Over ?217.93 billion in benefit claims were released to various healthcare facilities nationwide during the first nine months of 2025 by the Philippine Health Insurance Corporation (PhilHealth) – a figure that represents a 94.18 percent increase compared to the same period last year.
In a statement, PhilHealth emphasized that the surge in payments reaffirms its strengthened financial support for both Filipino patients and healthcare providers. They added, this also marks a major milestone in its drive to deliver prompt and reliable health insurance services.
Based on the data provided, from January to September 2025, PhilHealth’s claims payments rose sharply from ?112.23 billion in 2024 to ?217.93 billion this year, covering both public and private facilities across the country. Of this amount, ?127.79 billion went to private healthcare institutions, while ?90.14 billion was released to public hospitals.
Aside from the increase in disbursements for benefit claims, PhilHealth also highlighted significant progress in the turnaround time for claims processing, which now averages 22 days, according to records as of September 30, 2025. The public corporation noted that this improvement aligns with President Ferdinand R. Marcos Jr.’s directive to enhance the agency’s performance and ensure faster service delivery to the public.
PhilHealth explained that the rise in expenditures is largely due to payments for catastrophic conditions covered under the Z Benefit Packages, which include heart surgeries, cancer treatments, and kidney transplants. Likewise, it added that claims for high-cost outpatient services, such as hemodialysis, continue to grow significantly, reflecting the increasing medical needs of the population.
‘This commitment ensures that members diagnosed with life-threatening or complex illnesses receive sustained, high-value financial support,’ the agency said.
Moving forward, to strengthen the sustainability and accuracy of its payment mechanisms, PhilHealth reiterated its plan to transition to the Diagnosis-Related Group (DRG) payment system, a modernized approach that groups patient cases by diagnosis and required procedures.
PhilHealth President and Chief Executive Officer Dr. Edwin M. Mercado said the DRG system will make healthcare provider compensation more equitable and reflective of actual care requirements.
‘DRG will better account for the severity and resources needed for patient care, thereby ensuring that our healthcare providers are compensated accurately and sustainably for treating complex conditions,’ Dr. Mercado explained.
The DRG system is a patient classification and payment framework that groups cases according to diagnosis, treatment, and resource utilization, enabling more standardized and transparent reimbursement.
PhilHealth assured the public that it will continue to accelerate its claims processing through streamlined and automated systems to sustain the timely release of funds to accredited healthcare facilities.
The agency then reaffirmed its commitment to its ‘Mabilis, Tapat, at Mapagkakatiwalaan’ values as it continues to enhance service delivery for both members and healthcare partners nationwide.