Although the PhilHealth system is functioning as designed, a data scientist said the Philippines may want to consider models such as Taiwan’s, where almost all residents contribute through ‘fixed, manageable premiums’ based on their category.
Dr. Alicor Panao, a data scientist and associate professor at the University of the Philippines, said PhilHealth’s latest claims data show a system under increasing pressure and, from a financial sustainability point of view, an imbalance in who benefits most from the program.
Elderly members accounted for about 23% of total claims spending and 21% of claims volume. Sponsored members comprised 23% of spending and 25% of cases, while indigent members added 13% each.
‘These subsidized or sponsored groups account for 58% of total claims, indicating that health care support is reaching those who need it most,’ Panao said.
From a social equity perspective, the data indicate that health care support is reaching those who need it most, showing the health insurance system is carrying out its mandate.
‘From a financial sustainability point of view, however, the data reveal an imbalance,’ he said.
Panao said private and government employees accounted for about 22% of claims, even though they shouldered 96% of premium contributions.
From a social equity perspective, the data indicate that health care support is reaching those who need it most, showing the health insurance system is carrying out its mandate.
‘From a financial sustainability point of view, however, the data reveal an imbalance,’ he said.
Panao said private and government employees accounted for about 22% of claims, even though they shouldered 96% of premium contributions.
He said there is no need to worry about PhilHealth’s resources because it is guaranteed by the government through general appropriations and sin tax revenue, but the system’s design ‘makes formal employees carry the burden twice.’
‘First through the mandatory 5% salary premiums, and second through the broader income and consumption taxes that finance the national budget’s subsidies for nonpaying members,’ he said.
PhilHealth was given more than P120 billion for 2026.
Panao said that by broadening the contribution base so the entire population is directly invested in the fund, the government could shift away from a disproportionate reliance on a single class of workers and move toward a more equitable, more resilient health system.