State-run Philippine Health Insurance Corp. (PhilHealth) announced on Thursday a significant surge in benefit claims payments, releasing over P217.93 billion to healthcare facilities nationwide in the first nine months of 2025.
This represents a 94.18-percent increase from P112.23 billion paid out in the same period last year, demonstrating PhilHealth’s strengthened financial support for Filipino patients and providers, PhilHealth said in a statement.
The total claims payment in the first nine months of 2025 reached P217.93 billion, covering both public and private facilities. Private facilities received the majority of the funds, accounting for P127.79 billion, while public facilities received P90.14 billion in reimbursements.
PhilHealth also reported a substantial improvement in efficiency, achieving an average claims processing turnaround time of just 22 days as of Sept. 30, 2025. This progress aligns with President Ferdinand R. Marcos’ directive to enhance the agency’s performance and responsiveness.
The significant expenditure is largely driven by payments for catastrophic conditions covered by Z Benefit Packages—such as heart surgery, cancers and kidney transplantation—and high-cost services like outpatient hemodialysis.
This reflects the increasing medical needs of the population and the corporation’s commitment to ensuring sustained financial support for members diagnosed with life-threatening or complex illnesses.
To better align its payment system with the complexity of modern medical treatment, PhilHealth is actively pushing for a transition to the Diagnosis-Related Group (DRG) payment system.
“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,” said PhilHealth president and CEO Edwin Mercado.
DRG is a patient classification and provider payment system that groups patient cases, including services received, into standardized case groups according to diagnosis and treatment or procedure received.
PhilHealth assured the public that it would continue to accelerate its claims process through streamlined and automated systems to sustain the fast flow of funds to accredited healthcare facilities.
