Recto to DOH, PhilHealth: Boost zero balance billing too
Executive Secretary Ralph Recto has directed the Department of Health (DOH) and the Philippine Health Insurance Corp. (PhilHealth) to expand their health benefit packages, particularly for middle-income contributors who are paying the most for the national healthcare system.
In a statement Sunday, Recto stressed that contributors, especially middle-class Filipinos who consistently pay taxes and PhilHealth premiums, should receive benefits commensurate with their contributions.
He also told both agencies to strengthen the implementation of zero balance billing (ZBB) to improve healthcare affordability and access.
The directives were raised during a meeting on January 20 with Health Secretary Teodoro Herbosa and PhilHealth President and Chief Executive Officer Edwin Mercado, where they discussed system-wide reforms under the Universal Health Care (UHC) law.
At presstime, neither the DOH nor the Office of the Executive Secretary elaborated on how much more the middle class would benefit under the system over poorer Filipinos.
For instance, PhilHealth deductions on hospital bills for all members work through an All Case Rates (ACR) system, where the agency pays accredited hospitals a fixed amount per diagnosis.
That is then deducted from a patient’s total bill, covering both hospital and doctor’s fees, inclusive of professional fees up to a certain limit, before the final payment is settled.
Still, Recto urged officials to accelerate the expansion of PhilHealth benefit packages while ensuring that the ZBB is genuinely felt by patients in government hospitals.
The meeting last week focused on strengthening the ZBB, which aims to eliminate out-of-pocket expenses for patients, particularly indigents, and on addressing gaps in coverage that continue to burden families despite existing benefits.
They also discussed the need for closer coordination among national agencies and local government units (LGUs) to ensure that healthcare financing reforms translate into tangible relief across income groups.
According to the DOH, more than 1.3 million patients in 87 DOH hospitals nationwide had no hospital bills by the end of 2025 due to the ZBB program, with P74.6 billion in hospital costs fully covered from July to December 2025.
However, middle-income contributors are seen as bearing the financial brunt of the system as they are mandated to pay a 5-percent premium rate on their monthly basic salary to PhilHealth.
For the formally employed, the PhilHealth premium is split (2.5% each) between the employee and the employer, while the self-employed shoulder the full premium themselves. This rate was established by the UHC Law and has been in effect since 2024–2025.
The specific contribution amount to PhilHealth depends on whether the individual is formally employed or self-employed. Those whose incomes are P10,000 and below contribute a fixed rate of P500 per month.
Middle income individuals (those who earn from P10,000.01 to P99,999.99) contribute 5% of their monthly basic salary. Those with incomes of P100,000 and above must give a fixed P5,000 per month.
A coalition of doctors, health advocates, lawyers, and PhilHealth members recently sued Recto and the state health insurer regarding the transfer of P60 billion in excess PhilHealth funds to the National Treasury in 2024.
Recto, who was charged in connection to his previous role as Finance Secretary, has said the matter has already been resolved by the Supreme Court and that the government has fully complied with the ruling.
Under the 2026 General Appropriations Act (GAA), the health sector was allotted P448 billion, slightly below the P450 billion annual funding estimated for the full implementation of UHC.
Of this amount, P1 billion was allocated for the expansion of ZBB in selected secondary and tertiary hospitals operated by LGUs.
The Medical Assistance to Indigent and Financially Incapacitated Patients (MAIFIP) program received P51.6 billion in funding for 2026, a 25 percent increase from last year’s P41.1 billion.
PhilHealth also received a P53.1-billion government subsidy to cover premiums of more than 41 million indirect contributors, including senior citizens, persons with disabilities, indigents, and beneficiaries of the Pantawid Pamilyang Pilipino Program.
Additional funding was also allocated to expand the ZBB in specialty hospitals.
The Lung Center of the Philippines, National Kidney and Transplant Institute, Philippine Heart Center, and Philippine Children’s Medical Center each received P1 billion, while the University of the Philippines-Philippine General Hospital was allotted P800 million.
In the meeting with Recto, the DOH reported it is in the final stages of completing its DOH–LGU Healthcare Provider Network (HCPN) model, designed to support local governments providing higher-level medical care and to improve referral systems nationwide.
Editor’s Note: This is an updated article. Originally posted with the headline: “Recto to DOH, PhilHealth: Boost benefits for middle class”
