PhilHealth Should be under DOF instead of DOH says Senator Panfilo M. Lacson

 

Calls for Leadership Reform in PhilHealth

In light of a planned PhilHealth holiday, where private hospitals would refuse to honor PhilHealth coverage due to unpaid claims, presidential aspirant Senator Panfilo M. Lacson suggested that the agency be managed by someone well-versed in finance rather than a health practitioner. He argued that since PhilHealth primarily deals with insurance and fund management rather than direct healthcare services, it should fall under the jurisdiction of the Department of Finance (DOF) instead of the Department of Health (DOH). He emphasized that a finance expert, rather than a health professional or an individual without relevant expertise, should lead the institution to ensure better financial stewardship.

Various senators agreed with this suggestion, including Senator Mary Grace Natividad S. Poe-Llamanzares, who stated in a Viber message that it made sense for PhilHealth to be headed by someone experienced in finance. She noted that it was possible to find individuals with expertise in both public health and financial management, which would be more beneficial in addressing PhilHealth’s inefficiencies. According to Poe, appointing a competent leader with the right qualifications in both fields is key to improving the agency’s operations.

Senator Juan Edgardo M. Angara also expressed his support for integrating more financial experts, actuaries, and management professionals within PhilHealth. He added that the agency, aided by the Universal Health Care Law, had the potential to be a game-changer in the country’s healthcare system. However, he lamented that mismanagement and inefficiencies had hindered its effectiveness, calling PhilHealth “one of the weak links in the country’s health system.”

Beyond leadership concerns, experts and lawmakers have also pointed out the need for stronger oversight and financial reforms. Some have suggested that moving PhilHealth under the DOF could allow for stricter budget controls, more transparent fund allocations, and improved efficiency in claims processing. Supporters of this shift argue that with financial experts overseeing the agency, it would be better equipped to prevent fund mismanagement and corruption scandals that have plagued the institution in recent years.

However, opponents of this proposal caution that shifting PhilHealth to the DOF may not be a simple solution to the agency’s problems. They argue that while financial management is crucial, the agency’s primary function still revolves around healthcare, and placing it under the DOF may result in policies that prioritize cost-cutting over patient welfare. Others emphasize that the root of the issue lies not just in leadership but in overall institutional reforms, which require a balance between financial expertise and healthcare accessibility.

Support for Financial Expertise in Health Insurance

Senator Juan Edgardo M. Angara also expressed his support for increasing the number of financial experts, actuaries, and management professionals within PhilHealth. He argued that, despite the backing of the Universal Health Care (UHC) Law, the agency has failed to maximize its potential due to inefficiency and poor management. He referred to PhilHealth as “one of the weak links in the country’s health system,” highlighting the urgent need for a shift in leadership and oversight.

Senator Lacson further explained that moving PhilHealth under the DOF would ensure stricter financial monitoring and accountability. He pointed out that mismanagement and corruption scandals have plagued the agency in recent years, resulting in billions of pesos in questionable transactions and unpaid hospital reimbursements. He believes that placing it under the DOF would strengthen oversight and prevent financial mismanagement.

Supporters of this proposal argue that financial stability is just as critical as medical service delivery in ensuring the sustainability of universal healthcare. By placing the agency under the DOF, they believe PhilHealth can operate with better budget discipline, improved claims processing, and a more transparent allocation of funds. This could also attract professionals with a strong background in finance, insurance, and risk assessment, who can implement structural reforms to prevent fraud and inefficiencies.

Moreover, some economists and policy analysts have emphasized that managing a health insurance fund requires specialized financial expertise. Unlike other government health programs, PhilHealth functions as a social health insurance provider, meaning its ability to provide services depends on the proper collection, management, and disbursement of funds. A more finance-driven approach could improve fund sustainability and ensure that hospitals and patients receive their benefits on time.

However, critics warn that shifting the agency under the DOF alone may not resolve all of its problems. They stress that while financial expertise is crucial, it should not come at the expense of healthcare accessibility and patient-centered policies. Instead, they call for a balanced approach—one that integrates both financial discipline and healthcare efficiency to ensure that PhilHealth fulfills its mandate of providing affordable and quality healthcare for all Filipinos.

Senator Juan Edgardo M. Angara also expressed his support for increasing the number of financial experts, actuaries, and management professionals within PhilHealth. He argued that, despite the backing of the Universal Health Care (UHC) Law, the agency has failed to maximize its potential due to inefficiency and poor management. He referred to PhilHealth as “one of the weak links in the country’s health system,” highlighting the urgent need for a shift in leadership and oversight.

Senator Lacson further explained that moving PhilHealth under the DOF would ensure stricter financial monitoring and accountability. He pointed out that mismanagement and corruption scandals have plagued the agency in recent years, resulting in billions of pesos in questionable transactions and unpaid hospital reimbursements. He believes that placing it under the DOF would strengthen oversight and prevent financial mismanagement.

Calls for Systemic Reforms in PhilHealth Operations

Beyond leadership changes, lawmakers are also calling for comprehensive reforms within PhilHealth’s operations. Senator Poe stressed that PhilHealth must improve its claims processing system to avoid delayed payments to hospitals and medical providers. The inefficiencies in the agency’s reimbursement system have contributed to financial difficulties for many private hospitals, leading to the call for the PhilHealth holiday in the first place.

Meanwhile, healthcare and finance experts have proposed stricter auditing measures and digitalization of transactions to ensure greater transparency. They argue that the agency should enhance its financial systems to prevent anomalies and improve fund utilization. Implementing real-time tracking of claims and payments would ensure that hospitals receive their dues without prolonged delays, helping restore trust in the agency.

Strengthening Oversight and Accountability

To further address long-standing issues, some lawmakers have suggested establishing an independent regulatory body that will oversee the agency’s financial and operational activities. This body would be responsible for conducting regular audits, investigating irregularities, and ensuring compliance with government-mandated healthcare policies. By enhancing oversight, proponents believe the agency can significantly reduce cases of fraud, mismanagement, and inefficiencies that have plagued it for years.

Additionally, there have been calls to increase public-private collaboration in managing healthcare funds. Some experts suggest that partnering with private insurance companies and financial institutions could introduce best practices in risk management, fraud detection, and claims processing. By leveraging technology and expertise from the private sector, PhilHealth could transition into a more efficient and financially sustainable organization, ultimately benefiting both healthcare providers and Filipino patients.

The Future of Health Insurance Administration

The debate on whether PhilHealth should be under the DOF or DOH highlights the broader issue of health insurance administration in the Philippines. While some healthcare professionals insist that the agency should remain within DOH to maintain a health-focused approach, proponents of reform argue that shifting it to the DOF would prioritize financial sustainability and prevent corruption.

Moving forward, legislators are expected to conduct further studies on the feasibility of transferring PhilHealth’s oversight to the DOF. Regardless of the final decision, lawmakers emphasize that urgent action is needed to improve PhilHealth’s efficiency, restore credibility, and ensure that Filipinos receive the healthcare benefits they rightfully deserve.

As discussions continue, policymakers must strike a balance between financial stability and maintaining accessible healthcare services. While placing the agency under the DOF may enhance financial oversight, experts warn that it should not lead to overly rigid financial policies that could hinder much-needed healthcare assistance for Filipinos. Ensuring that healthcare priorities remain at the core of the agency’s mandate, regardless of which department oversees it, is essential for sustaining universal health coverage.

Moreover, any administrative restructuring must be accompanied by broader systemic reforms. Strengthening fraud detection mechanisms, streamlining claims processing, and enhancing digital infrastructure can significantly improve the agency’s operations. Ultimately, whether PhilHealth remains under the DOH or transitions to the DOF, the key priority should be creating a system that is both financially sound and capable of delivering quality healthcare to all Filipinos.

 

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