also included critical benefits like mental health services, select outpatient services
07:23and expanded access to maternal and child health programs, thus ensuring care across
07:30all life stages.
07:34We have also added preventive oral health services under the CONSULTA program and assistive
07:42mobility devices for those requiring rehabilitation.
07:46Recently we introduced a package for rare diseases we called Z-Miracles, which is a
07:52new package for 10 rare diseases.
07:56We enhanced packages for acute myocardial infarction, bypass surgeries and heart procedures
08:02alongside upcoming coverage for emergency care and optometric services.
08:08Just yesterday, another set of enhancements was approved by the field health board.
08:15Very soon we will be able to provide coverage for emergency care, optometric services and
08:22heart surgeries.
08:23We will also be increasing coverage for heart procedures including bypass surgeries to ensure
08:29that critical cardiac needs are addressed.
08:32We have also enhanced benefits for cataract surgery and lens implantation.
08:38We are also now finalizing the guidelines for the enhanced packages for acute myocardial
08:43infarction on heart attacks, peritoneal dialysis and kidney transplants.
08:51Soon we will publish the circulars for these packages for the benefit of our providers
08:57and members.
08:59Additionally, the removal of the single period of confinement policy ensures greater accessibility
09:06to services.
09:08All of these reforms underscore field health's utmost dedication to addressing the evolving
09:15health care requirements of our members.
09:20These significant benefit expansions mark a substantial stride towards our commitment
09:27to providing affordable, accessible and quality health care for all Filipinos.
09:33Never before has the Corporation implemented such extensive enhancements in a year.
09:42This is such a banner year for your field health and we thank all of our fellow health
09:47advocates for bringing all of this fruition.
09:53I would like to give special mention to Honorable Speaker Martin Romualdez, who from the second
10:00day of my appointment has promised and has constantly delivered on his promise to fully
10:11support field health.
10:14Maraming salamat po Honorable Speaker Martin Romualdez.
10:19With these enhancements, we aspire to eradicate the financial burden of health care costs,
10:27facilitate timely access to essential medical services, and ultimately elevate the quality
10:33of life for our valued members, the Filipino people.
10:39We also embarked on a campaign that promotes the provision of primary care services for
10:45all our members with the Konsultasyong Sulit at Tama Program.
10:51The Konsulta Program now provides Filipinos with covered benefits such as consultations
10:57with medical professionals, laboratory tests, and essential medications.
11:05We have accredited 2,943 Konsulta package providers this 2024 and they help us register
11:14more than 27 million members to the Konsulta Program.
11:20More than 6 million of them have availed of their first encounter with their medical professionals.
11:28This measures a firmer commitment to making health care equitable, accessible, and sustainable
11:33for every Filipino.
11:36Beyond expanding benefits, field health remained a guardian of financial protection also.
11:43Over 50% of hospital claims are now reimbursed within 30 days on the average.
11:51This improvement reflects our dedication to make adjustments for efficiency.
12:00In the face of significant hurdles, therefore, including the absence of a national government
12:07subsidy in this year's budget, field health remains steadily on course in its mission.
12:17Our plans to continue expanding aggressively benefits in the coming year, in fact, remain
12:23unchanged.
12:28While subsidies have historically been vital to enhancing the program and strengthening
12:33the health care system, field health's financial health enables us to fulfill our obligations
12:41and continue providing benefits to members, both direct and indirect contributors.
12:48We do wish to manage expectations, but rest assured that for 2024, all benefits will be
12:57paid, including those for our most vulnerable members, senior citizens, indigents, persons
13:04with disabilities, rebel returnees, and other marginalized sectors.
13:10Walang dapat ikabahala ang ating mga kababayan.
13:14Sagot po kayo ng field health.
13:16What we can assure in any case is that field health management will optimize our resources
13:25and will safeguard every peso entrusted to us and make sure it is spent effectively and
13:32responsibly.
13:35While we have made progress, we acknowledge that much, much, much, much remains to be
13:41done.
13:43Rebuilding trust is not a one-time effort, but an ongoing process.
13:48We continue to engage stakeholders from health care providers to local government units to
13:54ensure that the benefits we promise are the benefits we deliver.
13:59We are proud of our milestones at field health.
14:02We also recognize that meaningful reforms require trust, collaboration, and time.
14:11Field health is bound by the provisions of the law, and significant changes, including
14:16streamlined decision-making, may necessitate legislative adjustments.
14:21We are committed to transparency and accountability as we navigate these challenges, with leadership
14:28rooted in competence and a clear vision for universal health care.
14:34All this is to say, universal health care is not ours alone to make it happen.
14:41As representatives of the people, your support and collaboration are critical for field health.
14:48U.S. sustainability hinges not just on internal reforms but, equally important, also on a
14:55shared commitment to prioritize health as a national agenda.
15:01While we are committed to continuing with the reforms we have begun, we hope to be able
15:05to rely on Congress to explore solutions, including alternative funding mechanisms that
15:12can bolster our capacity to serve the Filipino people.
15:16In closing, may I assure this august body that field health is determined to fulfill
15:24its mandate.
15:26Despite the challenge, we remain optimistic with continuous sound management, strategic
15:36reforms, and the collective effort of all stakeholders.
15:41I believe we can build a field health that is not just renewed, but truly worthy of the
15:47trust of every Filipino.