BENEFIT claims paid by the Philippine Health Insurance Corp. (PhilHealth) are rising faster than its premium collections, figures in the first semester of the year show.
Total benefit claims paid rose by 44.53 percent to P210.09 billion from January to June from P145.36 billion in the same period in 2025, data from the government-run health insurer showed.
Private health facilities received the bulk, or P123.25 billion, of benefit claims, which increased year-on-year by 44.35 percent from P85.38 billion in 2025. Payments to government health facilities, likewise, jumped by 44.78 percent to P86.84 billion from P59.98 billion in the same period last year.
Premium contributions of members rose by 32.41 percent to P67.733 billion in the first quarter of this year from P51.152 billion in the same period last year, data from PhilHealth also showed.
Meanwhile, benefit claims expenses were higher at P97.216 billion, up by 32.33 percent from P73.464 billion a year ago.
The fast climb of PhilHealth’s payments is driven by the state health insurer’s tack to ramp up benefit packages and widen healthcare coverage for its members.
Last year, PhilHealth rolled out a program that offers an expanded package of accessible health services, including primary care checkups, medicines, basic laboratory tests and screening. This year, the state health insurer improved its benefit packages for leptospirosis and maternity care for non-hospital and outpatient facilities.
This dynamic was already flagged by Valerie Gilbert T. Ulep, senior research fellow at state-run think tank Philippine Institute for Development Studies.
Ulep has said that the government must do its part in sustaining PhilHealth as slower economic growth could undermine the insurer’s finances.
She noted that weak economic growth threatens premium collection growth and the government’s fiscal capacity to subsidize healthcare.
Still, PhilHealth President and CEO Edwin M. Mercado has said that the insurer will maintain the current premium contribution rate mandated by law.
Currently, the premium contribution rate is capped at 5 percent of a member’s monthly basic income. PhilHealth did not increase the rates this 2026, as this is the final scheduled adjustment under Republic Act 11223 or the Universal Health Care Act.
Such stance should be seen with Philhealth’s finances in mind.
In the first quarter of the year, the PhilHealth posted a net loss of P22.845 billion, 27.61-percent higher than the P17.902-billion loss the state health insurer suffered a year ago.
To note, the insurer’s expenses of P99.893 billion exceeded its income worth P77.047 billion in the first quarter.
Its reserve fund stood at P308.950 billion as of end-March.