The state of healthcare in the Philippines has been a growing concern, especially when it comes to the accessibility and efficiency of PhilHealth services. Many Filipinos continue to struggle with high medical costs, slow reimbursements, and limited coverage. Recognizing these gaps, AGRI Party-list Representative and senatorial aspirant Wilbert Lee has been a strong advocate for PhilHealth reform to ensure that benefits take priority over collections.

Lee, the principal author of House Bill No. 11357, has spearheaded amendments to the Universal Health Care (UHC) Act that aim to refocus PhilHealth’s priorities—shifting its focus from collecting premiums to expanding healthcare services and improving benefit distribution.

The Need for PhilHealth Reform

The current PhilHealth system places significant emphasis on premium collection, which often results in administrative inefficiencies and delays in disbursing benefits. This has left many Filipinos struggling to access necessary medical treatments despite being PhilHealth members.

Key Problems with the Current System:

• Delayed reimbursements for hospitals and patients
• Insufficient benefit packages that do not cover critical treatments
• High premium contributions that do not match the services provided
• Unspent funds that could have been allocated for expanded healthcare services

Proposed Amendments Under the PhilHealth Reform Bill

1. Administrative Budget Allocation Based on Benefit Payouts

Instead of calculating administrative costs based on premium collections, PhilHealth will allocate 7.5 percent of total reimbursements from the previous year. This ensures that administrative budgets grow in proportion to benefit distribution rather than simply being tied to premium revenues.

2. Faster Processing of Healthcare Benefits

With an improved budget allocation for administrative functions, PhilHealth will be able to hire more personnel, speed up claim reimbursements, and improve efficiency in healthcare service delivery.

3. Expanded PhilHealth Coverage

Through Lee’s amendments, PhilHealth will be required to increase coverage in key areas such as:

• Free dialysis treatments
• Expanded breast cancer treatment
• New benefit packages for kidney transplants and heart ailments
• Comprehensive outpatient emergency care services

4. Reduction of Premium Contributions

Another crucial amendment is the lowering of premium contributions to lessen the financial burden on members. The bill aims to make PhilHealth more affordable and accessible to all Filipinos, particularly those in low-income sectors.

Impact of Lee’s PhilHealth Reforms

Since exposing PhilHealth’s unused funds—which exceeded ₱500 billion in 2023—Lee’s advocacy has led to major improvements:

• 30 percent increase in PhilHealth benefits in 2024
• 50 percent additional increase in 2025
• Timely case rate assessments to ensure fair pricing for medical treatments
• Increased healthcare accessibility for marginalized communities

The Road to Universal Healthcare

Lee remains committed to his vision of universal healthcare for all Filipinos. His advocacy centers on ensuring that no one is denied medical care due to financial constraints. With PhilHealth reform, his goal is to make medicine and medical treatments government-funded, ensuring every Filipino gets the care they need.

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