Tingog Rep. Jude Acidre said the failure of the Duterte administration to adjust PhilHealth case rates for six consecutive years is major factor behind the agency’s inefficiencies and inability to provide adequate healthcare services.
Acidre made the remarks during a recent Committee on Good Government and Public Accountability hearing, where systemic lapses and leadership instability within PhilHealth were brought to light.
PhilHealth Executive Vice President Eli Santos admitted under questioning that the last adjustment to case rates was implemented in 2012, despite a policy requiring reviews every three years. Throughout the Duterte administration, no adjustments were made except for increasing dialysis sessions to 144 annually.
“So during the entire Duterte administration, PhilHealth did not make any adjustment to the rates?” Acidre asked. Santos confirmed, “Yes, Mr. Chairperson.”
Acidre pressed further, highlighting that this failure occurred as healthcare costs surged, particularly during the COVID-19 pandemic, leaving hospitals underpaid and PhilHealth members underserved.
“This failure to adjust the case rates periodically as per policy—and if you count it, there should have been at least three adjustments over the past 12 years—has exacerbated PhilHealth’s inefficiencies. Members are frustrated because the premiums they pay do not reflect the benefits they receive,” Acidre said.
He illustrated the impact of inflation, noting that a conservative annual rate of 3% would amount to a 36% increase over 12 years. Instead, stagnant case rates have eroded reimbursements and widened the gap between PhilHealth’s commitments and its actual services.
Acidre also scrutinized the leadership instability during the Duterte administration, where PhilHealth saw six presidents in six years. PhilHealth President and CEO Emmanuel Ledesma confirmed that such turnover hampered operations. “If you look at the administrations of President Aquino and President Duterte, that’s 12 years with 11 leadership changes. Clearly, there’s a breakdown in leadership,” Ledesma admitted.
According to Acidre, this instability contributed to operational inefficiencies, including delayed hospital reimbursements, poor data management, and persistent failures in PhilHealth’s digital systems. Acidre specifically cited the agency’s deficiencies flagged by COA, such as incomplete or erroneous data entries and duplications involving senior citizens, amounting to significant financial losses.
Addressing accountability, Acidre directly challenged Ledesma to act against individuals who exploited these inefficiencies for personal gain. “Mayroon kumita dyan, mayroon nagkapera. Can you commit that once you identify who these personalities are, they will bear the consequences of their actions?” Acidre asked.
Ledesma assured the committee of ongoing reforms, including a 30% workforce expansion to address manpower shortages and improvements in claims payments and benefit package reviews. He committed to submitting a detailed report to Congress and President Marcos by year-end.
Despite these assurances, Acidre called for full transparency regarding PhilHealth’s financial stability, noting that while Ledesma claimed the agency has sufficient funds, concrete calculations are needed to back this assertion.
In his closing remarks, Acidre emphasized that the Duterte administration’s failure to implement timely case rate adjustments, compounded by leadership instability and systemic lapses, left hospitals underpaid and patients underserved. He urged PhilHealth to ensure leadership stability, implement structural reforms, and conduct regular case rate reviews to restore public confidence.
“The Filipino people deserve a health insurance system that works efficiently, transparently, and reliably,” Acidre said.
